بیرون از سایه و در کانون توجه: هراس از سوخت اشتباهات اجتماعی خود مواجهه ای در اختلال اضطراب اجتماعی
|کد مقاله||سال انتشار||مقاله انگلیسی||ترجمه فارسی||تعداد کلمات|
|39232||2015||9 صفحه PDF||سفارش دهید||7700 کلمه|
Publisher : Elsevier - Science Direct (الزویر - ساینس دایرکت)
Journal : Journal of Anxiety Disorders, Volume 34, August 2015, Pages 24–32
Abstract In a study designed to clarify and extend previous research on social blunders in social anxiety, 32 participants with social anxiety disorder (SAD), 25 anxious control (AC) participants with anxiety disorders other than SAD, and 25 healthy control (HC) participants with no history of anxiety problems estimated the costs of hypothetical blunders committed by either themselves or by others. Participants with SAD rated the costs of their own imagined blunders as highly inflated relative to both AC and HC participants. In contrast, for blunders participants imagined others committing, only SAD and healthy control participants’ cost estimates differed from one another. Moreover, concerns about revealing self-flaws – and, in particular, about appearing socially incompetent – accounted for significant, unique variance in SAD participants’ exaggerated cost estimates of self blunders, over and above symptoms of social anxiety and depression. These results enhance our understanding of how and why socially anxious individuals negatively appraise social blunders and help to clarify the potential function and role of social mishap exposures in the treatment of SAD.
1. Introduction Social blunders are inadvertent violations of normative standards of behavior. Although blunders can be embarrassing and unpleasant, most people view them as relatively fleeting and inconsequential. For individuals with social anxiety disorder (SAD), however, committing a social blunder may represent a much greater threat. People with SAD are highly motivated to avoid the scrutiny and evaluation of others (Weeks, Rodebaugh, Heimberg, Norton, & Jakatdar, 2009). They tend to view themselves as having low social currency and as holding an especially tenuous position within the social hierarchy (Antony et al., 2005, Moscovitch et al., 2011, Rodebaugh, 2009 and Weisman et al., 2011). When their self-evaluative concerns are activated by social threat, they often adopt the use of safety behaviors that function to conceal the self and prevent perceived personal flaws from being exposed to the criticism of others (Moscovitch et al., 2013, Plasencia et al., 2011 and Taylor and Alden, 2011). Thus, from the perspective of the socially anxious, social mishaps may be particularly threatening by virtue of their power to thrust them unexpectedly into the spotlight, illuminating their deficiencies for all to see (Moscovitch, 2009). Socially anxious individuals’ fears of committing social blunders take shape within their imagination (Clark and Wells, 1995, Hofmann, 2007, Moscovitch et al., 2011 and Rapee and Heimberg, 1997). Before, during, and after social events, they tend to envision themselves behaving in a socially unacceptable manner, leading, at least in their minds, to dire interpersonal and emotional consequences (see Chiupka et al., 2012 and Hofmann, 2007). Within these images, the self is represented in a manner that corresponds with deeply held fears about appearing socially incompetent, visibly anxious, or physically unattractive (see Moscovitch et al., 2011). Although the imagined self is typically a negatively distorted representation of reality, the image carries significant meaning and impact for socially anxious individuals because it is often rooted in autobiographical memories of genuine earlier experiences during which they felt socially excluded, rejected, or humiliated (Hackmann et al., 2000 and Moscovitch et al., 2011). In a recent study, we investigated perceived social consequences of imagined social blunders in undergraduate students with high versus low levels of trait social anxiety (Moscovitch, Hesch, & Rodebaugh, 2012). Results indicated that high socially anxious participants perceived the negative consequences of imagined blunders as being highly inflated, whether they envisioned the blunders being committed by themselves or by a third party. In other words, socially anxious participants tended to overestimate how costly it would be for anyone to violate social standards, even when the costs were not personally relevant. While these findings support the notion that imagined blunders readily trigger exaggerated cost estimates in social anxiety (see Hofmann, 2007), they are inconsistent with the “double standard” hypothesis, which states that socially anxious individuals may be apt to apply higher standards of evaluation to their own social behavior than they are to the behavior of others (see Amir et al., 1998 and Voncken et al., 2006). Our confidence in these conclusions, however, is tempered by important methodological limitations of this prior study, including the use of an analog sample of socially anxious undergraduate students rather than a clinical sample of participants with social anxiety disorder as well as the absence of an anxious control group of participants with anxiety-related difficulties other than social anxiety. The present study is designed to improve upon these limitations and, in so doing, to clarify and extend the results of our original investigation. Deepening our understanding of the cognitive-behavioral facets of imagined social blunders in clinical samples may be of