Processing of facial affect under social threat in socially anxious adults: mood matters

Background: An important function of the human face is to communicate approval or disapproval toward others. Because socially anxious individuals are overly concerned about disapproval by others, it has been hypothesized that those individuals are faster at processing negative, specifically angry facial expressions than nonanxious individuals, especially under conditions of social threat. Method: To test this hypothesis, 25 socially anxious individuals and 24 nonanxious controls were asked to classify facial expressions associated with anger, sadness, fear, disgust, happiness, and surprise. Half of the participants performed this task while being confronted with social threat. Results: High socially anxious participants were faster than controls at classifying angry, sad, and fearful faces when confronted with social threat. No group difference was observed under the no‐threat condition. Conclusions: The findings suggest that socially anxious individuals are more hypervigilant toward threat‐related social cues, and that the processing of facial affect is dependent on the person's emotional state. Depression and Anxiety, 2009. © 2008 Wiley‐Liss, Inc.     

Within the mind's eye: Negative mental imagery activates different emotion regulation strategies in high versus low socially anxious individuals

Background and objectivesThe link between social anxiety (SA) and maladaptive emotion regulation has been clearly established, but little is known about the spontaneous regulation strategies that may be activated during social stress by negative involuntary mental images and whether the nature of such strategies might distinguish individuals with high vs. low trait SA.MethodsParticipants with high (n = 33) or low (n = 33) trait SA performed an evaluative speech and reported whether they experienced an involuntary negative mental image during the task. They also rated their negative affect (NA) and positive affect (PA) and the extent to which they viewed their image as being controllable and malleable. Finally, they described the types of strategies they spontaneously used to try to control or change their image intrusions. Reported strategies were then subjected to a content analysis and categorized by blinded coders.ResultsAmong high SA participants, image controllability was both diminished overall and positively correlated with PA. Whereas 90% of low SA individuals reported that they spontaneously self-regulated by altering the content or perceptual features of their images, only about half of the high SA participants used this strategy, with the other 50% reporting that they either suppressed their images or succumbed passively to them in whatever form they took.Limitations and conclusionsAlthough these initial findings require replication in future experimental studies on clinical samples, they also help to enrich our understanding of the strategies that are commonly used by high and low SA individuals to manage their image intrusions during in-vivo stress and suggest potential avenues for future research on the role of imagery in adaptive and maladaptive emotion regulation.     

Post-event processing and autobiographical memory in social anxiety: the influence of negative feedback and rumination

Two experiments investigated the extent to which the content of feedback and the style of post-event processing are associated with a bias in the retrieval of autobiographical memories by individuals high in social anxiety. In each experiment high and low socially anxious individuals responded to questions about autobiographical experiences, participated in a task involving real or imagined social encounters, and then recalled autobiographical memories. In Experiment 1 (n=50) participants focused on positive or negative feedback following the social task, while in Experiment 2 (n=59) participants engaged in either a ruminative or reflective response style following the social task. Experiment 1 showed that negative feedback led to the recall of memories with a significantly greater average anxiety rating only in the high social anxiety group. Experiment 2 demonstrated that the high social anxiety group who engaged in a ruminative response style recalled memories with the highest average anxiety rating. Implications of these findings for understanding the role of post-event processing as a maintaining factor in social anxiety are discussed.     

Attention training in socially anxious children: A multiple baseline design analysis

Current evidence has established an association between anxiety and attentional threat biases. Emerging research suggests these attentional biases may play a causal role in anxiety development. Clinical researchers have begun to develop treatments specifically designed to address these attentional processes. As such, Attention training (ATT) has been shown to be effective in the treatment of anxiety in adults. The current study represents an early attempt to implement ATT to treat social anxiety disorder (SOC) in children. Two boys meeting criteria for DSM-IV SOC participated in the study, along with their parents. Both boys received 10, 10-min sessions of ATT. A multiple-baseline design was used. Following treatment, both boys evidenced reductions in social anxiety. The current study provides preliminary evidence regarding the utility of ATT for treatment of childhood SOC. Future research is needed to further examine the use of this treatment strategy with youth and to explore the mechanisms of change.     

