Psychometric properties of the Self-Beliefs related to Social Anxiety (SBSA) scale in a sample of individuals with social anxiety disorder.

The Self-Beliefs related to Social Anxiety (SBSA) scale assesses maladaptive social-evaluative beliefs, a key aspect in models of social anxiety disorder (SAD) that is frequently measured in research and clinical contexts. The SBSA has been evaluated psychometrically in student samples, but not in a large sample of individuals diagnosed with SAD. The current study tested the psychometric properties of the SBSA in a sample of individuals with SAD pooled from several studies (total N = 284). Results showed that the optimal factor structure for the SBSA was a correlated three-factor model (high standard beliefs factor, conditional beliefs factor, unconditional beliefs factor). The SBSA total and its subscales (formed based on the factors) exhibited good internal consistency. In terms of construct validity, the SBSA total, the high standard beliefs subscale, and conditional beliefs subscale had stronger associations with a measure of social anxiety than with a measure of depression, although the unconditional beliefs subscale was similarly related to both measures of social anxiety and depression. In terms of discriminative validity, the sample of individuals with SAD had higher SBSA total and subscale scores compared with a sample of individuals without SAD (N = 32). These findings provide a psychometric evidence base justifying the use of the SBSA for the assessment of maladaptive social-evaluative beliefs.

Motivational interviewing prior to cognitive behavioural treatment for social anxiety disorder: A randomised controlled trial.

BACKGROUND: We examined whether providing three sessions of treatment based on motivational interviewing (MI) prior to Cognitive Behavioral Therapy (CBT) for Social Anxiety Disorder (SAD) improved outcomes. METHODS: Participants diagnosed with SAD (N = 186) were randomly allocated to receive three sessions of MI (MI+CBT; n = 85) or supportive counselling (SC+CBT; n = 101) prior to a 12-week group CBT program. Assessments occurred at baseline, after preparatory treatment, after CBT, and at 6-months follow-up. Outcomes were expectations for change, number of CBT sessions attended, self- and clinician-rated CBT homework completion, and self- and clinician-rated social anxiety severity. RESULTS: Conditions did not differ significantly on expectations for change, number of CBT sessions attended, or clinician-rated homework completion. Self-rated homework completion was greater in MI+CBT than in SC+CBT. Change over time in social anxiety severity did not differ between conditions overall, however, this outcome was significantly moderated by two variables; those in MI+CBT, as compared to SC+CBT, showed significantly poorer outcomes on self-reported social anxiety severity if they were higher in change readiness and significantly better outcomes on clinician-rated social anxiety severity if they were higher in functional impairment. LIMITATIONS: Although therapists in MI sessions were rated as behaving more consistently with MI than therapists in SC sessions, some MI consistent behaviors occurred in the SC sessions. CONCLUSIONS: Addition of a MI-based discussion prior to evidence-based CBT appears to benefit people with SAD who have high functional impairment but may interfere with outcomes for those higher in readiness for change.

Measurement equivalence of the Social Interaction Anxiety Scale (SIAS) and Social Phobia Scale (SPS) across individuals with social anxiety disorder from Japanese and Australian sociocultural contexts.

BACKGROUND: Cultural factors influence both the expression of social anxiety and the interpretation and functioning of social anxiety measures. This study aimed to test the measurement equivalence of two commonly used social anxiety measures across two sociocultural contexts using individuals with social anxiety disorder (SAD) from Australia and Japan. METHODS: Scores on the straightforwardly-worded Social Interaction Anxiety Scale (S-SIAS) and the Social Phobia Scale (SPS) from two archival datasets of individual with SAD, one from Australia (n = 201) and one from Japan (n = 295), were analysed for measurement equivalence using a multigroup confirmatory factor analysis (CFA) framework. RESULTS: The best-fitting factor models for the S-SIAS and SPS were not found to be measurement equivalent across the Australian and Japanese samples. Instead, only a subset of items was invariant. When this subset of invariant items was used to compare social anxiety symptoms across the Australian and Japanese samples, Japanese participants reported lower levels of fear of attracting attention, and similar levels of fear of overt evaluation, and social interaction anxiety, relative to Australian participants. LIMITATIONS: We only analysed the measurement equivalence of two social anxiety measures using a specific operationalisation of culture. Future studies will need to examine the measurement equivalence of other measures of social anxiety across other operationalisations of culture. CONCLUSIONS: When comparing social anxiety symptoms across Australian and Japanese cultures, only scores from measurement equivalent items of social anxiety measures should be used. Our study highlights the importance of culturally-informed assessment in SAD.

