Vulnerabilities in social anxiety: Integrating intra- and interpersonal perspectives.

What are the major vulnerabilities in people with social anxiety? What are the most promising directions for translational research pertaining to this condition? The present paper provides an integrative summary of basic and applied translational research on social anxiety, emphasizing vulnerability factors. It is divided into two subsections: intrapersonal and interpersonal. The intrapersonal section synthesizes research relating to (a) self-representations and self-referential processes; (b) emotions and their regulation; and (c) cognitive biases: attention, interpretation and judgment, and memory. The interpersonal section summarizes findings regarding the systems of (a) approach and avoidance, (b) affiliation and social rank, and their implications for interpersonal impairments. Our review suggests that the science of social anxiety and, more generally, psychopathology may be advanced by examining processes and their underlying content within broad psychological systems. Increased interaction between basic and applied researchers to diversify and elaborate different perspectives on social anxiety is necessary for progress.

Mediation of social anxiety and depression during internet-delivered treatment for social anxiety disorder.

Many individuals with social anxiety disorder (SAD) have depressive symptoms that meet criteria for major depressive disorder (MDD). In our study, we examined the temporal relationship between symptoms of social anxiety and symptoms of depression during the course of an 11-week internet-delivered cognitive behavioral treatment (ICBT) for SAD (n = 170). Specifically, we investigated whether weekly changes in social anxiety mediated changes in depression, changes in depression mediated changes in anxiety, both or neither. In addition, we compared individuals with SAD and MDD (n = 50) and individuals with SAD and no MDD (n = 120) to examine the role of MDD as a moderator of the social anxiety-depression relationship. Lower-level mediational modeling revealed that changes in social anxiety symptoms mediated changes in depression symptoms to a greater extent than vice versa. In addition, mediation among individuals with SAD and MDD was significantly greater compared to individuals with SAD and no MDD. Our findings suggest that ICBT is effective in treating individuals with SAD regardless of comorbid depression, and that focusing ICBT interventions on social anxiety can lead to significant reductions in depression among individuals with SAD.

Perception of interpersonal distance and social distancing before and during COVID-19 pandemic.

Since COVID-19 is easily transmitted among people in close physical proximity, the focus of epidemiological policy during the COVID-19 crisis included major restrictions on interpersonal distance. However, the way in which distance restrictions affected spatial perception is unclear. In the current study, we examined interpersonal distance preferences and perceptions at three time points: pre-pandemic, early post-pandemic, and late post-pandemic. The results indicate that following the pandemic outbreak, people perceived others as farther away than they actually were, suggesting that the distance restrictions were associated with an enlargement of perceived interpersonal distance. Interestingly, however, people maintained the same distance from one another as before the outbreak, indicating no change in actual distance behavior due to the risk of infection. These findings suggest that COVID-19 was associated with a change in the way distance is perceived, while in practice, people maintain the same distance as before. In contrast, COVID-related anxiety predicted both a preference for maintaining a greater distance and a bias toward underestimating perceived distance from others. Thus, individuals who were highly fearful of COVID-19 perceived other people to be closer than they actually were and preferred to maintain a larger distance from them. The results suggest that subjective risk can lead to an increased perception of danger and a subsequent change in behavior. Taken together, even when behaviors should logically change, the decision-making process can be based on distorted perceptions. This insight may be used to predict public compliance.

Catching a (sine) wave: Temporal dynamics of nonverbal synchrony in social anxiety disorder.

Individuals with social anxiety disorder (SAD) experience a range of interpersonal problems and studies have found that nonverbal synchrony (the coordination between interaction partners' movements) may be impaired in dyads in which one individual has SAD (Asher et al., 2020). In the present study, we examined the temporal dynamics of nonverbal synchrony during "getting aquatinted" conversations of individuals with and without SAD. Specifically, participants (n = 146) formed either SAD dyads (dyads in which one individual had SAD and the other did not; n = 37 dyads), or control dyads (dyads in which both individuals did not have SAD; n = 36 dyads). Dyads were randomized to either small talk or closeness-generating (i.e., intimate) conversations. We found that during conversations, nonverbal synchrony followed a repeating pattern of increases and decreases that was best modeled by a sinusoidal wave (explained variance = 63.74 %). We found significant Diagnosis × Social Context interactions in the temporal dynamics of nonverbal synchrony (i.e., in the parameters of sine waves). Specifically, we found that for SAD dyads (but not control dyads), the average sine wave amplitude which indicates increases and decreases in nonverbal synchrony was greater during small talk conversations compared to closeness-generating conversations. In addition, we found that among control dyads (but not SAD dyads), the average vertical offset of sine waves (i.e., the average level of nonverbal synchrony) during closeness-generating conversations was greater compared to small talk conversations. The findings are interpreted within the context of the social anxiety literature as capturing two distinct social-anxiety related processes, and suggest that when examined temporally (rather than averaged), nonverbal synchrony may be an important implicit biomarker of SAD.

