Katya C. Fernandez

More reasons to be straightforward: Findings and norms for two scales relevant to social anxiety

The validity of both the Social Interaction Anxiety Scale and Brief Fear of Negative Evaluation scale has been well-supported, yet the scales have a small number of reverse-scored items that may detract from the validity of their total scores. The current study investigates two characteristics of participants that may be associated with compromised validity of these items: higher age and lower levels of education. In community and clinical samples, the validity of each scales reverse-scored items was moderated by age, years of education, or both. The straightforward items did not show this pattern. To encourage the use of the straightforward items of these scales, we provide normative data from the same samples as well as two large student samples. We contend that although response bias can be a substantial problem, the reverse-scored questions of these scales do not solve that problem and instead decrease overall validity.

Profiling Predicting Social Anxiety From Facebook Profiles

Research on Facebook has suggested that individuals’ profiles are an accurate portrayal of the self and that it may be possible to identify traits such as narcissism and extraversion by viewing a Facebook profile. It has been suggested, however, that largely internal experiences, such as anxiety, should be less detectable in such contexts. In the current study, the authors tested if objective criteria (e.g., number of interests) on users’ profiles (N = 62) could discriminate between individuals who were higher and lower in social anxiety. The authors asked six coders to view each participant’s Facebook profile and rate the participant’s level of social anxiety and then tested whether these ratings correlated with the participant’s own self-reported social anxiety level. Our results suggest that social anxiety is recognizable both in objective criteria on the Facebook profile page and from raters’ impressions of the Facebook profile. Clinical and research implications are discussed.Research on Facebook has suggested that individuals’ profiles are an accurate portrayal of the self and that it may be possible to identify traits such as narcissism and extraversion by viewing a F...

Psychological Sequelae of Surgery in a Prospective Cohort of Patients from Three Intraoperative Awareness Prevention Trials

BACKGROUND:Elective surgery can have long-term psychological sequelae, especially for patients who experience intraoperative awareness. However, risk factors, other than awareness, for symptoms of posttraumatic stress disorder (PTSD) after surgery are poorly defined, and practical screening methods have not been applied to a broad population of surgical patients. METHODS:The Psychological Sequelae of Surgery study was a prospective cohort study of patients previously enrolled in the United States and Canada in 3 trials for the prevention of intraoperative awareness. The 68 patients who experienced definite or possible awareness were matched with 418 patients who denied awareness based on age, sex, surgery type, and awareness risk. Participants completed the PTSD Checklist-Specific (PCL-S) and/or a modified Mini-International Neuropsychiatric Interview telephone assessment to identify symptoms of PTSD and symptom complexes consistent with a PTSD diagnosis. We then used structural equation modeling to produce a composite PTSD score and examined potential risk factors. RESULTS:One hundred forty patients were unreachable; of those contacted, 303 (88%) participated a median of 2 years postoperatively. Forty-four of the 219 patients (20.1%) who completed the PCL-S exceeded the civilian screening cutoff score for PTSD symptoms resulting from their surgery (15 of 35 [43%] with awareness and 29 of 184 [16%] without). Nineteen patients (8.7%; 5 of 35 [14%] with awareness and 14 of 184 [7.6%] without) both exceeded the cutoff and endorsed a breadth of symptoms consistent with the Diagnostic and Statistical Manual Fourth Edition diagnosis of PTSD attributable to their surgery. Factors independently associated with PTSD symptoms were poor social support, previous PTSD symptoms, previous mental health treatment, dissociation related to surgery, perceiving that one’s life was threatened during surgery, and intraoperative awareness (all P ⩽ 0.017). Perioperative dissociation was identified as a potential mediator for perioperative PTSD symptoms. CONCLUSIONS:Events in the perioperative period can precipitate psychological symptoms consistent with subsyndromal and syndromal PTSD. We not only confirmed the high rate of postoperative PTSD in awareness patients but also identified a significant rate in matched nonawareness controls. Screening surgical patients, especially those with potentially mediating risk factors such as intraoperative awareness or perioperative dissociation, for postoperative PTSD symptoms with the PCL-S is practical and could promote early referral, evaluation, and treatment.

Interpersonal Constraint Conferred by Generalized Social Anxiety Disorder Is Evident on a Behavioral Economics Task

Although social anxiety disorder appears to confer impairment in friendships, evidence beyond self-report is minimal. We used the flexible iterated prisoners dilemma as a simulated interaction with a friend with 27 individuals with the generalized type of social anxiety disorder and 23 demographically equivalent individuals without the disorder. Participants with generalized social anxiety disorder were less giving on the task. Lower giving was also moderately associated with interpersonal variables (e.g., coldness). A trend was also found for participants with generalized social anxiety disorder to show lower assertiveness on the task. The connection between generalized social anxiety disorder and friendship impairment appears likely to be partially explained by interpersonal constraint that is perceived by others as coldness and manifests in a behavioral economics task.

Self and friend's differing views of social anxiety disorder's effects on friendships.

