Debra A. Hope

DSM-III-R subtypes of social phobia. Comparison of generalized social phobics and public speaking phobics.

Social phobic patients who fear most or all social interaction situations are labeled generalized social phobics in DSM-III-R. Thirty-five patients who met this criterion were compared with 22 social phobic patients whose fears were restricted to public speaking situations. Generalized social phobics were younger, less educated, and less likely to be employed, and their phobias were rated by clinical interviewers as more severe than those of public speaking phobics. Generalized social phobics appeared more anxious and more depressed and expressed greater fears concerning negative social evaluation. They performed more poorly on individualized behavioral tests and differed from public speaking phobics in their responses to cognitive assessment tasks. The two groups showed marked differences in their patterns of heart rate acceleration during the behavioral test. The implications of these findings for the classification and treatment of social phobic individuals are discussed.

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.

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.

Evaluation of the Social Interaction Self-Statement Test with a social phobic population

The convergent and discriminant validity of the Social Interaction Self-Statement Test (SISST) were evaluated in a sample of men and women awaiting treatment for fear and avoidance of social interactions. Partial correlations revealed that negative, but not positive, self-statement scores were generally related to self-report measures of anxiety and depression. Heart rate and subjective anxiety ratings derived from a behavioral simulation of a personally relevant anxiety-provoking situation were unrelated to SISST scores. However, subjects reports of negative thoughts obtained via the thought-listing procedure were related to the SISST negative self-statement scores, suggesting that the negative subscale of the SISST and the thought-listing procedure tap similar dimensions. Finally, the negative subscale of the SISST discriminated between social phobics whose primary fear involved social interactions and social phobics whose anxiety was confined to public-speaking situations. The findings support the use of the SISST with clinically socially anxious patients.

Social anxiety and the recall of interpersonal information

Sixty subjects classified as high or low in social anxiety participated in a structured heterosocial interaction under conditions of either high or low social-evaluative threat. Following the interaction, subjects were asked to recall detailed information about the interaction partner’s appearance and the content of the conversation. Socially anxious subjects recalled less information and made more errors in recall than nonanxious subjects. Contrary to prediction, social-evaluative threat did not affect recall. Anxious subjects also reported greater self-focused attention during the interaction. High self-focused attention was associated with superior recall for nonanxious subjects but associated with more frequent omission errors for anxious subjects. Results support cognitive-behavioral formulations of social anxiety which propose that socially anxious individuals engage in self-focused thinking which may impair their ability to process social information.

The validity of the social avoidance and distress scale and the fear of negative evaluation scale with social phobic patients

Turner, McCanna and Beidels (1987) recent evaluation of the Social Avoidance and Distress Scale (SADS) and the Fear of Negative Evaluation Scale (FNE) with anxiety disordered patients concluded that the SADS and FNE lacked discriminant validity and may be inappropriate for subject selection or outcome evaluation in studies of social phobia. This paper raises some concerns with the interpretation of the data presented by Turneret at. (1987) and presents additional data from studies in our laboratories that may qualify their conclusions. It is asserted that (a) the SADS and FNE are not appropriate for diagnostic screening of social phobic patients, (b) Turner et al.s findings may have been the result of clinically meaningful social anxiety in several of the anxiety disorders, (c) significant differences among the anxiety disorders may have been hidden by heterogeneity among patients who receive the diagnosis of social phobia, and (d) the distribution of FNE scores in Turner et al.s sample may have been unusually depressed.

Supplemental Information on Social Anxiety

The goal of this chapter is to provide the therapist with background information on social anxiety and its treatment beyond that provided in the Client Workbook. We begin this chapter with a brief overview of the epidemiology and psychopathology of social anxiety disorder. We then present our model of social anxiety in greater detail than in the Client Workbook to more thoroughly introduce the theoretical underpinnings of our treatment.