Marisol J. Voncken

Social anxiety disorder: Questions and answers for the DSM-V.

Background: This review evaluates the DSM‐IV criteria of social anxiety disorder (SAD), with a focus on the generalized specifier and alternative specifiers, the considerable overlap between the DSM‐IV diagnostic criteria for SAD and avoidant personality disorder, and developmental issues. Method: A literature review was conducted, using the validators provided by the DSM‐V Spectrum Study Group. This review presents a number of options and preliminary recommendations to be considered for DSM‐V. Results/Conclusions: Little supporting evidence was found for the current specifier, generalized SAD. Rather, the symptoms of individuals with SAD appear to fall along a continuum of severity based on the number of fears. Available evidence suggested the utility of a specifier indicating a “predominantly performance” variety of SAD. A specifier based on “fear of showing anxiety symptoms” (e.g., blushing) was considered. However, a tendency to show anxiety symptoms is a core fear in SAD, similar to acting or appearing in a certain way. More research is needed before considering subtyping SAD based on core fears. SAD was found to be a valid diagnosis in children and adolescents. Selective mutism could be considered in part as a young childs avoidance response to social fears. Pervasive test anxiety may belong not only to SAD, but also to generalized anxiety disorder. The data are equivocal regarding whether to consider avoidant personality disorder simply a severe form of SAD. Secondary data analyses, field trials, and validity tests are needed to investigate the recommendations and options. Depression and Anxiety, 2010.

Mindfulness and task concentration training for social phobia: A pilot study.

A new treatment for social phobia is evaluated: mindfulness training and task concentration training. The treatment consisted of nine sessions of 45–60 minutes and was administered individually. Nine severely socially phobic patients participated. No changes in complaints were observed during the waiting-list period. One patient withdrew during the treatment. Results show that treatment was well accepted and highly effective in reducing social phobia, and results were maintained at a 2-month follow-up. Effects of the treatment were most pronounced on Fear of Negative Evaluation and on the self-ideal discrepancy. Attention as well as cognitive changes may be responsible for the effectiveness. Explanations for the effects and clinical implications are discussed.

Social performance deficits in social anxiety disorder: reality during conversation and biased perception during speech.

Cognitive models emphasize that patients with social anxiety disorder (SAD) are mainly characterized by biased perception of their social performance. In addition, there is a growing body of evidence showing that SAD patients suffer from actual deficits in social interaction. To unravel what characterizes SAD patients the most, underestimation of social performance (defined as the discrepancy between self-perceived and observer-perceived social performance), or actual (observer-perceived) social performance, 48 patients with SAD and 27 normal control participants were observed during a speech and conversation. Consistent with the cognitive model of SAD, patients with SAD underestimated their social performance relative to control participants during the two interactions, but primarily during the speech. Actual social performance deficits were clearly apparent in the conversation but not in the speech. In conclusion, interactions that pull for more interpersonal skills, like a conversation, elicit more actual social performance deficits whereas, situations with a performance character, like a speech, bring about more cognitive distortions in patients with SAD.

Not self-focused attention but negative beliefs affect poor social performance in social anxiety: An investigation of pathways in the social anxiety–social rejection relationship

Patients with social anxiety disorder (SAD) not only fear negative evaluation but are indeed less likeable than people without SAD. Previous research shows social performance to mediate this social anxiety-social rejection relationship. This study studied two pathways hypothesized to lead to poor social performance in social anxiety: increased self-focused attention and negative beliefs. State social anxiety was experimentally manipulated in high and low-blushing-fearful individuals by letting half of the participants believe that they blushed intensely during a 5 min getting-acquainted interaction with two confederates. Participants rated their state social anxiety, self-focused attention, and level of negative beliefs. Two confederates and two video-observers rated subsequently likeability (i.e., social rejection) and social performance of the participants. In both groups, the social anxiety-social rejection relationship was present. Although state social anxiety was related to heightened self-focused attention and negative beliefs, only negative beliefs were associated with relatively poor social performance. In contrast to current SAD models, self-focused attention did not play a key-role in poor social performance but seemed to function as a by-product of state social anxiety. Beliefs of being negatively evaluated seem to elicit changes in behavioral repertoire resulting in a poor social performance and subsequent rejection.

Changing Interpretation and Judgmental Bias in Social Phobia : A Pilot Study of a Short, Highly Structured Cognitive Treatment

Interpretation and judgmental biases concerning negative evaluation are considered important maintaining factors in social phobia. Cognitive models imply that solely changing these core cognitions reduces social anxiety. Standardizing such an intervention in these core biases may simplify and shorten treatment and therefore increase its accessibility. We present pilot data (n =13) of a short (9 sessions), standardized cognitive therapy developed to intervene directly and solely in interpretation and judgmental biases in social phobia. Described are the design of this therapy and the cognitive techniques. This short therapy was effective in reducing social phobic complaints (effect size of 1.4) and interpretation and judgmental biases. In addition, we have indications that this treatment has high accessibility because of its short duration and standardization.