particular interest to anxiety researchers because of the potential for treatment advancements in this area. Based on the established findings that inflated social cost estimates play a central role in the persistence and treatment of SAD (Hofmann, 2004, Foa et al., 1996, McManus et al., 2000, Smits et al., 2006 and Taylor and Alden, 2008), some investigators have promoted the value of integrating intentional social mishap exposures into cognitive behavioral treatment protocols for SAD. During such exposures, perceived social costs are targeted by having patients repeatedly commit blunders for the purpose of observing and learning that feared consequences (e.g., being ridiculed by others) do not typically occur ( Hofmann and Scepkowski, 2006 and Fang et al., 2013). Despite the potential utility of this intervention, a recent experimental study showed that social mishap exposures may be less effective than cognitive restructuring for facilitating reductions in social cost biases and reducing symptoms of social anxiety ( Possis et al., 2013). In fact, Possis et al. (2013) reported that post-intervention measures of social anxiety and social cost did not differ between the social mishap condition and a psychoeducation control condition. These mixed findings are representative of the literature in this area, which is still quite small and lacking consistent or conclusive data on exactly how and why socially anxious individuals misinterpret social blunders. Thus, more research is needed to enhance our understanding of how social mishaps are imagined and perceived in social anxiety and to develop a strong empirical foundation upon which practitioners can rely in order to implement evidence-based interventions for SAD. In the present study, participants with a clinical diagnosis of SAD, anxious control (AC) participants with anxiety disorders other than SAD, and healthy control (HC) participants with no history of anxiety problems provided estimates of the perceived interpersonal and emotional costs of hypothetical social blunders that they imagined being committed both by themselves and by others. We formulated hypotheses based on the tenets of cognitive models of SAD that ascribe a central role to negative self-perception in the development and maintenance of the disorder (Clark and Wells, 1995, Hofmann, 2007, Moscovitch, 2009 and Rapee and Heimberg, 1997). To this end, we expected that for blunders that participants imagined committing themselves, individuals with SAD would report inflated social costs relative to both ACs and HCs. We predicted that SAD participants’ exaggerated cost estimates of self blunders would be associated specifically with how concerned they felt about the possibility that their perceived personal flaws would be exposed to others. Conversely, we hypothesized that for blunders participants imagined other people committing, individuals with SAD would not overestimate costs relative to ACs because such cost estimates would not be fueled by concerns about self-exposure.
نتیجه گیری انگلیسی
. Results 3.1. Preliminary analyses Table 1 displays the characteristics of the groups and associated tests of equivalence. As expected, the groups differed across the symptom measures, with HC participants reporting significantly fewer symptoms across all measures relative to both AC and SAD participants. The AC and SAD participants differed significantly only on the SPIN (p < .001), NSPS social competence (p < .01), and NSPS signs of anxiety (p = .01). The groups also differed significantly in age, such that AC participants were slightly older than HC participants (p = .04). When we repeated our data analyses with age entered as a covariate, the pattern of results was identical to those reported below. Finally, the groups did not differ in reported racial/ethnic background, with the majority of participants in each of the groups identifying as Caucasian/White. Other participants identified as East Asian (e.g., Chinese, Japanese, Korean; n = 5), South Asian (e.g., Indian, Pakistani; n = 5), Southeast Asian (e.g., Filipino, Vietnamese, Indonesian; n = 1), Black/African (n = 1), Middle Eastern (n = 1), Other (n = 3), and Choose Not to Respond (n = 1). A close inspection of the data across the Hamilton and Waterloo sites revealed no differences between the two sites for participants with SAD (n = 25 in Waterloo vs. n = 7 in Hamilton) or AC participants (n = 8 at Waterloo vs. n = 17 at Hamilton) in demographics (age, gender, race; all ps > .05), diagnostic composition (number of comorbid disorders; all ps > .37), or responses to imagined blunders committed by either the self (all ps > .17) or others (all ps > .41). 