نگرانی خود تصویر و ارتباط آنها با رفتارهای ایمنی و عاطفه منفی در اختلال اضطراب اجتماعی
|کد مقاله||سال انتشار||مقاله انگلیسی||ترجمه فارسی||تعداد کلمات|
|39207||2013||11 صفحه PDF||سفارش دهید||10216 کلمه|
Publisher : Elsevier - Science Direct (الزویر - ساینس دایرکت)
Journal : Behaviour Research and Therapy, Volume 51, Issue 8, August 2013, Pages 476–486
Abstract It has been proposed that self-portrayal concerns – fundamental worries that particular negative self-attributes will become exposed during social encounters and criticized by others – underlie the experience of social anxiety (SA) and drive associated avoidance and safety behaviors ( Moscovitch, 2009). The development of the Negative Self Portrayal Scale (NSPS) to assess such concerns across the dimensions of social competence, signs of anxiety, and physical appearance has helped yield promising initial findings that support the basic tenets of Moscovitch's (2009) theoretical model in samples of undergraduate students ( Moscovitch & Huyder, 2011). The present study investigated the nature of self-portrayal concerns and their relation to affect and behavior in a sample of 194 community-based participants consisting of (a) 62 individuals with a principal diagnosis of generalized SAD, either with (n = 35) or without (n = 27) an additional depressive disorder diagnosis, (b) 51 individuals with another principal anxiety disorder diagnosis, either with (n = 22) or without (n = 29) an additional diagnosis of SAD, and (c) 81 healthy controls. Participants completed trait questionnaires, daily diaries of naturalistic social encounters, and a laboratory-based speech task. Results demonstrated (a) that a diagnosis of SAD confers unique risk for elevated self-portrayal concerns, (b) that such concerns predict significant variance in safety behavior use across diverse contexts, and (c) that the use of safety behaviors mediates the relation between such concerns and the experience of heightened negative affect. Implications for case conceptualization and treatment of SAD are discussed.
نتیجه گیری انگلیسی
Results Phase 1 (self-report questionnaires) Descriptive statistics and sample characteristics The mean scores and standard deviations of all measures for each of the participant groups are presented in Table 2. Across measures, the data were normally distributed and no significant problems with skew or kurtosis were identified (see Cohen, Cohen, West & Aiken, 2003). Collapsed across groups, the effects of gender and ethnicity on Phase 1 measures were examined in separate multivariate analyses of variance (MANOVAs), with the set of scores for the measures in Table 2 entered as the joint dependent variables. There were no significant effects of either gender, Pillai's Trace = .07, F(6,143) = 1.84, p = .10, ηp2 = .07, or ethnicity, Pillai's Trace = .24, F(30,705) = 1.20, p = .23, ηp2 = .05. Table 2. Mean total and subscale scores by Group for phase 1 measures (standard deviations in parentheses). Measure Group membership SAD without depressive disorder SAD with depressive disorder Anxious controls without additional SAD Anxious controls with additional SAD Healthy controls (a) N = 27 (b) N = 35 (c) N = 29 (d) N = 22 (e) N = 81 NSPS total 81.0 (20.2) e 85.3 (22.5) ce 64.3 (28.6) be 74.5 (18.9) e 47.0 (25.3) abcd Social competence 35.0 (9.7) ce 38.0 (10.5) ce 26.4 (13.3) abe 32.6 (9.0) e 19.4 (7.6) abcd Physical appearance 21.7 (7.1) e 25.0 (8.0) e 19.3 (10.4) 22.3 (8.8) e 14.4 (6.7) abd Signs of anxiety 23.7 (6.9) ce 22.4 (7.7) e 17.9 (7.0) ae 20.1 (5.8) e 13.8 (5.5) abcd SAFE total 90.7 (20.1) ce 91.1 (17.8) ce 72.9 (25.0) abe 88.1 (17.6) e 56.7 (16.2) abcd Active behaviors 39.1 (7.3) ce 39.5 (6.7) ce 28.1 (9.5) abde 36.0 (7.8) ce 22.0 (11.0) abcd Restricting behaviors 38.6 (10.2) e 39.4 (9.6) e 32.8 (11.9) e 40.3 (9.1) e 26.2 (8.0) abcd Managing physical symptoms 13.4 (6.0) e 12.4 (4.7) e 11.3 (6.5) 12.0 (4.8) e 8.5 (3.0) abd Notes. SAD = Social Anxiety Disorder; NSPS = Negative Self-Portrayal Scale; SAFE = Subtle Avoidance Frequency Examination; Groups are labeled a–e in the top row of the table. Within each column, superscripts indicate significant differences (p < .05 based on Tukey's HSD) between the group in that column and the group(s) whose label(s) correspond(s) with that/those superscript(s). Table options Diagnostic specificity In addition to examining how the groups compared to one another across the NSPS subscales (Table 2), we wished to investigate elevations in self-portrayal concerns across diagnostic subgroups relative to zero. Thus, all NSPS subscale scores were separately converted into respective z-scores by subtracting the total sample mean from each score on each scale, and then dividing the result by the standard deviation of the entire sample. Subsequently, mean scores on the NSPS for each group were compared to the grand mean for all participants in the sample. Fig. 1 depicts the z-scores for each NSPS subscale across groups and illustrates whether a particular group mean differed from the grand sample