Week 3: Social Anxiety Disorder Flashcards
What are the 2 cognitive behavioural models of SAD and how are they distinguished?
- Clark and Wells:
-Suggest that self-focused attention is the central, if not only, critical attentional process that generates anxiety, impairs performance, and precludes the perception of information inconsistent with social fear.
-SAD individuals reliably direct their attention toward internal cues - Rapee and Heimberg
-The importance of vigilance to socially relevant threat stimuli in the environment
–Namely negative evaluation in the audience
-Suggest that SAD individuals direct their attention toward both internal and external cues
Which of the two models assumes that the individual will not look to the audience to determine performance?
Clark and Wells’s
In the Clark and Wells model, which dysfunctional beliefs and assumptions are activated upon detection of an audience?
Others hold high standards for their performance
Conditional beliefs about social evaluation
Unconditional beliefs about the self.
In the Clark and Wells model, which critical and unidirectional process is it centered on?
Self-focused attention and creating the impression of oneself as a social object
How do interoceptive perception influence SAD, according to Clark and Wells? (3)
The fear of negative outcomes forces one to overmonitor themselves (Self-Focus):
-Physiological arousal increases, which causes one to perceive themselves as anxious and failing
-This over attendance also inhibits performance, by reducing cognitive capacity.
-Safety behaviours to hide and distract from physical cues
Which bias is unique to the Rapee & Heimberg model?
Bias for detecting negative external cues
According to Rapee & Heimberg, what sort of components comprise the individual’s perception of “self-as-object”?
This self-image is a composite of several inputs, such as:
-How one generally appears to others (information obtained in mirrors, photographs, etc.)
-Past difficult experiences in social situations which are consistent with core beliefs and the self-schema
Define ‘Self-Focus’ in social anxiety
An awareness of self-referent internally generated information that stands in contrast to an awareness of externally generated information derived through sensory receptors (Ingram, 1990)
In the context of SAD, what does ‘Private’ and ‘Public’ mean?
Private
* Involves goals that are autonomous and egocentric, which do not require a consideration of others’ reactions to one’s behavior
Public
* Related to behaviors that take into account the reactions, needs, or desires of others and thus is necessarily influenced by the aim for social consensus or a consideration for how one’s actions influence others’ perceptions of oneself.
What is interesting about self-images? (4)
Images more likely to be seen from observer perspective
Typically linked to specific social memories
Viewing self as observer appears unique to social anxiety, as opposed to other anxiety disorders
Additionally, SAD individuals rate negative self-imagery as familiar and ego-syntonic
True or False:
Using mirrors will cause individuals with SAD to perceive themselves more, which will increase self-focus, and thereby increase anxiety.
False:
Causal Effects of Self-Focus: General Manipulation
Mirrors to induce self-focus:
* SAD participants listed fewer negative personality characteristics
Inconsistent with Clark & Wells, greater self-focus did not result in greater negative self-perception
Define Interpretation Bias
The tendency to interpret ambiguous or neutral stimuli as threatening.
How might interpretation bias manifest in SAD?
SA has been associated with:
o Threat interpretations of positive social events (Alden et al. 2008)
o Failure to accept others’ positive reactions at face value
o More negative interpretations of positive events than individuals with other anxiety disorders, including panic disorder and generalized anxiety disorder (GAD), but not obsessive-compulsive disorder
Quicker detection of high-intensity anger and fear under conditions of moderate threat
Slower detection of low-intensity sadness and anger (if no threat)
How could one possibly intervene on spontaneous imagery in SAD?
Imagery Rescripting
-Begins with a period of cognitive restructuring focusing on the negative belief reflected in the spontaneous and recurring image reported by the client.
-Involves repeated evocation of the memory, insertion of corrective information into the image, and a compassionate stance toward the self in imagery.
