Craig S. Holt

A comparison of two measures of perfectionism

Abstract This study compares two recently developed measures of perfectionism. College students completed the Frost, Marten, Lahart and Rosenblate (1990; Cognitive Therapy and Research, 14 , 449–468) Multidimensional Perfectionsim Scale and the Hewitt and Flett (1991; Journal of Personality and Social Psychology, 60 , 456–470) scale of the same name. Their relationship to each other, as well as to measures of affect, were examined. There was considerable overlap in the two measures of perfectionism. Frost et al. s Total Perfectionism score appears to reflect a global dimension of perfectionism which is correlated with Hewitt and Fletts Self-Oriented and Socially-Prescribed scales, and less closely related to the Other-Oriented scale. Frost et al. s Personal Standards scale was most closely associated with Hewitt and Fletts Self-Oriented Perfectionism scale. Frost et al. s Concern over Mistakes, Parental Expectations and Parental Criticism scales were independently correlated with Hewitt and Fletts Socially-Prescribed Perfectionism scale. The subscales from each measure showed differential relationships with measures of positive and negative affect. Those dimensions which have been found to be related to symptoms of psychopathology were most closely related to negative affect (e.g. Concern over Mistakes, Socially- Prescribed Perfectionism), while those which have been found to be related to more “healthy” characteristics were associated with positive affect (e.g. Personal Standards, Other-Oriented Perfectionism). A factor analysis using the 9 subscales resulted in a conceptually clean two-factor solution. The first of these reflected maladaptive evaluation concerns, and the second reflected positive achievement strivings. The implications of these findings for the understanding of the construct of perfectionism are discussed.

Assessment of anxiety in social interaction and being observed by others : The social interaction anxiety scale and the social phobia scale

Social phobia has become a focus of increased research since its inclusion in DSM-III. However, assessment of social phobia has remained an underdeveloped area, especially self-report assessment. Clinical researchers have relied on measures that were developed on college populations, and these measures may not provide sufficient coverage of the range of situations feared by social phobic individuals. There is a need for additional instruments that consider differences in the types of situations (social interaction vs. situations involving observation by others) that may be feared by social phobics and between subgroups of social phobic patients. This study provides validational data on two instruments developed by Mattick and Clarke (1989): the Social Interaction Anxiety Scale (SIAS), a measure of anxiety in social interactional situations, and the Social Phobia Scale (SPS), a measure of anxiety in situations involving observation by others. These data support the use of the SIAS and SPS in the assessment of individuals with social phobia.

Avoidant personality disorder and the generalized subtype of social phobia

Social phobia and avoidant personality disorder (APD) may be given as comorbid diagnoses. However, it is not known if the labels provide independent, useful diagnostic information. We classified social phobics by social phobia subtype and presence of APD. Generalized social phobics with and without APD (ns = 10 and 10) and nongeneralized social phobics without APD (n = 10) were distinguished on measures of phobic severity. The generalized groups also showed earlier age at onset and higher scores on measures of depression, fear of negative evaluation, and social anxiety and avoidance than did the nongeneralized group. APD criteria of general timidity and risk aversion were more frequently endorsed by social phobics with APD. The data suggest that both the generalized subtype of social phobia and the presence of APD do provide useful diagnostic information but the additional diagnosis of APD may simply identify a severe subgroup of social phobics.

Cognitive—behavioral group treatment for social phobia: Effectiveness at five-year followup

Empirical studies of the behavioral or cognitive—behavioral treatment of social phobia have appeared with increasing frequency over the last decade, and there is reason for cautious optimism in the evaluation of treatment effectiveness. However, few studies have reported systematic followup data, and there is little information available about the durability of change in treated social phobics. We report on the followup evaluation of cognitive—behavioral group therapy (CBGT) for social phobia. Patients who received CBGT or a credible alternative treatment were recontacted after a period of 4.5 to 6.25 years and completed a battery of self-report questionnaires, an individualized behavioral test, and a structured interview with an independent assessor. Patients who received CBGT remained more improved than alternative treatment patients on measures from all assessment modalities. However, due to the long followup period, only a portion of the original study sample could be assessed, and these patients may have been less severely impaired than patients who did not participate in the long-term followup. Limitations of the current study and issues of sample attrition in the conduct of long-term followup studies are discussed.

The issue of subtypes in the diagnosis of social phobia

Abstract A number of changes will occur in the criteria for diagnosis of anxiety disorders with the publication of DSM-IV. For social phobia, a central issue has been the specification and definition of subtypes. DSM-III-R specified a generalized subtype, but the DSM-IV subworkgroup on social phobia considered additional subtyping strategies, and struggled with issues of number and definition. This paper reviews the literature on subtyping in clinical samples of individuals with social phobia, and considers issues such as demographic differences, clinical features, and treatment response. The issue of overlap between generalized social phobia and avoidant personality disorder is considered. An analysis of the subtype issue from a situationist perspective is also presented. Options for subtyping that were considered for DSM-IV are presented, and issues that require further research on subtypes of social phobia are discussed.