Nonverbal synchrony in diagnostic interviews of individuals with social anxiety disorder.

The present study examined nonverbal synchrony (i.e., synchrony between individuals' movement) during diagnostic interviews of individuals with and without social anxiety disorder (SAD). Specifically, 42 individuals with SAD and 42 individuals without SAD underwent a structured clinical interview, and videos of clinical interviews were analysed using Motion Energy Analysis (an objective machine-based video analysis) to quantify each individuals' movement as well as dyadic synchrony. Results indicated that interviews of individuals with SAD had significantly lower levels of nonverbal synchrony compared to interviews of individuals without SAD. In addition, interviews of individuals with SAD had lower levels of pacing compared to interviews of individuals without SAD (pacing refers to synchrony in which the interviewer initiates movement to which the participant responds). Analyses with social anxiety represented as a continuum of severity (vs. a diagnostic dichotomy) resulted in similar findings. Thus, individuals with SAD synchronized with interviewers' movement to a lesser extent compared to individuals without SAD, and social anxiety was associated with diminished synchrony. Implications for psychopathology and diagnosis of SAD are discussed.

Pride in social anxiety disorder.

The present study examined differences in the experience of pride between individuals with and without social anxiety disorder (SAD), and is the first to examine both the effects of context on pride and the temporal relationship between pride and anxiety in participants' daily lives. Eighty-eight participants took part in the study, half (n = 44) met diagnostic criteria for SAD and half (n = 44) did not. Both groups completed an experience sampling measurement (ESM) to assess the levels of pride and anxiety and the nature of interpersonal contexts in which these emotions were experienced every day for 21 consecutive days. Using multilevel linear modeling, our findings suggest that pride is diminished among individuals with SAD, that situations percieved as highly neagative and positive, or as highly meaningful and positive are associated with the highest levels of pride, and that the experience of pride is associated with subsequent reductions in anxiety among individuals with SAD. These findings point to the role of pride in the disorder and can be used to inform and enhance therapeutic interventions for SAD.

Pre-reproductive stress in adolescent female rats alters maternal care and DNA methylation patterns across generations.

Stress during development affects maternal behavior and offspring phenotypes. Stress in adolescence is particularly consequential on brain development and maturation, and is implicated in several psychiatric disorders. We previously showed that pre-reproductive stress (PRS) in female adolescent rats affects behavior and corticotropin releasing hormone receptor 1 (CRHR1) expression in first- (F1) and second- (F2) generation offspring. We further showed that offspring phenotypes are partially reversed by post-stress treatment with fluoxetine (FLX) or the CRHR1 antagonist NBI27914 (NBI). Epigenetic processes, such as DNA methylation, are implicated in the stress response and interact with maternal care quality across generations. Here, we asked whether PRS and FLX or NBI exposure would affect maternal care and global DNA methylation in the brains of exposed dams and their adult F1 and paternally-derived F2 offspring. We found that PRS decreased self-care while increasing pup-care behaviors. PRS also increased DNA methylation in the amygdala of dams and their F1 male offspring, but decreased it in F2 females. Drug treatment had no effect on maternal care, but affected DNA methylation patterns in F0 and F1 generations. Furthermore, PRS altered the expression of DNA methylating enzymes in brain, blood and oocytes. Finally, maternal care variables differentially predicted methylation levels in PRS and control offspring. Thus, the effects of adolescent stress are long-lasting and impact methylation levels across three generations. Combined with our findings of epigenetic changes in PRS-exposed oocytes, the present data imply that biological changes and social mechanisms act in concert to influence adult offspring phenotypes.

Does acceptance lead to change? Training in radical acceptance improves implementation of cognitive reappraisal.