A systematic review of visual avoidance of faces in socially anxious individuals: Influence of severity,type of social situation,and development

Although visual avoidance of faces is a hallmark feature of social anxiety disorder (SAD) on clinical and theoretical grounds, empirical support is equivocal. This review aims to clarify under which conditions socially anxious individuals display visual avoidance of faces. Through a systematic search in Web of Science and PubMed up to March 2019 we identified 61 publications that met the inclusion criteria. We discuss the influence of three factors on the extent to which socially anxious individuals avoid looking at faces: (a) severity of social anxiety symptoms (diagnosed SAD versus High Social Anxiety levels in community samples [HSA] or related characteristics [Shyness, Fear of Negative Evaluation]), (b) three types of social situation (computer facial-viewing tasks, speaking tasks, social interactions), and (c) development (age-group). Adults with SAD exhibit visual avoidance across all three types of social situations, whereas adults with HSA exhibit visual avoidance in speaking and interaction tasks but not in facial-viewing tasks. The relatively few studies with children and adolescents suggest that visual avoidance emerges during adolescence. The findings are discussed in the context of cognitive-behavioral and skills-deficit models. Suggestions for future research include the need for developmental studies and more fine-grained analyses of specific areas of the face.     

Early maladaptive schemas and social anxiety in adolescents: The mediating role of anxious automatic thoughts

Cognitive models state that cognitions are organized hierarchically, so that the underlying schemas affect behavior via more automatic, superficial cognitive processes. This study aimed to demonstrate that early maladaptive schemas predict anxious automatic thoughts, and to show that such automatic thoughts act as mediators between schemas and prospective changes in social anxiety symptoms. The study also examined an alternative reverse model in which schemas acted as mediators between automatic thoughts and social anxiety. A total of 1052 adolescents (499 girls and 553 boys; M_age = 13.43; SD_age = 1.29) completed measures of early maladaptive schemas, socially anxious automatic thoughts, and social anxiety symptoms at Times 1, 2, and 3. The results revealed bidirectional longitudinal relationships among schemas and automatic thoughts that were consistent in content (e.g., the disconnection/rejection schemas and automatic thoughts of negative self-concept). Furthermore, the automatic thoughts of anticipatory negative evaluation by others at Time 2 mediated the relationship between the other-directedness schemas at Time 1 and social anxiety symptoms at Time 3. These findings are consistent with hierarchical cognitive models of social anxiety given that deeper schemas predict more surface-level thoughts. They also support that these more surface-level thoughts contribute to perpetuating schemas. Finally, results show that early maladaptive schemas of the other-directedness domain play a relevant role in the development and maintenance of social anxiety.     

Video feedback with peer ratings in naturalistic anxiety-provoking situations for social anxiety disorder: Preliminary report

The present study aimed to examine how video feedback can affect perceived performance and anticipatory anxiety in various naturalistic social anxiety-provoking situations among clinical patients diagnosed with social anxiety disorder (SAD) and to examine predictors that might influence response to video feedback. Participants were 52 consecutive patients with DSM-IV SAD who participated in a group-based CBT program. Our results demonstrated that video feedback was associated with a decrease in the underestimation of own performance as well as the perception of feared outcomes. Moreover, anticipatory anxiety decreased after video feedback combined with peer feedback. Male sex, comorbidity with other anxiety disorders, and benzodiazepine prn, as well as patients' initial anxiety and avoidance were negative predictors of the effect of video feedback.     

Adaptive and maladaptive emotion regulation strategies: Interactive effects during CBT for social anxiety disorder

There has been a increasing interest in understanding emotion regulation deficits in social anxiety disorder (SAD; e.g., Hofmann, Sawyer, Fang, & Asnaani, 2012). However, much remains to be understood about the patterns of associations among regulation strategies in the repertoire. Doing so is important in light of the growing recognition that people's ability to flexibly implement strategies is associated with better mental health (e.g., Kashdan et al., 2014). Based on previous work (Aldao & Nolen-Hoeksema, 2012), we examined whether putatively adaptive and maladaptive emotion regulation strategies interacted with each other in the prediction of social anxiety symptoms in a sample of 71 participants undergoing CBT for SAD. We found that strategies interacted with each other and that this interaction was qualified by a three-way interaction with a contextual factor, namely treatment study phase. Consequently, these findings underscore the importance of modeling contextual factors when seeking to understand emotion regulation deficits in SAD.     

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

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

Cerebral blood flow during anticipation of public speaking in social phobia: a PET study.

BACKGROUND: The aim was to examine the neural correlates of anxiety elicited by the anticipation of public speaking in individuals with social phobia.Positron emission tomography and (15)O-water was used to measure regional cerebral blood flow in subjects with DSM-IV defined social phobia during anxiety anticipation. Heart rate and subjective anxiety were also recorded. While being scanned, subjects were speaking alone either before or after speaking in public. To evaluate anticipatory anxiety we compared individuals speaking alone before they were speaking in front of an audience with those who did the reverse. RESULTS: Heart rate and subjective anxiety measures confirmed anticipatory anxiety in social phobics who performed their private speech before their public. This was accompanied by enhanced cerebral blood flow in the right dorsolateral prefrontal cortex, left inferior temporal cortex, and in the left amygdaloid-hippocampal region. Brain blood flow was lower in the left temporal pole and bilaterally in the cerebellum in the anticipation group. CONCLUSIONS: Brain regions with altered perfusion presumably reflect changes in neural activity associated with worry about anticipated public performance. We speculate that anticipatory anxiety in social phobics originates in an affect sensitive fear network encompassing the amygdaloid-hippocampal region, prefrontal, and temporal areas.     