Cognitive‐behavioral group therapy versus phenelzine in social phobia: Long term outcome

To evaluate the effects of maintenance treatment and durability of gains after treatment discontinuation, responders to either phenelzine (PZ) or cognitive‐behavioral group therapy (CBGT) from an acute trial comparing these two treatments as well as pill placebo and a psychotherapy control (educational supportive group therapy) were enrolled into maintenance and treatment‐free follow‐up phases. Experimental design: Responders to an acute trial contrasting PZ and CBGT entered a six‐month maintenance phase. Patients who continued to respond through the maintenance phase entered a six‐month treatment free phase. Patients receiving pill placebo or educational supportive group therapy in the acute trial did not enter the long term study. Principal observations: PZ patients entered maintenance more improved than CBGT patients, and nonrelapsing PZ patients maintained their superior gains throughout the study. Relapse during maintenance did not differ between treatments. However, PZ patients showed a trend toward greater relapse during treatment‐free follow‐up. There was a greater relapse among patients with generalized social phobia with phenelzine. Conclusions: PZ and cognitive‐behavioral group therapy may differ in their long term effects. The superiority seen with PZ on some measures in the acute study persisted in patients who maintained their gains over the course of maintenance and treatment‐free follow‐up. However, CBGT may lead to a greater likelihood of maintaining response after treatment has terminated. Replication with larger samples is needed, as is a study of the acute and long‐term efficacy of combined PZ and CBGT. Depression and Anxiety 10:89–98, 1999.

Social phobia and perfectionism

Abstract Clinical evidence suggests that components of perfectionism may have special relevance to social phobia. This study examines this relationship by comparing 61 patients with social phobia and 39 community volunteers with no anxiety disorder on Frost, Marten, Lahart and Rosenblates (1990) Multidimensional Perfectionism Scale (MPS). Social phobia patients scored higher on subscales assessing concern over mistakes, doubts about actions, and perceived parental criticism. Community volunteers scored higher on the organization subscale. It was further hypothesized that, for the social phobia patients, perfectionism would be associated with greater symptom severity. Correlational analysis confirmed that the Concern over Mistakes and Doubts about Actions subscales of the MPS were consistently associated with greater social anxiety, trait anxiety, and general psychopathology. Implications for the treatment of social phobia patients are considered.

An Investigation of Gender Differences in Social Phobia

The present study was an exploratory investigation of gender differences in a large sample of persons with social phobia. Potential differences in demographic characteristics, comorbidity, severity of fear, and situations feared were examined. No differences were found on history of social phobia, social phobia subtype, or comorbidity of additional anxiety disorders, mood disorders, or avoidant personality disorder. However, women exhibited more severe social fears as indexed by several assessment instruments. Some differences between men and women also emerged in their report of severity of fear in specific situations. Women reported significantly greater fear than men while talking to authority, acting/performing/giving a talk in front of an audience, working while being observed, entering a room when others are already seated, being the center of attention, speaking up at a meeting, expressing disagreement or disapproval to people they do not know very well, giving a report to a group, and giving a party. Men reported significantly more fear than women regarding urinating in public bathrooms and returning goods to a store. Additionally, there were some differences in the proportion of men and women reporting fear in different situations. Specifically, more women than men reported fear of going to a party, and more men than women reported fear of urinating in a public restroom. Gender differences among patients with social phobia are discussed in the context of traditional sex-role expectations.

Cognitive-behavioral group treatment for social phobia in adolescents. A preliminary study.

The present study is a preliminary evaluation of the effectiveness of a new cognitive-behavioral group treatment protocol for social phobia in adolescents. Five adolescents with social phobia were treated in a 16-session group treatment program, with parental involvement in selected sessions. Treatment involved skills training (social skills, problem solving, assertiveness), cognitive restructuring, behavioral exposure, and homework. Self-report measures of anxiety and depression, taken throughout treatment, indicated significant improvements over a 1-year follow-up period. Behavior test measures also indicated a decrease in subjective anxiety ratings after treatment which was maintained at follow-up. Structured diagnostic interviews 1 year after treatment confirmed full remission of social phobia for four subjects, with one subjects phobia in partial remission. Overall, the present findings support the continued evaluation of this protocol for social phobic adolescents.

Situational domains of social phobia

Abstract Although social phobia is defined as severe anxiety in social situations, little is known about the range or prevalence of social situations that elicit anxiety in social phobic individuals. The present study developed the concept of situational domains, groups of similar situations that may provoke anxiety in subsets of social anxious persons. Four conceptually derived situational domains were examined: formal speaking/interaction, informal speaking/interaction, observation by others, and assertion. Ninety-one social phobic patients were classified as anxiety-positive or anxiety-negative within each situational domain, varying inclusion criteria of anxiety experienced in each situation and the number of anxiety-producing situations within a domain. Patients were highly likely to be classified to the formal speaking/interaction domain, regardless of inclusion criteria employed or presence of anxiety within other domains. Support was also found for previous findings that most social phobics experience anxiety in more than one social situation, even under conservative classification criteria. Implications for the current diagnostic nosology and directions for future research are discussed.