Articles week 2 - Social Anxiety Disorder

What does the Heimberg model of SA/SAD do?

It delineates the processes by which individuals with SA are affected by their fear of evaluation in social situations

Explain the Heimberg model (in steps)

• The perception of an audience stimulates a mental representation as seen by the audience

• Because of negative self imagery (from a history of negative social experiences) the individual concludes that the audiences opinion of them is poor

• & that the audience holds very high standards for them

• The combination of the opinion + high standards leads to threat of evaluation

• This leads to anxiety

• Attention bias makes the vicious cycle repeat

What information processing biases exist

1. Attention bias

   • Attention towards social threat may be accompanied by bias away from positive social information

2. Interpretation bias

   • The tendency to interpret ambiguous or neutral stimuli as threatening

3. Implicit association bias

   • A negative attitude of which one is not consciously aware against a specific social group

4. Imagery and visual memories

   • More likely to imagine recent social interaction as if looking at the self from an observers point of view

   • Occurs spontaneously during anxiety provoking situations, remains stable & negative over time and situations

   • Negative self imagery

5. Interrelations among these information processing biases

   • Negative self imagery affects autobiographical memory

   • Relationship between attention and interpretation biases

What is self focused attention & role in SA?

• An awareness of self- referenced, internally generated information

  • Plays a role in the SAD maintenance - keeps them from disconfirming negative expectations (Clark & Wells)

  • Use internal cues. to evaluate their social performance

  • Deliberate coping strategy aimed at preventing embarrassment or negative evaluation

  • BUT only negative beliefs were associated with poor social performance

What is a therapeutic approach to reduce self-focused attention?

Task Concentration Training: Focus on their task and environment

What is emotion regulation?

The process by which an individual influences which emotions they experience when the emotions are experienced, and howe the emotions are experienced and expressed

• SAD characteristic - negative

• Use cognitive reappraisal to build self-efficacy

What is the self-regulation depletion hypothesis

• Deplete the self-control resources necessary to effectively prevent socially undesirable behaviours

• Excessive attempts to make positive impression, appear and feel less anxious & avoid rejection

• Effect: Decreased likelihood of positive interpersonal outcomes and reduced positive affect

What is the information processing perspective?

• Biased attention & interpretation lead to decrease in positive affect in SA

• Biased attention towards threat is accompanied by biased attention away from positive information

What are the two types of pp with SAD with varying behavioural reactions to social threat?

1. The avoidant, unassertive and submissive response style

2. Angry, Hostile and mistrusting interpersonal styles

What is post-event processing

A thought process in which individuals review their own actions and the reactions of the other individual following an event or in anticipation of a similar upcoming event

• Negative self-impressions lead to biased retrieval of negative memories which perpetuates SA

What are the main influencing factors in understanding ethology, maintenance and treatment of SAD

• Information processing biases

• Self-focused attention (driving force in anxiety cycle)

• Emotion regulation

• Safety behaviour

• Impaired response to positive stimuli

What does the Clark & Wells model of SAD say?

• The cognitive abnormalities and maintenance processes

• People with SA: firm beliefs of making a good impression but also believe that they come across badly

• Broad beliefs (I’m weird) lead them to make assumptions about themselves and their social environment - such as having high expectations of themselves

• Negative beliefs are activated in social settings - trigger alarm

• Sense of threat motivates a chain of cognitive, affective and behaviour responses

• These responses are self-perpetuating and closed off to new information

What are the inter-linked (unhelpful) processes that are emphasised by the cognitive model of clark & wells?

• Internal focus of attention

  • Fail to process the actual social situation and reactions - increased awareness of feared sensation

• Internal information to infer how one appears

  • They think they look as anxious as they feel, observer perspective activated (negative)

• Safety behaviour

  • Prevents from discovering that the feared outcome was unlikely to happen anyway

  • Either avoidant or making good impression (preparation)

  • Prevents disconfirmation

• Anticipatory worry & Post-event processing

  • Driven by memories of past failures & negative self-images

  • Or detailed revisiting of a previous event -failure

— good model for adolescent because self-focused attention is emphasised which has a parallel with self.consciousness (which is heightened in adolescence) ; Safety behaviours ; Avoidant safety behaviours (elicit neg responses from peers - sensitive to peer rejection)

What are the developmental sensitive factors relevant to the application of the model to adolescents

1. Parenting factors

   • Overprotection/pushing perpetuates social threat perceptions

2. Friendship & Peer Victimisation

   • Negative peer relationship predicts SA

   • Peer difficulties reinforces negative beliefs & behaviours associated with SA

3. Social media

   • Self-presentation; Victimisation & Safety behaviours

What are the differences between the model of Clark & Well & Rapper & Heimberg?

Clark & Wells:

• Exclusively attend to negative thoughts and self-images (& effectively away from external cues) during social situation

• Assessment of danger in social situation is independent of threat actually present in the environment

• Social phobics use interoceptive information to construct an impression of themselves which they assume reflects what other pp observe

Rapper & Heimberg:

• Simultaneously attend to internal cues & external stimuli indicative of negative evaluation

• These are interdepend - one has cause implications for the existence of the other

BUT BOTH SAY:

• Attention to threat stimuli is crucial in the maintenance of social fear

What is internal focus in SA

• Self-focused attention = awareness of internally generated information contrasting with external sensory input

  • Private self-focus: Goals that are autonomous and egocentric which do not require a consideration of others reaction to one’s behaviour

  • Public self focus: Behaviours that take into account the reactions, needs or desires of others - aim for social consensus - how one’s actions influence others perception of oneself —> associated to SA