Searching for evidence on the validity of generalized anxiety disorder: Psychopathology in children of anxious mothers

The diagnostic validity of generalized anxiety disorder (GAD) is tested by examining the relationship between GAD in mothers and children's overanxious disorder (OAD), separation anxiety (SA), and anxious symptoms in 331 mother-child dyads from a geographically based probability sample. Data on the relationship between mothers' major depressive disorder (MDD) and children's depression are presented for comparison. The National Institute of Mental Health (NIMH) Diagnostic Interview Schedule (DIS) was used in mothers and the NIMH Diagnostic Interview Schedule for Children (DISC), in children. Children of mother with GAD were not at increased risk for OAD, SA, or anxious symptoms. In contrast, MDD in mothers conferred a risk for OAD in younger children and of MDD in older children. Additionally, older children of depressed mothers exhibited significantly more depressive symptoms. The presence of diffuse anxiety in children of mothers with MDD may represent a non-specific response pattern in psychiatrically vulnerable children. Like GAD in adults, these anxiety symptoms in children may constitute a prodromal manifestation of other disorders and transient responses to life stressors.     

Perception of arousal in social anxiety: effects of false feedback during a social interaction

Cognitive models suggest that during social interactions, socially anxious individuals direct their attention to internal cues of arousal and use this information to erroneously infer how they appear to others. High (N=36) and low (N=36) socially anxious adults had a conversation with a stooge, and were led to believe by false feedback that they were experiencing either an increase or decrease in arousal, or evaluating the comfort level of the feedback equipment. Compared to the other groups, participants who believed their arousal had increased, reported greater anxiety, poorer perceived performance, more physical cues of anxiety, and greater underestimation of their performance and overestimation of the visibility of their anxiety. The effects were not specific to participants with high social anxiety. Observers rated the behaviour of participants who believed that their arousal had decreased most favourably. The results have implications for the treatment of social phobia.     

Mindsets in social anxiety: a new look at selective information processing

According to the Rubicon Model of Action Phases (in: J. Gollwitzer, 1996), Motivation, volition, and action, Enzyclopedia of psychology, series "motivation and emotion", Vol. 4, Hogrefe, G?ttingen, 1996, pp. 531-582), different stages in goal pursuit are accompanied by different mindsets that enhance processing of mindset-congruous information. Before people engage in action, they usually deliberate possible goals for a given situation (deliberative mindset). Once a goal is chosen, they plan how to achieve this particular goal (implemental mindset). The present experiments tested the hypothesis that people with social anxiety show a reversal of mindsets when approaching social situations. In Experiment 1, 20 students were asked to either deliberate goals for a hypothetical social conflict (deliberation), or to think about steps to solve the conflict (implementation). An unexpected recognition test demonstrated different recognition memory for deliberation-related versus implementation-related information in the two groups, consistent with the hypothesis of different mindsets. In Experiment 2, 48 students who were either high or low in social anxiety were randomly assigned to either the deliberation or the implementation condition. Participants high in social anxiety showed a pattern in the recognition test that was consistent with a reversal of mindsets. When asked to plan social situations, they showed an inappropriate deliberative mindset. In contrast, they lacked a deliberative mindset when deliberating goals for the social situation. The result indicate that socially anxious people engage in information processing that interferes with successful goal attainment when approaching social situations.     

Attributional and emotional responses to socially ambiguous cues: Validation of a new assessment of social/emotional information processing in healthy adults and impulsive aggressive patients

A self-report questionnaire was developed to assess attributional and emotional responses to aversive, but socially ambiguous, actions by one or more provocateurs. Multiple vignettes were developed and were followed by questions related to attribution of the provocateur’s intent and the subject’s emotional response to the provocateur’s actions. The resulting social information processing-attribution and emotional response questionnaire (SIP-AEQ) was administered to 923 community-based adults (ages 18-45). Factor analysis revealed a three-factor structure reflecting hostile attribution, instrumental attribution, and benign attribution to provocation. A cross-validational study substantiated the factor structure. The modified 8-vignette SIP-AEQ demonstrated good internal reliability, and convergent and discriminant validity. The hostile attribution items showed a significant relationship with measures of emotion processing and responsiveness. Further analysis in a sample of impulsive aggressive patients and healthy control subjects noted similar psychometric properties and good separation between groups. Implications regarding the cognitive and emotional correlates of aggression are discussed.     