Third-wave cognitive behavioral treatments such as dialectical behavioral therapy (DBT) theorize that emotional acceptance facilitates cognitive change. However, empirical evidence to support this notion is scarce. This study assessed how a two-week online training in using acceptance or cognitive change DBT skills influences the implementation of these strategies in an emotion regulation task. During six training sessions, 120 healthy individuals recorded personal negative events. In a Radical Acceptance group, participants implemented a DBT skill aimed to promote acceptance of the negative events they described. In a Check the Facts group, participants reappraised their interpretations of the described events. A Control group described negative events but did not use any DBT skill. Results supported our preregistered hypotheses showing that following the training, participants who practiced Radical Acceptance improved in their ability to implement both emotional acceptance and cognitive reappraisal (cognitive change) in an emotion regulation task. In contrast, the Check the Facts group improved only in the ability to use cognitive reappraisal, but not emotional acceptance. The control group did not improve in either strategy. The findings provide empirical evidence to support the notion that cultivating acceptance can subsequently improve the ability to reinterpret reality for coping adaptively with negative events.

Emotions in social anxiety disorder: A review.

Extant cognitive behavioral models of social anxiety disorder (SAD) have primarily focused on cognitions and behaviors that maintain the disorder. Emotional aspects of SAD have been investigated but have not been sufficiently integrated into current models. To facilitate such integration, we reviewed the literature on emotional constructs (emotional intelligence, emotional knowledge, emotional clarity, emotion differentiation, and emotion regulation), and discrete emotions (anger, shame, embarrassment, loneliness, guilt, pride, and envy) in SAD and social anxiety. We present the studies conducted on these constructs, summarize the main findings, suggest areas for future research, discuss the findings in the context of existing models of SAD and attempt to integrate the findings into these existing models of the disorder. Clinical implications of our findings are also discussed.

Swipe right, swipe left: Initial interactions in social anxiety disorder.

Individuals with SAD have difficulties initiating and maintaining relationships. However, little is known about the preinteraction behavior of individuals with SAD. Individuals with (n = 40) and without SAD (n = 40) who reported being attracted to individuals of the opposite sex participated in a preregistered lab-based experiment using a novel task similar to existing initial interaction/dating applications. Specifically, participants viewed 112 profiles of individuals from the opposite sex that included pictures (either happy/smiling or neutral) and descriptive texts and were requested to choose partners for a future interaction. Participants could swipe right to indicate their willingness to meet an individual, swipe left to indicate their lack of willingness to meet the individual, or press a button to receive more information before making their decision. Participants were also requested to provide a photo of themselves and write a short description of themselves ostensibly for inclusion in the database. We found that individuals with SAD were less likely to swipe right compared to individuals without SAD, and their likelihood to swipe right did not increase in response to happy/smiling pictures. Individuals with SAD also sought less information about others before making their swiping decisions compared to individuals without SAD. Finally, individuals with SAD provided shorter self-descriptions and more neutral pictures compared to individuals without SAD. These findings could not be accounted for by depression and remained above and beyond depressive symptoms. Our findings suggest that significant SAD-related biases may exist even in preinteraction stages of relationship development (i.e., before initial interactions occur) and research and clinical implications are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Man vs. machine: A comparison of human and computer assessment of nonverbal behavior in social anxiety disorder.

Social anxiety disorder (SAD) is a common psychological disorder associated with broad interpersonal impairment. Most previous studies have examined nonverbal behavior in SAD using human coders. However, one recent study utilized a machine-based analysis of nonverbal behavior and dyadic synchrony in SAD (Asher, Kauffmann, & Aderka, 2020). In the present study, we compared human and computer assessments of nonverbal behavior in social anxiety to enhance our knowledge about their commonalities and unique differences in capturing nonverbal behavior in the context of SAD. Specifically, the present study included 152 individuals: 38 individuals diagnosed with SAD and 114 individuals without SAD. Participants formed 76 opposite-sex interaction dyads comprising either two individuals without SAD (n = 39 control dyads) or one individual with SAD and one individual without SAD (n = 37 SAD dyads). All participants underwent a getting-acquainted task and were videotaped during the conversation. Half of the interactions were small talk interactions and half were closeness-generating interactions that required significant self-disclosure. We found that both types of coding were associated with self-reported social anxiety but that machine-based coding was superior in capturing social anxiety in closeness-generating contexts. Implications for research on nonverbal behavior in SAD are discussed.

Blend in or stand out: social anxiety levels shape information-sharing strategies.

Although living in social groups provides many benefits for group members, such groups also serve as a setting for social competition over rank and influence. Evolutionary accounts suggest that social anxiety plays a role in regulating in-group conflict, as individuals who are concerned about social threat may choose to defer to others to maintain the hierarchical status quo. Here, we examine how social anxiety levels are related to the advice-giving style an individual adopts: a competitive influence-seeking strategy or a defensive blend-in strategy. We begin by demonstrating that similarity to others drives activity in the brain's valuation system, even during a competitive advice-taking task. Then, in three behavioural experiments, we show that social anxiety levels are related to the tendency to give advice resembling the advice given by rival advisers and to refrain from status-seeking behaviour. Social anxiety was also associated with negative social comparisons with rival advisers. Our findings highlight the role of competing social goals in shaping information sharing.