Social anxiety disorder is known to be associated with self-report of global friendship quality. However, information about specific friendships, as well as information beyond self-report, is lacking. Such information is crucial, because known biases in information processing related to social anxiety disorder render global self-ratings particularly difficult to interpret. We examined these issues focusing on diagnosed participants (n = 77) compared with community control participants (n = 63). We examined self-report regarding global (i.e., overall) friendship quality and a specific friendships quality; in addition, we examined friend-report of that friendships quality. Results suggested that social anxiety disorder has a negative impact on self-perception of friendship quality for a specific friendship, but that this effect is less evident as reported by the friends. Specifically, social anxiety disorder was associated with a tendency to report worse friendship quality in comparison to friend-report, particularly in participants who were younger or had less long-lasting friendships. However, friend-report did show clear differences based on diagnostic group, with friends reporting participants with social anxiety disorder to be less dominant in the friendship and less well-adjusted. Overall, the findings are consistent with results of other studies indicating that social anxiety disorder has a strong association with self-ratings of impairment, but that these ratings appear out of proportion with the report of observers (in this case, friends).

Testing the effects of social anxiety disorder on friendship quality across gender and ethnicity.

Previous research suggests that social anxiety disorder (SAD) has a specific relationship with impairment in friendship quality; however, potential moderators of this relationship have not been tested. The current study examines whether the specific effect of SAD on friendship quality is stable or varies across gender and ethnicity in a large epidemiological dataset. Results indicate that the underlying construct of friendship quality differed slightly but significantly between men and women; as a result, effects of SAD were tested in men and women separately. After partially constraining friendship quality across ethnic groups, our results indicated that the relationship between SAD and friendship quality remained robust in all groups. In addition to replicating the finding that SAD specifically relates to perceived friendship quality, the current study highlights the need to test whether underlying constructs such as friendship quality are consistent across the groups that make up heterogeneous samples.

Social anxiety and discomfort with friendly giving.

Individuals higher in social anxiety report more impaired friendship quality, which past research suggests may stem from constrained warmth. We examined three motivations for constrained warmth in friendships and determined how these motivations related to social anxiety and friendship impairment. To do so, we assessed the psychometric properties of the Favor Scale (FS), which measures an individuals response to friendly giving. Results indicated that the FS has three subscales: negative reactions to favors (NEG), positive reactions to favors (POS), and expectation of tit-for-tat behavior (E-TFT). Structural equation modeling demonstrated that social anxiety related directly to NEG, and indirectly to POS and E-TFT through NEG. POS related directly to friendship quality, indicating that friendships may be impaired in social anxiety disorder due to the cumulative effects of responding negatively to friendly behavior.

Self-reported social skills impairment explains elevated autistic traits in individuals with generalized social anxiety disorder

Screening for autism in individuals with generalized social anxiety disorder (GSAD) is complicated by symptom overlap between GSAD and autism spectrum disorder (ASD). We examined the prevalence of self-reported autistic traits within a sample of participants with a diagnosis of GSAD (n=37) compared to individuals without a GSAD diagnosis (NOSAD; n=26). Of the GSAD sample participants, 70.84% self-reported autistic traits above a cut-off of 65 on the Autism Quotient-Short (AQ-S) and reported significantly more autistic traits on 3 of 5 AQ-S subscales compared to the NOSAD group. Diagnosis uniquely predicted variation in the social skills subscale above and beyond the other subscales and other predictors. Furthermore, variation in the social skills subscale largely explained group differences on the other subscales. Our results suggest caution in utilizing measures like the AQ-S with clinical populations characterized by social difficulties such as individuals with a GSAD diagnosis.

The Core Extrusion Schema–Revised Hiding Oneself Predicts Severity of Social Interaction Anxiety

Cognitive behavioral models of social anxiety disorder (SAD) suggest that fear of negative evaluation is a core fear or vulnerability for SAD. However, why negative evaluation is feared is not fully understood. It is possible that core beliefs contribute to the relationship between fear of negative evaluation and SAD. One of these beliefs may be a core extrusion schema: a constellation of beliefs that one’s true self will be rejected by others and therefore one should hide one’s true self. In the current study (N = 699), we extended research on the Core Extrusion Schema and created a shortened and revised version of the measure called the Core Extrusion Schema–Revised. The Core Extrusion Schema–Revised demonstrated good factor fit for its two subscales (Hidden Self and Rejection of the True Self) and was invariant across gender and ethnicity. The Hidden Self subscale demonstrated excellent incremental validity within the full sample as well as in participants diagnosed with generalized SAD. Specifically, the Hidden Self subscale may help explain severity of social interaction anxiety. This measure could be used with individuals diagnosed with generalized SAD to design exposures targeting these core beliefs.

Does centrality in a cross-sectional network suggest intervention targets for social anxiety disorder?

Objective: Network analysis allows us to identify the most interconnected (i.e., central) symptoms, and multiple authors have suggested that these symptoms might be important treatment targets. This is because change in central symptoms (relative to others) should have greater impact on change in all other symptoms. It has been argued that networks derived from cross-sectional data may help identify such important symptoms. We tested this hypothesis in social anxiety disorder. Method: We first estimated a state-of-the-art regularized partial correlation network based on participants with social anxiety disorder (n = 910) to determine which symptoms were more central. Next, we tested whether change in these central symptoms were indeed more related to overall symptom change in a separate dataset of participants with social anxiety disorder who underwent a variety of treatments (n = 244). We also tested whether relatively superficial item properties (infrequency of endorsement and variance of items) might account for any effects shown for central symptoms. Results: Centrality indices successfully predicted how strongly changes in items correlated with change in the remainder of the items. Findings were limited to the measure used in the network and did not generalize to three other measures related to social anxiety severity. In contrast, infrequency of endorsement showed associations across all measures. Conclusions: The transfer of recently published results from cross-sectional network analyses to treatment data is unlikely to be straightforward.