Justin W. Weeks

Empirical validation and psychometric evaluation of the brief fear of negative evaluation scale in patients with social anxiety disorder

The Brief Fear of Negative Evaluation Scale (BFNE; M. R. Leary, 1983a) is often used to assess fear of negative evaluation, the core feature of social anxiety disorder. However, few studies have examined its psychometric properties in large samples of socially anxious patients. Although the BFNE yields a single total score, confirmatory factor analysis indicated a 2-factor solution to be more appropriate, with the 1st factor consisting of all straightforwardly worded items (BFNE-S) and the 2nd of all reverse-scored items (BFNE-R). Support was obtained for the convergent and discriminant validity of the BFNE and BFNE-S, but not the BFNE-R. These results suggest that standard scoring of the BFNE may not be optimal for patients with social anxiety disorder.

Whether, how, and when social anxiety shapes positive experiences and events: a self-regulatory framework and treatment implications.

Although neglected in diagnostic criteria lists, theoretical models, and treatment approaches, attenuated positive emotions and cognitions distinguish social anxiety and social anxiety disorder from other anxiety conditions (and cannot be accounted for by comorbidity with depression). We present a self-control resource depletion model to explain how the intense self-regulatory efforts of high socially anxious individuals dampen positive experiences and events. We review existing research on individuals with social anxiety difficulties, focusing on impoverished positive experiences and quality of life, atypical reactions to overtly positive social outcomes, the absence of a normative bias toward the positive in social situations, and a meaningful subset of individuals who show signs of impulsive, short-lived positive events. We also discuss findings from the social psychology literature for how to enhance positive experiences, positive events, and self-regulatory capacity in individuals with social anxiety difficulties. The aim of the review is to broaden theory, research, and treatment efforts to the positive spectrum of human functioning.

The Bivalent Fear of Evaluation Model of Social Anxiety: Further Integrating Findings on Fears of Positive and Negative Evaluation

Accumulating evidence supports the premise that fear of evaluation in general is important in social anxiety, including fear of positive evaluation (FPE) as well as fear of negative evaluation (FNE). This study tested various hypotheses pertaining to a novel, expanded conceptualization of social anxiety involving these two distinct fears: the bivalent fear of evaluation (BFOE) model. Responses from a large undergraduate sample (N = 585) were examined. In addition, responses from a subsample of participants qualifying for a probable diagnosis of social anxiety disorder (SAD; n = 133) were examined, via mediational analyses, for potential mechanisms underlying FPE within highly socially anxious individuals. FPE exhibited a unique and significantly stronger relationship with concerns of social reprisal due to making positive impressions than did FNE. FPE related uniquely and negatively to trait positive affect/automatic thoughts, whereas FNE, FPE, and social anxiety all related uniquely and positively to trait negative affect/automatic thoughts. FPE, FNE, and social anxiety all related uniquely and positively to disqualification of positive social outcomes (DPSO). However, FPE related most strongly to DPSO attributions at the level of the self, and these attributions mediated the relationship between FPE and negative automatic thoughts in an analog clinical sample. Concerns of social reprisal due to making positive impressions on others mediated the relationship between FPE and DPSO attributions to others in an analog clinical sample. The obtained findings replicate and extend support for the BFOE model of social anxiety. Implications for the theoretical conceptualization and treatment of SAD are discussed.

Psychometric Evaluation of the Fear of Positive Evaluation Scale in Patients With Social Anxiety Disorder

The Fear of Positive Evaluation Scale (FPES; J. W. Weeks, R. G. Heimberg, & T. L. Rodebaugh, 2008) was designed to assess fear of positive evaluation, a proposed cognitive component of social anxiety. Although previous findings on the psychometric properties of the FPES have been highly encouraging, only 1 previous study has examined the psychometric profile of the FPES in a sample of patients with social anxiety disorder (T. A. Fergus et al., 2009). The primary purpose of the present study was to conduct a large multisite examination of the psychometric profile of the FPES among patients with a principal diagnosis of social anxiety disorder (n = 226; generalized subtype = 97.8%). Responses of nonanxious control participants (n = 42) were also examined. The factorial validity, internal consistency, test-retest reliability, construct validity, and treatment sensitivity of the FPES were strongly supported by our findings. Furthermore, an FPES cutoff score was identified for distinguishing levels of fear of positive evaluation characteristic of patients with social anxiety disorder from those characteristic of the control group. Results provide additional support for the psychometric properties of the FPES in clinical samples.

To Avoid Evaluation, Withdraw : Fears of Evaluation and Depressive Cognitions Lead to Social Anxiety and Submissive Withdrawal

We propose a cognitive model of social anxiety-related submission based upon psycho-evolutionary accounts of social anxiety and depression and present results of two studies supporting this model. We tested a confirmatory factor model consisting of three latent lower-order factors (fear of negative evaluation, fear of positive evaluation, and depressive cognitions), all of which load onto a single latent higher-order submissive cognitions factor. In essence, we propose that the symptoms associated with social anxiety and depression (in part) served adaptive functions for coping with social threats in the ancestral environment and that the cognitive symptoms associated with these disorders may function collectively as integrated components of a social anxiety-related submission mechanism. Confirmatory factor analysis indicated that the hypothesized model fit well. A score derived from the submissive cognitions factor correlated strongly with social anxiety-related measures and less strongly with measures of generalized anxiety/worry in Studies 1 and 2. Furthermore, this submissive cognitions score correlated in the expected direction with self-report measures of social comparison, negative affect, and positive affect in Study 2, and mediational analyses indicated that submissive cognitions may mediate the relationship between social comparison and submissive behaviors. Findings from both studies provide support for the proposed model.