Comorbid major depressive disorder in cognitive-behavior group treatment for social anxiety disorder: An examination of processes of symptom change.

Individuals with social anxiety disorder (SAD) typically have elevated depressive symptoms and approximately 50% also meet criteria for major depressive disorder (MDD; Beesdo et al., 2007). In the present study, we examined the relationship between social anxiety and depressive symptoms during cognitive-behavior group treatment (CBGT) for SAD. Specifically, we compared individuals with SAD and comorbid MDD and individuals with SAD without MDD to examine the role of MDD as a moderator of social anxiety-depression relationship. Participants were 90 individuals seeking treatment for SAD (36% were diagnosed with MDD), who completed self-report measures of social anxiety and depression every 2 weeks during CBGT. Lower level mediational modeling indicated that for individuals without MDD, a reciprocal relationship was observed in which changes in both social anxiety and depressive symptoms mediated changes in each other. However, changes in social anxiety explained all subsequent changes in depression, whereas changes in depression explained 11.26% of subsequent changes in social anxiety. For individuals with both SAD and MDD, neither social anxiety nor depression significantly mediated changes in each other. Our findings suggest that different processes of change occur for individuals with and without MDD and clinical implications of these findings are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Distinct and interacting impacts of trait anxiety and a state anxiety manipulation on attentional switching.

BACKGROUND AND OBJECTIVES: According to the Attentional Control Theory, individuals with high levels of anxiety often shift their attention inefficiently due to increased effort to meet task demands. However, literature on the effects of anxiety on shifting performance is discrepant. This study examined the impacts of trait and state anxiety on attentional shifting and whether worry or depression explained variance in shifting. DESIGN AND METHODS: One-hundred thirty-eight undergraduate psychology students were randomized to the Trier Social Stress Test (TSST) or control TSST. Subjects completed measures of state/trait anxiety, worry, and depression and a computerized attention task. Statistical analyses included linear mixed modelling (LMM), t-tests, and ANOVAs. RESULTS: Results revealed significant effects of state and trait anxiety and worry, but not depression. Type (location/direction) and presentation (switch/repeat) of trials also affected response times. Trait anxiety significantly related to trial presentation but did not interact with trial type. State anxiety did not significantly relate to either trial index. State and trait anxiety significantly impacted overall response time. Results revealed variations in cognitive flexibility, but no interactions between state and trait anxiety in predicting task switching. CONCLUSION: These findings are discussed in the context of Attentional Control Theory and relevant empirical research.

The effect of depression on treatment outcome in social anxiety disorder: an individual-level meta-analysis.

Social anxiety disorder (SAD) is highly comorbid with depression. In the present meta-analysis, we conducted the first individual-level examination of the association between pre-treatment depression and improvement in social anxiety symptoms during treatment. We identified eligible studies on cognitive behavior therapy (CBT) and pharmacotherapy for SAD and contacted authors to obtain individual-level data. We obtained these data from 41 studies, including 46 treatment conditions (n = 4,381). Our results showed that individuals who had high levels of depression at pre-treatment experienced greater decreases in social anxiety symptoms from pre- to post-treatment, but not at follow-up. When analyzing treatment modalities (individual CBT, group CBT, internet-delivered CBT, and pharmacotherapy), we found that depressive symptoms were associated with better post-treatment outcomes for individual CBT and internet-delivered CBT, but not for pharmacotherapy or group CBT. Our findings suggest that depression does not negatively affect treatment outcome in SAD and may even lead to improved outcomes in some treatment formats. Clinical implications of these findings are discussed.

Are some therapists better at facilitating and consolidating sudden gains than others?

BACKGROUND: Changes during psychotherapy often include sudden symptom improvements, called sudden gains (SGs), which have been identified as being superior to gradual symptom change with regard to treatment success. This study investigates the role of therapists in initiating and/or consolidating SGs. METHODS: The analyses are based on a sample of patients (N = 1937) who were seen by 155 therapists and received individual psychotherapy at a university outpatient clinic. First, the therapist effect (TE) on SG was investigated using multilevel modeling (MLM). Second, MLM was used to explore the relative importance of patient and therapist variability in SGs as they relate to outcome. RESULTS: The TE on SGs accounted for 1.8% of variance, meaning that therapists are accountable for inter-individual differences in their patients' likelihood to experience SGs. Furthermore, results revealed a significant effect of SGs on outcome for both levels, while therapist differences regarding the consolidation of SGs were not significant. CONCLUSIONS: The analyses indicated that some therapists are better in facilitating and initiating SGs. The process of triggering SGs seems to be a therapist skill or competence, which opens up an additional pathway to positive outcomes that could be used to improve clinical training.