Anticipatory Processing, Maladaptive Attentional Focus, and Postevent Processing for Interactional and Performance Situations: Treatment Response and Relationships With Symptom Change for Individuals With Social Anxiety Disorder.

Anticipatory processing, maladaptive attentional focus, and postevent processing are key cognitive constructs implicated in the maintenance of social anxiety disorder (SAD). The current study examined how treatment for SAD concurrently affects these three cognitive maintaining processes and how these processes are associated with each other as well as with symptom change from pre- to posttreatment. The sample consisted of 116 participants with SAD receiving group cognitive behavioral therapy. All three cognitive maintaining processes were measured relative to a speech task and again relative to a conversation task. Across both tasks, the three cognitive process variables demonstrated decreases from pre- to posttreatment. Within the same task, a slower rate of decrease in a specific cognitive process variable from pre- to posttreatment was predicted from higher pretreatment levels of either one or both of the other cognitive process variables. Additionally, higher levels of pretreatment conversation-related anticipatory processing and maladaptive attentional focus predicted a slower rate of decrease in social anxiety symptoms from pre- to posttreatment. Results are consistent with cognitive models of SAD and have important implications for enhancing existing treatments.

Changes in the self during cognitive behavioural therapy for social anxiety disorder: A systematic review.

A consistent feature across cognitive-behavioural models of social anxiety disorder (SAD) is the central role of the self in the emergence and maintenance of the disorder. The strong emphasis placed on the self in these models and related empirical research has also been reflected in evidence-based treatments for the disorder. This systematic review provides an overview of the empirical literature investigating the role of self-related constructs (e.g., self-beliefs, self-images, self-focused attention) proposed in cognitive models of SAD, before examining how these constructs are modified during and following CBT for SAD. Forty-one studies met the inclusion criteria. Guided by Stopa's (2009a, b) model of self, most studies examined change in self-related content, followed by change in self-related processing. No study examined change in self-structure. Pre- to post-treatment reductions were observed in self-related thoughts and beliefs, self-esteem, self-schema, self-focused attention, and self-evaluation. Change in self-related constructs predicted and/or mediated social anxiety reduction, however relatively few studies examined this. Papers were limited by small sample sizes, failure to control for depression symptoms, lack of waitlist, and some measurement concerns. Future research directions are discussed.

Development and validation of the Core Beliefs Questionnaire in a sample of individuals with social anxiety disorder.

BACKGROUND: Prominent cognitive models of social anxiety have consistently emphasised the importance of beliefs about the self in the aetiology and maintenance of social anxiety. The present study sought to develop and validate a new measure of core beliefs about the self for SAD, the Core Beliefs Questionnaire (CBQ). METHODS: Three versions of the CBQ were developed: a Trait version (fundamental absolute statements about the self), a Contingent version (statements about the self related to a specific social-evaluative situation), and an Other version (statements about how others view the self in social-evaluative situations generally). The psychometric features of the scales were examined in clinical (n=269) and non-clinical (n=67) samples. RESULTS: Exploratory factor analysis yielded a one factor model for all three versions of the questionnaire. Total scores differentiated individuals with SAD from individuals without a psychiatric condition, and demonstrated excellent internal consistency. The three CBQ versions had positive associations with social anxiety while controlling for depression, although zero-order correlations indicated the Trait version was more strongly related to depression than social anxiety, the Contingent version was similarly related to depression and social anxiety, and the Other version was more strongly related to social anxiety than depression. Scores on all three versions of the CBQ reduced from pre- to post-treatment and this change predicted treatment outcome. LIMITATIONS: This is the first validation study of the CBQ. CONCLUSIONS: This study provides initial support for the reliability and validity of the CBQ.