Video Feedback:
-Studies that added cognitive preparation demonstrated robust effects on self-perceptions of performance, and the magnitude of the discrepancy between self ratings and observer ratings predicted responses to video feedback
–However, little impact on:
SA
Confidence
Willingness to approach a subsequent public speaking task
Why might Task Concentration Training reduce social anxiety? Which sort of SAD might particularly benefit from this intervention?
o Reduction of focus on negative self-aspects correlates with reductions in SA
o Also, reduction in self-focused attention during treatment was a significant predictor of long-term change in SA and fears of blushing, trembling, and sweating
> (Task Concentration Training) More effective than applied relaxation in treating individuals with SAD with fears of blushing, trembling, or sweating
Why might acceptance and mindfulness-based approaches also reduce SAD?
They target avoidance, which theoretically can be applied to Self-Focus tendencies
How is the influence of SAD on emotionality characterized? (3)
SAD characterized by:
-Reduced emotionality
–SAD negatively predicted by heightened intensity of emotions (Mennin et al., 2007)
-Emotional hyperreactivity
-Emotion regulation deficits.
What emotional outcomes is SAD related to? (9)
Poor understanding of emotions
Negative reactivity (this was not found with GAD)
Less aware of emotions
-Including poor understanding of them
Suppression of emotion
Difficulties in emotional responding
Fear of emotional experiences
Endorsement of the following beliefs:
-It is important to have control of emotional expression,
-Emotional expression may lead to social rejection
-Expressing one’s emotions communicates weakness.
More suppression of positive emotions
Situation selection (avoidance)
What is the Fear of Positive Evaluation?
“The sense of dread associated with being evaluated favorably and publicly, which necessitates a direct social comparison of the self to others and therefore causes an individual to feel conspicuous and ‘in the spotlight”
In the context of SAD, what is positive emotion regulation? (2 perspectives)
SA is associated with the down-regulation of positive emotional states
Kashdan et al. proposes a self-regulation depletion hypothesis.
-There exists a paradox in SA in which excessive attempts to make a positive impression, appear and feel less anxious, and avoid rejection deplete the self-control resources necessary to effectively prevent socially undesirable behaviors.
Information processing perspective:
-Investigators have implicated both biased attention and interpretation in diminished positive affect in SA.
-Moreover, training of attention toward positive information heightened positive emotional reactivity in SA
True or False:
Those with SAD tend to experience anger more often, including in non-social situations
True
True or False:
Those SAD tend to express anger more frequently
False
They are more likely to suppress or direct the anger inward
Two subsets of people with SAD with varying behavioral reactions to social threat:
- One group reported the avoidant, unassertive, and submissive response style prototypical of individuals with SAD
- The other group reported angry, hostile, and mistrusting interpersonal styles.
Categories of Safety Behaviours (SAD)
Hirsch et al., 2004: (2)
Avoidance subtype
-Associated with:
higher state anxiety
Negative reactions from interaction partner
Impression management
-E.g.,
–Excessive self-monitoring and rehearsal
-Not associated with negative perception from observers
True or false
Lack of parental control is more significantly related to social anxiety than overcontrol in adolescents.
False
A recent review concluded that the majority of available studies (75%) point to a significant contribution of parental overcontrol to adolescent anxiety in general
Some evidence of association with social anxiety symptoms in pre-adolescents
List the potential ways a parent can play a role in causing a adolescent’s SAD (3), plus a caveat.
Parental over-control or overprotection.
Modeling of social fears, discomfort, avoidance, and communicating negative evaluations
Parents perceived as more socially isolating and preoccupied with the opinions of others
Caveat:
-Information reported by adolescent, in which SAD group is already known to be negatively biased.
