Literature 3 Social Anxiety and SAD (Morrison, Heimberg)

Heimberg model of SAD

1\. Perception of an audience

2\. Mental representation “as seen by the audience”

3\. This representation is filled additionally with negative self-beliefs derived from previous experiences and negative cognitive schemas one has

4\. At the same time the person thinks that the audience holds very high unattainable standards for their performance (evaluative threat)

5\. This leads to anxiety and additionally further deflates self-perception

6\. Information processing biases, for ex attentional bias towards perceiving external negative stimuli (angry audience), internal visible stimuli (blushing, sweating), internal visible only to the person stimuli (heartbeat)

7\. This further deflates the mental representation of self as viewed by the audience

→ vicious circle

Attention bias

types:


1. **to social threat**

→ evidence that attention bias to social threat plays a crucial role in the maintenance of
2. **away from positive stimuli** (positive social information)

→ evidence that training of attention toward positive information may heighten positive emotional reactivity, thus implying a causal relationship between attention toward positive information and positive affectivity in SA
3. **reduced attentional control**: anxious individuals unable to effortfully regulate their attention

* differences in how easily attention bias develops natural
* inverse relationship between anxiety and attentional control
* children’s attentional control inverse relationship with appropriate social responding

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Treatment implications: CBT, MBSR, attention training

Interpretation Bias

= tendency to interpret ambiguous stuff as threatening

* research on **“offline” measures** (conscious cognitive processes): evidence for @@interpretation bias of ambiguous stuff as threatening@@
* research on “**online” measures** (automatic): provide evidence for for @@lack of positive bias@@
* Threat interpretation of positive events and failure to accept positive reactions in SAD
* Negative interpretation of positive events correlated with perfectionism and severity of interpersonal fears
* @@Biased interpretation of emotional facial expression@@:
* SA associated with quicker detection of anger/fear
* in no-treat condition, SA associated with slower detection of sad/anger → relationship between SA and facial emotion detection __varies according to state of anxiety one is currently__ in and __intensity of facial expression__
* @@Biased interpretation accuracy@@ when quick judgement (disgust face interpreted as angry)

Implicit associations

* Highly socially anxious women had positive self-associations but this effect was much weaker than among healthy sample
* Individuals with high SA were less likely than individuals with low SA to exhibit implicit association between self and positive social attributes following a speech threat
* Individuals high in SA exhibited smaller implicit self-calm associations than did low anxious controls

→ Partial evidence in support of causal relationship between implicit associations and SA

→ Treatment: training positive implicit associations may change self-anxiety associations

Imagery and Visual Memories

* SAD patients are more likely than non-anxious to imagine recent social situations from an observer’s point of view (observer perspective imagery)
* **Observer perspective** is reported to randomly occur during anxiety-provoking situations, be negative and remain stable over time and across situations (onset of SAD often reported around the date of reported memory)
* **Negative self-imagery** elicited higher self-reported anxiety, more observable anxious behaviours and exaggerated negative self-appraisal of performance in individuals with SAD.
* Positive self-imagery is decreased in SAD (impoverished, less detailed and slower retrieval)

→ Treatment: imagery rescripting, video feedback (works only when paired with cognitive preparation)

Interrelations among information processing biases

* Negative self-imagery affects autobiographical memory (quicker recall of negative memories but slower recall of positive memories)
* Negative self-imagery affects negative interpretation bias and vice versa
* The link between interpretation and memory biases (memory intrusions consistent with previously made interpretations)
* The link between attention and interpretation biases (interpretation modification facilitated disengagement from social threat cues)

Self-focused attention

= awareness of self-referent, internally generated information

* Increased self-focused attention plays a role in the maintenance of SAD
* SAD patients report higher levels of self-focused attention
* Some evidence that the relationship between self-focused attention and anxiety is __bidirectional__ (both can increase the other)
* the study showed that anxiety induction resulted in increased self-focused attention
* Self-focused attention can be a deliberate **coping strategy (experimental avoidance)** to suppress, control or alter uncomfortable internal experiences
* Little evidence showing that self-focused attention has a big effect on social performance (some research shows very little influence)
* Modern support for the relationship between heightened self-focus and poorer social performance
* Self-focused attention is an important predictor of recovery

→Treatment: Task concentration training, Mindfulness approaches (decrease experiential avoidance)

Emotions and emotion regulation

* reduced emotionality,
* emotional hyperreactivity
* emotion regulation deficits,
* poor understanding of emotions
* negative reactivity to emotions,
* expressive suppression of emotions
* maladaptive beliefs about emotion regulation
* negative beliefs about emotional expression

→ Treatment: support for using cognitive reappraisal (emotion regulation strategy)

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**Atypical responding to positive material and experiencing positive emotions**

* Diminished response to positive stimuli or events
* Reduced positive affect (but not in other types of anxiety and not explained by depression, also present in the recovered)
* Maladaptive beliefs about positive events and positive emotions
* Fears of positive evaluation
* Down-regulation of positive affective states
* **“self-regulation depletion hypothesis”**- excessive attempts to make a positive impression deplete the self-control resources needed to prevent socially undesirable behaviours → this decreases the likelihood of positive satisfying social interactions and relationships


* **Information processing perspective:** biased attention away from positive information mediating factor between SA and low positive affect


* Self-focused attention shown to also decrease positive affect in SA

→ Treatment: engaging in kind acts proven to increase positive affect, CBT, loving kindness and compassion meditation

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**Anger and Behavioural Disinhibition**

Anger in SAD:

* Much greater compared to controls on all dimensions -
* Poorer anger expression skills (suppressing, internalizing)

Behavioural disinhibition in (a subset of) SAD:

* 2 subsets of SAD: the typical (avoidant, submissive etc.) and __the subset with angry and impulsive interpersonal styles__
* Novelty seeking (substance use problems)
* Greater anger, suppression, decreased psychological flexibility
* Poorer physical health, less educated

Safety behaviours

SA individuals do not always exhibit maladaptive social behaviour, but only in socially ambiguous or threatening situations. This may reflect **self-protective strategies → safety behaviours**: low self-disclosure, low eye contact

Safety behaviours do not really help (but those with SAD think they do), and in reality, they contribute to maintenance by interfering with the formation of new non-threatening associations.

Double standard: SAD individuals believe others’ use of safety behaviours is maladaptive but their use of safety behaviours is good

Safety behaviours are associated with the negative interpersonal outcome

Types:

* avoidance safety behaviours (associated with negative perception by others and a higher state of anxiety),
* impression management behaviours (associated with impeding corrections about subsequent interactions)

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**Elimination of safety behaviours** leads to decreased anxiety and making a better interpersonal impression on others (increased social approach behaviour)

post-event processing (PEP)

* Common in SA, often negatively focused and leads to biased retrieval of negative memories (maintenance of SA)
* Predictors: negative beliefs and assumptions (mediate the relationship between SA and PEP)
* Negative self-imagery may encourage PEP
* Some evidence that self-focused attention causes PEP

→ Treatment: PEP slows down recovery, mindfulness decreases SA well when PEP induced, distraction doesn’t