I blush, therefore I will be judged negatively : influence of false blush feedback on anticipated others' judgments and facial coloration in high and low blushing-fearfuls

In the present study, we investigate whether people attribute costs to displaying a blush. Individuals with and without fear of blushing were invited to have a short conversation with two confederates. During the conversation, half of the individuals received the feedback that they were blushing intensely. The study tested whether the belief that one is blushing leads to the anticipation that one will be judged negatively. In addition, the set-up permitted the actual physiological blush response to be investigated. In line with the model that we propose for erythrophobia, participants in the feedback condition expected the confederates to judge them relatively negatively, independent of their fear of blushing. Furthermore, sustaining the idea that believing that one will blush can act as a self-fulfilling prophecy, high-fearfuls showed relatively intense facial coloration in both conditions, whereas low-fearfuls only showed enhanced blush responses following false blush feedback.

The SPAI-18, a brief version of the Social Phobia and Anxiety Inventory: reliability and validity in clinically referred and non-referred samples

We developed a new version of the Social Phobia and Anxiety Inventory (SPAI) in order to have a brief instrument for measuring social anxiety and social anxiety disorder (SAD) with a strong conceptual foundation. In the construction phase, a set of items representing 5 core aspects of social anxiety was selected by a panel of social anxiety experts. The selected item pool was validated using factor analysis, reliability analysis, and diagnostic analysis in a sample of healthy participants (N = 188) and a sample of clinically referred participants diagnosed with SAD (N = 98). This procedure resulted in an abbreviated version of the Social Phobia Subscale of the SPAI consisting of 18 items (i.e. the SPAI-18), which correlated strongly with the Social Phobia Subscale of the original SPAI (both groups r = .98). Internal consistency and diagnostic characteristics using a clinical cut-off score > 48 were good to excellent (Cronbachs alpha healthy group = .93; patient group = .91; sensitivity: .94; specificity: .88). The SPAI-18 was further validated in a community sample of parents-to-be without SAD (N = 237) and with SAD (N = 65). Internal consistency was again excellent (both groups Cronbachs alpha = .93) and a screening cut-off of > 36 proved to result in good sensitivity and specificity. The SPAI-18 also correlated strongly with other social anxiety instruments, supporting convergent validity. In sum, the SPAI-18 is a psychometrically sound instrument with good screening capacity for social anxiety disorder in clinical as well as community samples.

Through rose-coloured glasses : An empirical test of narcissistic overestimation

BACKGROUND Grandiosity is designated as a hallmark trait of narcissism. The current study tested whether narcissistic traits are related to overestimation of a range of agentic performances. METHOD Eighty-five non-patients executed six objective tasks to assess their level of (emotional) intelligence, first impression, attractiveness, social skills and learning performance. They were also asked to estimate their level of functioning in these six areas. This estimation was given on two moments: before and after performing the objective tasks. Our main variable of interest was the degree to which subjective estimation exceeds objective scores. RESULTS Narcissistic traits were related to overestimation of (emotional) intelligence, attractiveness and social skills, particularly at a global level before performing the tasks. LIMITATIONS The use of a homogenous student sample; Mainly agentic performances, were studied. CONCLUSION Overall, the findings provide a theoretical validation of unwarranted feelings of grandiosity as a core narcissistic criterion. Copyright

Cognitieve therapie bij sociale angststoornis

Sociale-angststoornis (ook wel sociale fobie ) is een aanhoudende angst om negatief beoordeeld te worden door andere mensen in situaties waarin men sociaal moet functioneren (APA, 2000; Bogels e.a., 2010). De angst voor negatieve evaluatie heeft betrekking op hoe men sociaal gezien op de ander overkomt (zoals dom, raar, onaardig, incompetent, zwak, minder, saai, oninteressant of arrogant). Bij ongeveer een derde van de patienten heeft deze negatieve evaluatie specifiek betrekking op bepaalde lichamelijke reacties zoals blozen, zweten of trillen (Bogels, Mulkens & De Jong, 1997).

Turning negative memories around: Contingency versus devaluation techniques

BACKGROUND AND OBJECTIVES It is assumed that fear responses can be altered by changing the contingency between a conditioned stimulus (CS) and an unconditioned stimulus (US), or by devaluing the present mental representation of the US. The aim of the present study was to compare the efficacy of contingency- and devaluation-based intervention techniques on the diminishment in - and return of fear. We hypothesized that extinction (EXT, contingency-based) would outperform devaluation-based techniques regarding contingency measures, but that devaluation-based techniques would be most effective in reducing the mental representation of the US. Additionally, we expected that incorporations of the US during devaluation would result in less reinstatement of the US averseness. METHODS Healthy participants received a fear conditioning paradigm followed by one of three interventions: extinction (EXT, contingency-based), imagery rescripting (ImRs, devaluation-based) or eye movement desensitization and reprocessing (EMDR, devaluation-based). A reinstatement procedure and test followed the next day. RESULTS EXT was indeed most successful in diminishing contingency-based US expectancies and skin conductance responses (SCRs), but all interventions were equally successful in reducing the averseness of the mental US representation. After reinstatement EXT showed lowest expectancies and SCRs; no differences were observed between the conditions concerning the mental US representation. LIMITATIONS A partial reinforcement schedule was used, resulting in a vast amount of contingency unaware participants. Additionally, a non-clinical sample was used, which may limit the generalizability to clinical populations. CONCLUSION EXT is most effective in reducing conditioned fear responses.