mean (i.e., from zero) on any particular scale. Results indicated that all groups whose participants received a diagnosis of SAD reported significantly or marginally significantly higher negative self-portrayal concerns than the average participant response in the sample (all ps < .10 or lower), and that this was true irrespective of whether an additional depressive disorder diagnosis was present. The presence of an additional depressive disorder within the context of principal SAD served to intensify participants' self-portrayal concerns even further above the sample mean, but only for the dimensions of social competence and physical appearance; concerns about signs of anxiety, however, were elevated to an equivalent degree among both depressed and nondepressed participants with a principal diagnosis of SAD. In contrast, self-portrayal concerns among the subset of anxious controls without a diagnosis of SAD did not differ from the grand mean. Finally, healthy controls reported significantly less concern than all of the clinical groups across each of the three NSPS subscales. Mean Z-scores for NSPS subscales by Group. For significance tests from zero: ... Fig. 1. Mean Z-scores for NSPS subscales by Group. For significance tests from zero: †p < .10; *p < .05; **p < .01; ***p < .001. Figure options Phase 2 (daily diaries) Compliance A total of 158 participants (81.4% of those in Phase 1) completed the daily diary surveys. The most frequent stated reasons for not participating in this phase included feeling too anxious and not having enough time. The mean time to complete the required seven diary entries was 8.2 days (SD = 4.2). A between-subjects ANOVA revealed no differences across the five participant groups in completion time, F(4,152) = .94, p = .45, ηp2 = .02. Aggregate NSPS group comparisons To investigate group differences in the strength of naturalistic self-portrayal concerns, aggregate (i.e., mean) NSPS scores were calculated for each participant across reported events by summing each of their NSPS total scores across each of their daily diaries, and then dividing that value by the number of events reported. An ANOVA indicated significant differences between the groups overall on the NSPS, F(4,153) = 11.0, p = .00, ηp2 = .22. Follow-up Tukey HSD posthoc analyses revealed that participants with any (principal or additional) clinical diagnosis of SAD, irrespective of the presence of a depressive disorder diagnosis, reported significantly stronger self-portrayal concerns (Ms = 61.9–62.2, SDs = 15.6–20.1) during their naturalistic social encounters than those in the healthy control group (M = 43.5; SD = 14.4), all ps < .001. Moreover, those with a principal diagnosis of SAD and an additional depressive disorder (M = 62.2; SD = 20.1) reported significantly higher average scores on the NSPS than the anxious control group without SAD (M = 50.1; SD = 22.3; p < .001), but did not differ from those with principal SAD without depression (M = 64.8; SD = 17.7; p = .98) or anxious controls with secondary SAD (M = 61.9; SD = 15.6; p = .99). Those with a principal diagnosis of SAD without depression had greater NSPS concerns than anxious controls without SAD (M = 50.1; SD = 22.3; p = .03), but did not differ from anxious controls who had an additional diagnosis of SAD (M = 61.9; SD = 15.6; p = .98). Finally, self-portrayal concerns among the anxious control group without additional SAD did not differ from those reported by healthy controls. Relation between naturalistic self-portrayal concerns and safety behaviors The data collected from longitudinal designs such as this one are well suited to multilevel modeling, which enables researchers to examine the effects of one variable on another across a large sampling of events for each person across time. Moreover, multilevel designs can assess whether these effects are moderated by characteristics of the person. The diary data from Phase 2 have a multilevel structure consisting of two levels of analysis. Each social event represents an observation nested within a participant. The first level (within-person) contains information related to individual reactions of participants upon encountering a particular situation on a given day (e.g., self-portrayal concerns; level of safety behaviors; feelings about the situation). The second level (between-person) is comprised of participant-level data and represents variation between individuals which may influence within-person variables and relations between variables at Level 1. The primary Level 2 variable of interest was group membership status. Data were analyzed in HLM 6.0 (Raudenbush & Bryk, 2002) using restricted maximum-likelihood estimates. Robust standard errors are reported because these estimates are relatively insensitive to violations of homoscedasticity (see Chou, Bentler, & Satorra, 1991). Intercepts and slopes were allowed to vary at random for all Level 1 variables entered into each respective model. These estimates were then pooled across participants producing fixed (or