A Review of Scales to Measure Social Anxiety Disorder in Clinical and Epidemiological Studies.

To advance research into social anxiety disorder (SAD) and provide efficacious treatments for individuals with SAD, researchers and clinicians must have effective assessment instruments for identifying the disorder in terms of its diagnostic criteria, symptoms, and the presence of specific maintaining factors. This review highlights the main lines of existing adult and youth research on scales that form part of diagnostic instruments that assess SAD, scales that measure social anxiety symptoms, and scales that measure theory-based psychological maintaining factors associated with SAD. The review also highlights methodological issues that impact on the use of the aforementioned scales. The continued refinement and comparative evaluation of measures for SAD, culminating in the ascertainment of optimal measures, will improve the assessment and identification of the disorder. Improved identification of the disorder will contribute to the advancement of SAD research and treatment.

Differential effects of traffic sign stimuli upon speeding in school zones following a traffic light interruption.

Motorists whose journey has been interrupted by signalized traffic intersections in school zones resume their journey at a faster vehicle speed than motorists who have not been required to stop. Introducing a flashing "check speed" sign 70m after the traffic intersections counteracts this interruptive effect. The present study examined which aspects of a reminder sign are responsible for reducing the speeding behavior of interrupted motorists. When a sign that combines both written text and flashing lights was introduced, interrupted motorists did not speed, traveling on average 0.82km/h below the 40km/h speed limit when measured 100m from traffic intersections. Alternatively, when only the flashing lights were visible the interrupted motorists sped 3.36km/h over the 40km/h speed limit. Similar vehicular speeds were observed when only the written text was visible and when no sign was present (7.67 and 7.49km/h over the 40km/h speed limit, respectively). This indicates that static reminder signs add little value over the absence of a school zone reminder sign; the presence of both cues is necessary to fully offset the interruptive effect. This study also highlights the benefit of using exogenous visual cues in traffic signs to capture drivers' attention. These findings have practical implications for the design and use of traffic signs to increase compliance with posted speed limits.

An empirical analysis of Moscovitch's reconceptualised model of social anxiety: How is it different from fear of negative evaluation?

Cognitive-behavioural models propose that excessive fear of negative evaluation is central to social anxiety. Moscovitch (2009) instead proposes that perceived deficiencies in three self attributes: fears of showing signs of anxiety, deficits in physical appearance, or deficits in social competence are at the core of social anxiety. However, these attributes are likely to overlap with fear of negative evaluation. Responses to an online survey of 286 participants with a range of social anxiety severity were analysed using hierarchical multiple regression to identify the overall unique predictive value of Moscovitch's model. Altogether, Moscovitch's model provided improvements in the prediction of safety behaviours, types of fears and cognitions; however only the fear of showing anxiety subscale provided unique information. This research supports further investigations into the utility of this revised model, particularly related to utility of explicitly assessing and addressing fears of showing anxiety.

Speeding in school zones: violation or lapse in prospective memory?

Inappropriate speed is a causal factor in around one third of fatal accidents (OECD/ECMT, 2006). But are drivers always consciously responsible for their speeding behavior? Two studies are reported which show that an interruption to a journey, caused by stopping at a red traffic light, can result in failure to resume the speed of travel prior to the interruption (Study 1). In Study 2 we showed that the addition of a reminder cue could offset this interruption. These studies were conducted in a number of Australian school zone sites subject to a 40 km/h speed limit, requiring a reduction of between 20 km/h and 40 km/h. Motorists who had stopped at a red traffic signal sped on average, 8.27 km/h over the speed limit compared with only 1.76 km/h over the limit for those who had not been required to stop. In the second study a flashing "check speed" reminder cue, placed 70 m after the traffic lights, in the same school zones as those in Study 1 eliminated the interruptive effect of stopping with drivers resuming their journey at the legal speed. These findings have practical implications for the design of road environments, enforcement of speed limits, and the safety of pedestrians.