Emotional & Behavioural Symptoms of SAD (9)
o Fear of situations in which you may be judged negatively
o Worry about embarrassing or humiliating yourself
o Fear that others will notice that you look anxious
o Fear of physical symptoms that may cause you embarrassment
o Avoidance of doing things or speaking to people out of fear of embarrassment
o Avoidance of situations where you might be the center of attention
o Anxiety in anticipation of a feared activity or event
o Post- analysis of performance and identification of flaws social interactions
o Expectation of the worst possible consequences from a negative experience during a social situation
Physical symptoms of SAD (9)
o Blushing
o Fast heartbeat
o Trembling
o Sweating
o Upset stomach or nausea
o Trouble catching your breath
o Dizziness or lightheadedness
o Feeling that your mind has gone blank
o Muscle tension
How are introverts distinct from SAD?
Not limited by their preference for solitude
True or False: Major depression typically occurs before the onset of SAD
False
SAD typically starts first, often many years prior to the onset of depression
Do we treat depression or SAD first?
No case is the same
Risk factors for onset of social anxiety? (4)
Environment
* Certain parenting styles → overcontrolling, quick to criticize, reluctant to show affection, or overly concerned with the opinions of others
* Early shaming/public embarrassment experiences → 92% of an adult sample with social phobia reported a history of severe teasing in childhood, vs 50% and 35% in their panic disorder and OCD groups.
Genes
* Parent with SAD → 30-40 percent greater likelihood of developing SAD.
* Unclear → The extent to which the parent-child social anxiety association is based on genetics vs. parenting style
What assumptions are typically activated in the Clark and Wells’ model? (3)
-High Standards of Social Performance
-Conditional beliefs about social evaluation
-Unconditional beliefs about the self
What is unique about the R & H model? (2)
-Processes do not operate in isolation; each component interacts with the others in the form of a positive feedback loop
-Inclusion of external stimuli
What is unique about the C&W model?
-Emphasis only on internal cognitive processes in the maintenance of SAD.
-Closed anxiety program – in the beginning there is focus on the outside but once you start focusing internally you shut
down to external stimuli (no ability to disconfirm your assumptions &
beliefs.)
What % of clients who undergo exposure therapy do not show clinically significant improvement?
50% (Loerinc et al., 2015)
Of those who respond to exposure, what % show a relapse?
19-52%
What 2 conditions are necessary for change of unrealistic fears, according to Emotional Processing Theory?
- Person’s fear and anxiety need to be triggered or activated. If this is not done, the fear structure cannot be changed
- Realistic information needs to replace the original, unrealistic information in the fear structure
Criticisms of the Emotional Processing Theory: (3)
➢ No much evidence found
➢ Within-session anxiety reduction does not
always predict treatment success
➢ Meta-analysis → only Between Session Habituation moderately associated with treatment outcome
What are the key steps to planning and designing a behavioural experiment? (5)
What are you most afraid of? What could happen?
Under which circumstances do you think it most likely that this will actually happen?
Design
Think of an experiment with which you can best test your expectation.
Determine the duration and frequency that are necessary to violate your expectation.
Check the feasibility of the experiment.
How might Self-Efficacy play a role in SAD? (5)
- Social self-efficacy predicted the level of social anxiety regardless of the interpersonal relationship (peers or strangers) in which the
action is taking place (Hannesdóttir & Ollendick, 2007) - The less perceived social competence an individual has, the more social anxiety he or she will experience (Smari et al., 2001)
- Self-efficacy beliefs have been linked to motivation, behavioral change, and enhanced affect regulation and psychosocial functioning
(Bandura 2003) - Suggested to mediate the link between negative self-statements and SAD (Rudy et al., 2011)
- Thought to decrease the use of dysfunctional strategies during social situations (Thomasson & Psouni, 2010)
According to Bandura, what are the 4 avenues within which we can cultivate self-efficacy?
- Successful Achievement of Tasks (most effective)
* Exposure - Vicarious Learning
-Important that the subject resembles the learner
* Therapist modeling
* Role play - Verbal Persuasion
-Encouragement
* Psycho-education
* Cognitive Restructuring - Physiological State
* Psycho-education
* Interoceptive exposure
* Relaxed breathing