Just do something: An experimental investigation of brief interventions for reducing the negative impact of post-event processing in social anxiety disorder

Post-Event Processing (PEP) is prevalent and problematic in Social Anxiety Disorder (SAD) but is typically not a direct target in evidence-based treatments such as cognitive behavioural therapy (CBT) for SAD. The primary aim of the current study was to examine the impact of several theoretically and empirically derived interventions for PEP in SAD, including concrete thinking, abstract thinking, and distraction in comparison to a control (i.e., do nothing) condition. Based on prior research, we hypothesized that the concrete and distract conditions would be associated with positive benefits, including reductions in PEP and improvements in self-perception, whereas the abstract and control conditions would not. The second aim of the study was to identify baseline variables that predict the trajectory of change in PEP over time. Participants (N=92) with a principal diagnosis of SAD completed a social stress task and were randomly assigned to one of four conditions. Participants completed measures at baseline, post-intervention/control, and at 1-week, and 1-month follow-up. Contrary to hypotheses, all three active conditions were similarly effective at reducing PEP and improving self-perceptions relative to the control condition. In the absence of an intervention, engagement in PEP remained high up to a month following the social stress task. Higher levels of baseline state anxiety, intolerance of uncertainty, and use of safety behaviours predicted greater PEP, even in the presence of an intervention. These results highlight the benefits of relatively brief interventions that disrupt the course of PEP for people with SAD. Such interventions can be easily incorporated into CBT protocols for SAD to enhance their effects.     

Auditory perceptual learning is not affected by anticipatory anxiety in the healthy population except for highly anxious individuals: EEG evidence

ObjectiveA recent neurocomputational model proposed that anxious hypervigilance impedes perceptual learning. This view is supported by the observed modulation of the mismatch negativity (MMN), a biomarker of implicit perceptual learning processes, in anxiety disorders. However, other studies found that anxious states sensitize brain responses with no impact on perceptual learning. The present research aimed to elucidate the impact of anticipatory anxiety on early stimulus processing in the healthy population.MethodsWe used electroencephalography to investigate the impact of unpredictable threat on the amplitude of the MMN and other components of the auditory evoked response in healthy participants during a passive auditory oddball task.ResultsWe found a general sensitization of early components of the auditory evoked response and changes in subjective and autonomic measures of anxiety during threat periods. The MMN amplitude did not differ during threat, compared to safe periods. However, this difference was modulated by the level of state or trait anxiety.ConclusionWe propose that anxiety sensitizes early brain responses to unspecific environmental stimuli but affects implicit perceptual learning processes only when an individual is located at the higher end of the anxiety spectrum.SignificanceThis view might distinguish between an adaptive role of anxiety on processing efficiency and its detrimental impact on implicit perceptual learning observed in psychiatric conditions.     

The Fear of Positive Evaluation Scale: Psychometric properties in a clinical sample

Cognitive models of social anxiety suggest that fear of negative evaluation (FNE) is the central cognitive dimension underlying the disorder. The Fear of Positive Evaluation Scale (FPES; Weeks, Heimberg, & Rodebaugh, 2008) was recently developed to assess an additional cognitive dimension purported to underlie social anxiety disorder (SAD), but its psychometric properties have yet to be examined in clinical populations. The present study, with 133 treatment-seeking patients, examined the applicability of the FPES with a clinical sample. Results indicated that the FPES was factorially distinct from a measure assessing FNE, and patients with SAD (n = 51) had higher mean scores on the FPES than patients with other anxiety disorders (n = 82). The FPES also showed adequate reliability (internal consistency), good convergent and discriminant validity, acceptable criterion-related validity in predicting social interaction anxiety symptoms, and appropriate sensitivity to treatment. The FPES appears to have good psychometric properties and is a promising new assessment tool for better understanding SAD.     

Cognitive training for divergent thinking in schizophrenia: A pilot study

Individuals with schizophrenia demonstrate deficits in divergent thinking. This ability is indispensable for generating creative solutions and navigating the complexities of social interactions. In a pilot study, seventeen stable schizophrenia outpatients were randomly assigned to a training program for divergent thinking or a control program on convergent thinking. After eight weeks of training, participants in the divergent thinking program had significantly greater improvements on measures of idea fluency, negative symptoms, and interpersonal relations than did participants receiving the control program. These preliminary results suggest that interventions for divergent thinking in schizophrenia may lead to improvements in patients' social functioning.