average) effects of each predictor on its respective dependent measure. No constraints were imposed on the relations among random components. All variables were centered based on their respective grand means, with the exception of group status, which was effect-coded using healthy controls as the reference group. Comparative model fit was performed using the −2 log likelihood deviance difference statistical test in HLM 6.0 (Raudenbush & Bryk, 2002). HLM produces estimates of the proportion of true variance for a parameter estimated within an unconditional-means model. Across days, the proportion of reliable variance in the means was separately estimated at .95 for the NSPS, .93 for the PANAS and .95 for SAFE total scores completed on the diary forms. Within an HLM hierarchical linear regression framework, we tested our main hypothesis that greater self-portrayal concerns were related to elevated use of safety behaviors across a series of naturalistic social encounters. Total NSPS ratings for a given situation were used to predict the level of total safety behavior use on the situation-specific SAFE measure. The fixed-effect results supported the prediction that greater self-portrayal concerns were associated with greater use of safety behaviors during naturalistic social situations (unstandardized fixed-effect = .52; SE = .04; t157 = 13.9; p < .001). The model including total NSPS concerns explained 56.0% more variance in SAFE scores than an unconditional (i.e., intercept only) model which did not include any predictors for explaining SAFE scores. In a follow-up analysis investigating whether self-portrayal concerns predicted the use of safety behaviors even after controlling for negative affect (NA), participants' PANAS NA scores during their reported naturalistic social situations were entered as a predictor variable in an initial step. In the first step, NA was associated with increased SAFE scores across time (unstandardized fixed-effect = .77; SE = .06; t156 = 11.8; p < .001), explaining approximately 37.4% more between-person variance than a model with no predictors. The contribution of PANAS NA remained significant (unstandardized fixed-effect = .53; SE = .05; t156 = 10.5; p < .001) when NSPS total scores were added to the model on a second step of the regression. Moreover, higher NSPS scores continued to predict the use of safety behaviors, even after accounting for NA experienced during the interaction itself (unstandardized fixed-effect = .44; SE = .03; t156 = 17.2; p < .001). Including NSPS total scores in the model in the second step helped to explain a total of 68.6% of the score variance in safety behaviors, when compared to the model with no predictor variables specified. The comparative fit of the model with NSPS included was also significantly better than the model which included NA as the sole predictor, χ2(4) = 630.1, p < .001. A third HLM analysis examined the effects of the set of three NSPS subscale scores on safety behaviors in step 2 over and above the contribution of PANAS NA ratings in step 1. The findings are outlined in Table 3. Each distinct facet of the NSPS uniquely predicted variance in safety behavior use during participants' social interactions. For this final model, none of the variances (i.e., random effects) associated with the NSPS subscale slopes were significant, indicating that none of the Level 2 variables increased the prediction of variance in the model (all ps > .097). Thus, although a diagnosis of SAD appears to be associated with higher mean levels of NSPS concerns, the strength of the relation between self-portrayal concerns and safety behaviors does not depend on participants' diagnostic status. Table 3. Results of hierarchical linear model using NSPS scores to predict total SAFE scores while controlling for PANAS negative affect in phase 2 daily diaries. Fixed effect Unstandardized fixed effect Standard error t-Ratio df p-Value Step 1 Intercept −4.3 1.0 −4.5 156 <0.001 PANAS-NA .77 .07 11.7 156 <.001 Step 2 Intercept −3.89 0.58 −6.67 156 <0.001 PANAS-NA 0.49 0.06 8.58 156 <0.001 NSPS social competence 0.45 0.05 8.43 156 <0.001 NSPS physical appearance 0.38 0.06 6.53 156 <0.001 NSPS signs of anxiety 0.62 0.09 6.77 156 <0.001 Notes. NSPS = Negative Self-Portrayal Scale; SAFE = Subtle Avoidance Frequency Examination; PANAS-NA = Positive and Negative Affect Schedule-Negative Affect Subscale. Table options Phase 3 (laboratory speech task) Compliance A total of 147 individuals participated in the laboratory-based phase of the study, representing 75.8% and 93.0% of those participating in the first two phases, respectively. The most frequent reported reasons for not participating in this phase of the study included feeling too anxious and not having enough time. Relation between self-portrayal concerns and safety behaviors during a standardized social task It is reasonable to expect that self-portrayal concerns reported immediately before participating in a stressful social situation (e.g., a public speaking task) should be