All by myself: Loneliness in social anxiety disorder.

In the present study we examined loneliness among individuals with and without social anxiety disorder (SAD), contexts that may moderate the experience of loneliness, and the temporal relationship between loneliness and social anxiety. We examined 88 individuals (44 with SAD and 44 without SAD) and used experience sampling (ES) methods, comprising of real-time measurement of naturally occurring events and participants' emotional reactions to them during participants' daily lives over the course of 21 days. Hierarchical linear models indicated that individuals with SAD reported significantly more loneliness compared to individuals without SAD. We also found that characteristics of social situations (negativity, positivity, and meaningfulness) were all positively and significantly associated with loneliness among individuals with SAD. Thus, social situations that were experienced as more negative, more positive, and more meaningful all resulted in increased loneliness for individuals with SAD. We also found a significant Positivity × Meaningfulness interaction that indicated that the effect of positivity was attenuated when meaningfulness was high. Notably, none of these effects were found for individuals without SAD. Finally, we found that for individuals with SAD, both anxiety and loneliness predicted changes in each other and combined to form a deleterious cycle. However, evidence for such a cycle was not found for individuals without SAD. The role of loneliness in the psychopathology of SAD and its maintenance, as well as clinical implications are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The Medium is the Message: Effects of Mediums of Communication on Perceptions and Emotions in Social Anxiety Disorder.

We examined the use of voice/text and visual mediums and their effects on perceptions and emotions in social anxiety disorder (SAD). Our sample included 88 individuals: 44 individuals with SAD and 44 non-socially-anxious (NSA) individuals. We used an experience sampling methodology (ESM) in which participants received daily links to online measures at random times during the day, for 21 days and reported on social interactions, emotions and perceptions. Results indicated that individuals with SAD used voice/text mediums to a greater extent and used visual mediums to a lesser extent compared to NSA individuals. However, despite preferring voice/text mediums, use of visual mediums resulted in immediate increases in positive perceptions and emotions for individuals with SAD. These findings were above and beyond the effect of depressive symptoms and remained when social anxiety was represented as a continuum of severity. This has important implications for exposure interventions in the treatment of SAD.

The grass is always greener: Envy in social anxiety disorder.

In the present study we examined envy in social anxiety disorder (SAD) and its potential role in maintaining the disorder. In addition, we examined social contexts and modes of communication that may serve as moderators of envy in SAD, and the temporal relationship between envy and anxiety in the disorder. Our sample included 88 individuals (44 with SAD and 44 without SAD) who underwent an experience sampling procedure in which participants received daily measures of emotions for 21 days. Using multilevel linear modeling we found that individuals with SAD experienced elevated envy compared to individuals without SAD and this was enhanced in social (compared to non-social) contexts. For individuals with SAD, visual modes of communication were associated with elevated envy compared to voice/text communication. Finally, envy predicted subsequent anxiety above and beyond previous anxiety and additional negative emotions. The role of envy in the psychopathology and maintenance of SAD, as well as clinical implications are discussed.

Using machine-learning to predict sudden gains in treatment for major depressive disorder.

OBJECTIVE: Sudden gains during psychotherapy have been found to consistently predict treatment outcome but evidence on predictors of sudden gains has been equivocal. To address this gap, the present study utilized three machine learning algorithms to predict sudden gains during treatment for major depressive disorder. METHOD: We examined predictors of sudden gains in two large samples of individuals receiving treatment in a partial hospital setting (n = 726 and n = 788; total N = 1514). Predictors included age, gender, marital status, education, employment status, previous hospitalization, comorbid diagnoses, and pretreatment measures of depressive and generalized anxiety symptoms. We used three machine learning models: a Random Forest model, a Random Forest model with an adaptive boosting meta-algorithm, and a Support Vector Machine model. RESULTS: In both samples, sudden gains were identified and found to significantly predict outcome. However, none of the machine learning algorithms was able to identify robust predictors of sudden gains. Thus, even though some models achieved fair prediction of sudden gains in the training subset, prediction in the test subset was poor. CONCLUSIONS: Despite the use of a large sample and three machine-learning models, we were unable to identify robust demographic and pretreatment clinical predictors of sudden gains. Implications for clinical decision making and future studies are discussed.