Assessing the latent structure of the intolerance of uncertainty construct: an initial taxometric analysis.

Researchers have increasingly suggested that people with anxiety disorders share a common fear that the uncertain future will be catastrophic. Intolerance of uncertainty (IU) - the tendency to consider possible negative events as unacceptable and threatening, irrespective of probabilities - is representative of such fears. A key role has been indicated for IU in several anxiety and mood disorders; however, the present study appears to be the first latent structure examination of IU. Responses were obtained from a large sample (n=977; 65% women) unselected with regard to IU level, comprising anxiety disorder outpatients (i.e., putative taxon members), and community residents (i.e., putative complement class members). MAXEIG, MAMBAC, and L-Mode were performed with indicator sets drawn from the Intolerance of Uncertainty Scale-12. Assessments also included objective Comparison Curve Fit Indices. Results yielded converging evidence that IU symptoms have a dimensional latent structure. Comprehensive findings, implications, and future research directions are discussed.

Social appearance anxiety, perfectionism, and fear of negative evaluation: distinct or shared risk factors for social anxiety and eating disorders?

Social anxiety and eating disorders are highly comorbid. Social appearance anxiety (i.e., fear of negative evaluation of ones appearance), general fear of negative evaluation, and perfectionism have each been proposed as risk factors for both social anxiety disorder and the eating disorders. However, no research to date has examined all three factors simultaneously. Using structural equation modeling in two diverse samples (N=236; N=136) we tested a model in which each of these risk factors were uniquely associated with social anxiety and eating disorder symptoms. We found support for social appearance anxiety as a shared risk factor between social anxiety and eating disorder symptoms, whereas fear of negative evaluation was a risk factor only for social anxiety symptoms. Despite significant zero-order relationships, two facets of perfectionism (high standards and maladaptive perfectionism) did not emerge as a risk factor for either disorder when all constructs were considered. These results were maintained when gender, body mass index, trait negative affect, and depression were included in the model. It is possible that treating negative appearance evaluation fears may reduce both eating disorder and social anxiety symptoms.

Impact of cognitive-behavioral therapy for social anxiety disorder on the neural bases of emotional reactivity to and regulation of social evaluation

UNLABELLED We examined whether Cognitive-Behavioral Therapy (CBT) for social anxiety disorder (SAD) would modify self-reported negative emotion and functional magnetic resonance imaging brain responses when reacting to and reappraising social evaluation, and tested whether changes would predict treatment outcome in 59 patients with SAD who completed CBT or waitlist groups. For reactivity, compared to waitlist, CBT resulted in (a) increased brain responses in right superior frontal gyrus (SFG), inferior parietal lobule (IPL), and middle occipital gyrus (MOG) when reacting to social praise, and (b) increases in right SFG and IPL and decreases in left posterior superior temporal gyrus (pSTG) when reacting to social criticism. For reappraisal, compared to waitlist, CBT resulted in greater (c) reductions in self-reported negative emotion, and (d) increases in brain responses in right SFG and MOG, and decreases in left pSTG. A linear regression found that after controlling for CBT-induced changes in reactivity and reappraisal negative emotion ratings and brain changes in reactivity to praise and criticism, reappraisal of criticism brain response changes predicted 24% of the unique variance in CBT-related reductions in social anxiety. Thus, one mechanism underlying CBT for SAD may be changes in reappraisal-related brain responses to social criticism. CLINICALTRIALSGOV IDENTIFIER NCT00380731. http://www.clinicaltrials.gov/ct2/show/NCT00380731?term=social+anxiety+cognitive+behavioral+therapy+Stanford&rank=1.

Exploring the latent structure of two cognitive components of social anxiety: taxometric analyses of fears of negative and positive evaluation

Background: Recent evidence suggests that social anxiety disorder is best characterized as having a dimensional latent structure. Methods: In this study, we examined the latent structure of two cognitive components of social anxiety, fear of negative evaluation (FNE) and fear of positive evaluation (FPE), in a large undergraduate sample. Two taxometric procedures (MAMBAC, Mean Above Minus Below a Cut and MAXEIG, MAXimum EIGenvalue) were performed with indicator sets drawn from self‐report measures of FNE and FPE. Results and conclusions: Taxometric analyses, as well as comparison analyses utilizing simulated dimensional and taxonic datasets, yielded converging evidence that both FNE and FPE have a dimensional latent structure. Depression and Anxiety, 2009.

The longitudinal relationship between fear of positive evaluation and fear of negative evaluation

Abstract Available research suggests that fear of negative evaluation and fear of positive evaluation are related but distinct constructs that each contribute to social anxiety, implying a need to focus on these fears in treatment. Yet, this research is almost entirely based on cross-sectional data. We examined the longitudinal relationship between fears of positive and negative evaluation over three time points in a sample of undergraduate students. We tested competing models consistent with two basic positions regarding these fears: (1) that fear of positive evaluation only appears to affect social anxiety because it arises from the same, single underlying trait as fear of negative evaluation, and (2) fears of positive and negative evaluation are correlated, but clearly distinct, constructs. The best-fitting model was an autoregressive latent-trajectory model in which each type of fear had a separate trait-like component. The correlation between these trait-like components appeared to fully account for the relationships between these constructs over time. This investigation adds to the evidence in support of the second position described above: fear of positive evaluation is best interpreted as a separate construct from fear of negative evaluation.