associated with greater use of safety behaviors during the social encounter itself. Hierarchical regression analyses were performed to test this hypothesis. In order to distinguish between the effects of self-portrayal concerns and general effects of NA on use of safety behaviors, PANAS NA scores reported both before and after the speech (r = .84; p < .001) were entered as separate covariates in all analyses (tolerance statistics detected no concerns about multicollinearity). Table 4 presents the results of the NSPS and its subscales in predicting self-reported safety behaviors on both the total score of the SAFE and each of the three subscale scores. The pattern of the reported results in Table 4 mirrors that of additional analyses (not reported here) wherein NA was not included as a covariate. Table 4. Separate hierarchical regression analyses using NSPS scores to predict SAFE scores while controlling for PANAS negative affect before and after the speech in phase 3 laboratory task. Predictors SAFE active behaviors SAFE restricting behaviors SAFE managing physical symptoms SAFE total Standardized β ΔR2 Standardized β ΔR2 Standardized β ΔR2 Standardized β ΔR2 Step 1 PANAS-NA before .45*** .38** .34* .46*** PANAS-NA after .33** .29* .12 .32** Step 2 .04** .04** .07** .05** PANAS-NA before .23* .13 .03 .19 PANAS-NA after .30** .26* .07 .28** NSPS total .31** .34** .44** .38** Step 1 PANAS-NA before .45*** .38** .34* .46*** PANAS-NA after .33** .29* .12 .32** Step 2 .04** .06** .11** .06** PANAS-NA before .24* .11 −.01 .17 PANAS-NA after .28** .29* .10 .29** NSPS Social Comp .17 −.13 −.16 .01 NSPS Phys App .01 .25* .30** .17* NSPS Signs of Anx .13 .27* .37* .27* Notes. PANAS-NA = Positive and Negative Affect Schedule-Negative Affect Subscale; NSPS = Negative Self-Portrayal Scale; Social Comp = Social Competence; Phys App = Physical Appearance; Signs of Anx = Signs of Anxiety; SAFE = Subtle Avoidance Frequency Examination; Whole Sample: N = 147; †p < .10; *p < .05; **p < .01. Table options In the first set of regressions, PANAS NA ratings before and after the speech were entered as control variables in step 1, anticipatory NSPS total scores were entered as the predictor variable in step 2, and SAFE total and subscale scores were entered in separate analyses as outcome variables. As shown in the top half of Table 4, NSPS total scores while anticipating the speech explained an additional 4–7% of the variance in the three SAFE subscale scores and in SAFE total scores after accounting for the contribution of NA (all βs = .31–.44, all ps < .01). As illustrated in the bottom half of Table 4, when the analyses were repeated with the three NSPS subscale scores entered as a set to predict SAFE scores, they accounted together for approximately 4% of SAFE active safety behaviors scores (p < .01); however, none of the individual NSPS subscales on its own uniquely predicted active safety behaviors in a significant manner (ps > .11). By comparison, NSPS concerns about physical appearance and signs of anxiety both uniquely contributed to the prediction of SAFE restricting behaviors and management of physical symptoms of anxiety scores, as well as SAFE total scores (all ps < .05; ΔR2 = .06–.11 for the second step of each model). Safety behaviors as a mediator of the relation between self-portrayal concerns and NA To test the hypothesis that the use of safety behaviors during a social event mediates the relation between anticipatory self-portrayal concerns and post-event NA, direct and indirect effects of NSPS total scores on PANAS NA scores were generated using the Monte-Carlo bootstrapping method in Amos 20.0 (Arbuckle, 2008). The total sample size was 136 after removing participants with any missing data from the analysis. The effects were generated after resampling from the observed cases 2000 times. There was a significant direct effect of pre-speech self-portrayal concerns on post-speech NA (β = .37, p < .001), controlling for SAFE scores. Also significant were the direct effects of pre-speech NSPS concerns on use of safety behaviors during the speech (β = .70, p < .001) and use of safety behaviors during the speech on post-speech NA (β = .37, p < .001). Furthermore, the standardized indirect effect of pre-speech NSPS concerns on post-speech NA through the reported use of safety behaviors during the speech was also significant, β = .26, p < .001, and was estimated to be within a non-zero range between .13 and .39 based on the 95%, bias-corrected confidence interval. Taken together, this mediational model demonstrates that self-portrayal concerns prior to the speech led to increased use of safety behaviors during the speech, and that these actions ultimately produced higher enduring levels of NA after the stressful situation had ended. Using the validation ratio ( Freedman, 2001) or the mediational ratio ( Ditlevsen, Christensen, Lynch, Damsgaard, & Keiding, 2005), 2 the indirect effect of safety behaviors constituted 59% of the total effect of anticipatory NSPS concerns on postevent NA. 3