2 3.2. Group differences Results of the omnibus MANOVA examining group differences in estimated costs of imagined blunders committed by participants themselves generated a very large effect, Λ = .06, F(4, 71) = 291.94, p < .001, partial η2 = .94, n = 77. Tests of between-subjects effects demonstrated significant differences between groups for each of the four composite scores, all F's > 11.98, all p's < .001, all partial η2's > .25. Post hoc tests revealed that participants with SAD reported significantly higher ratings than both the AC (p's ≤ .04) and HC (p's < .001) groups across all four measures. Moreover, the AC group rated their embarrassment, shame, and social costs significiantly higher than the HC group (p's ≤ .009), but did not differ from the HC group in terms of their ratings of negative response from others (p = .14). Means and SDs are outlined in Table 2 and group differences in perceived social costs of self blunders are presented graphically in Fig. 1. Table 2. Means (SDs) across participant groups for ratings of perceived consequences of imagined blunders for self and others. Variable SAD M (SD) [n] AC M (SD) [n] HC M (SD) [n] I. Imagined blunders – actor 1. Social cost 14.81 (5.23)  10.86 (6.76)  5.04 (4.56)  2. Embarrassment 19.81 (4.00)  15.83 (4.89)  12.28 (4.11)  3. Shame 16.03 (5.97)  10.54 (6.40)  5.44 (5.02)  4. Negative response 13.87 (5.52)  9.52 (6.19)  6.75 (4.62)  II. Imagined blunders – observer 1. Social cost 3.35 (2.01)  3.08 (2.01)  1.96 (1.63)  2. Embarrassment 5.87 (1.38)  5.56 (1.33)  4.68 (1.25)  3. Shame 3.94 (2.03)  3.36 (1.87)  2.21 (1.64)  4. Negative response 3.10 (1.69)  3.04 (1.84)  1.64 (1.08)  Note. SAD = participants with social anxiety disorder; AC = anxious control participants (no SAD); HC = healthy control participants; imagined blunders = composite of responses to scenarios 1–6; imagined observed blunders = composite of responses to scenarios 7–8. Different sample sizes across tests reflect differences in missing values across tests. Table options Perceived social costs (range=0–24) of social blunders in which participants ... Fig. 1. Perceived social costs (range = 0–24) of social blunders in which participants imagined themselves as the social actor committing the blunder. Ratings of participants with social anxiety disorder (SAD), anxious control (AC) participants, and healthy control (HC) participants all differed significantly from one another. Figure options Results of the omnibus MANOVA examining group differences in estimated costs of imagined blunders committed by others also generated a very large effect, Λ = .05, F(4, 71) = 313.90, p < .001, partial η2 = .95, n = 77. Tests of between-subjects effects demonstrated significant differences between groups for each of the four composite scores, all F's > 3.32, all p's < .04, all partial η2's > .08. Post hoc tests revealed that participants with SAD reported significantly higher ratings than HC participants (p's < .04) across all four measures. The AC participants differed from the HC group only in their ratings of negative response from others (p = .005), but not in their ratings on the other three measures (p's > .10). SAD and AC participants did not significantly differ in any of their ratings (p's > .37). Means and SDs are outlined in Table 2 and group differences in perceived social costs of others’ blunders are illustrated in Fig. 2. Perceived social costs of social blunders (range=0–8) in which another person ... Fig. 2. Perceived social costs of social blunders (range = 0–8) in which another person was imagined as the social actor committing the blunder in participants with social anxiety disorder (SAD), anxious controls (AC), and healthy controls (HC). Between-group comparisons showed that HC participant ratings differed significantly from those of the SAD participants, but AC participants’ ratings did not differ from the other two groups. Figure options 3.3. Regression analyses Inspection of VIF and tolerance values indicated no concerns about multicollinearity for any of the regression analyses. Bivariate correlations between predictor variables are presented in Table 3.3 Table 3. Bivariate (Pearson) correlations between predictor variables for SAD participants only. Variable DASS (Dep), n = 32 NSPS (Total), n = 28 NSPS (SocComp), n = 28 NSPS (SignAnx), n = 31 NSPS (PhysApp) n = 32 SPIN (Total) .20 .66* .48* .63* .51* DASS (Dep) .10 .24 .12 .03 NSPS (Total) .79* .84* .76* NSPS (SocComp) .59* .33 NSPS (SignAnx) .48* Note. SPIN (Total) = Social Phobia Inventory (Total Score); DASS (Dep) = Depression Anxiety Stress Scales (Depression Subscale); NSPS = Negative Self Portrayal Scale; Total = Total Score; SocComp = Social Competence Subscale Score; SignAnx = Signs of Anxiety Subscale Score; PhysApp = Physical Appearance Subscale Score; differences in ns across measures represent differences in missing data (which were deleted pairwise for these analyses); *p < .001 (2-tailed). Table options Results of the first regression analysis revealed that SPIN scores and NSPS total scores accounted for approximately 29% of the variance in estimated costs of blunders that SAD participants imagined committing themselves, F(2, 26) = 4.82, p = .017, n = 27. NSPS total scores uniquely predicted social costs (Beta = .55, t = 2.37, p = .026, partial r = .44), but SPIN scores did not (Beta = −.02, t = −.09, p = .93, partial r = −.02). When NSPS total scores were replaced with NSPS subscale scores in a separate analysis, the model accounted for approximately 35% of the variance in cost estimates for SAD participants’ own imagined blunders, F(4, 26) = 2.92, p = .04, n = 27. Only NSPS concerns about flaws in social competence scores uniquely predicted social costs (Beta = .52, t = 2.28, p = .033, partial r = .44), whereas the other NSPS subscale scores as well as the SPIN scores did not (all ps > .49). Conversely, SPIN and NSPS scores did not explain significant variance in estimated costs of blunders that SAD participants imagined others committing, with the combination of SPIN and NSPS total scores accounting for only 0.2% of the variance in estimated costs of others’ blunders, F(2, 26) = .03, p = .97, n = 27. Given these nonsignificant results, the second planned regression analysis substituting NSPS total scores for subscores was not attempted.