ارزیابی رفتاری از عملکرد اجتماعی: نظام رتبه بندی برای هراس اجتماعی

The Social Performance Rating Scale (SPRS) is a modification of the rating system for behavioral assessment of social skills, originally developed by Trower et al. (Trower, P., Bryant, B., & Argyle, M. (1978). Social skills and mental health. Pittsburgh: University of Pittsburgh Press) and subsequently adapted by Turner and colleagues (e.g., Turner, S. M., Beidel, D. C., Dancu, C. V., & Keys, D. J. (1986). Psychopathology of social phobia and comparison to avoidant personality disorder. Journal of Abnormal Psychology, 95, 389–394). Designed to yield ratings of social performance appropriate for use in a socially phobic population and based on videotaped role plays, the five SPRS ratings are gaze, vocal quality, speech length, discomfort, and conversation flow. The sum of these ratings provides an internally consistent total score. In an initial study of the psychometric properties of the SPRS, three groups were assessed: individuals with social phobia, another anxiety disorder, or no psychological disorder. Inter-rater reliability for individual items and the total score proved excellent, and positive evidence for convergent, divergent, and criterion-related validity was obtained.

Behavioral assessment of the quality of social performance displayed by socially phobic people has been plagued by a number of conceptual, methodological, and psychometric problems. In contrast to the extensive literature on the reliability and validity of social skills assessment in schizophrenia (e.g., Bellack et al., 1990), suprisingly little attention has been paid to the validation of objective methods for behavioral assessment of social performance of people with clinical social phobia, even though these methods are frequently used in studies of psychopathology and psychotherapy of social phobia. Further development of such assessment would be of benefit not only to researchers but also to clinicians wishing to assay their clients' social difficulties. This is the topic of the present paper. The assessment literature on social skills among sub-clinical socially anxious people and other clinical populations (e.g., alcoholic patients) provides an empirical background for this effort. As advocated by Monti et al. (1984), we approach behavioral ratings of social performance at the midi-level of assessment. Following Monti et al. (1984) and Trower et al. (1978) we argue that the anchored rating scales typical of midi-level assessment avoid the problem of the dubious ecological and convergent validity of micro-level assessment (e.g., counts of behaviors such as smiles) while providing more information for research and treatment than single-item global ratings. Although not as easy to apply as global ratings, midi-level ratings need not be excessively onerous if kept to a relatively small number of items. We began by focusing on a promising reduction of the very extensive coding system from Trower et al. (1978) by Turner et al. (1986). These authors demonstrated the utility of this rating system in making the difficult distinction between clients with avoidant personality disorder and those with DSM-III (American Psychiatric Association, 1980) social phobia but without avoidant personality. Such data suggest a sensitive coding system for assessment of social performance in those who are less grossly impaired or inhibited than the oft-studied chronic schizophrenic patient. Turner et al. selected one rating to represent each of Trower et al.'s three main categories of ratings: gaze (nonverbal), voice tone and volume (voice quality), and length (conversation properties). To these they added an overall performance rating and a rating of apparent discomfort. Each was rated on a 5-point scale ranging from very poor to very good. In our initial study with these rating scales (Terrill et al., 1993), the raters expressed frustration in not being able to capture distinctions they noted among a sample of normal individuals and fairly high functioning but quite phobic participants with social phobia. Indeed, the range of ratings was largely limited to 2 points on the 5-point scales, and, not suprisingly, reliability and validity coefficients suffered. Based on this experience and a further pilot study in which similar difficulties emerged, our prior experience with behavioral assessment of social interaction (e.g., Tran and Chambless, 1995), and on the literature on available ratings systems, we subsequently modified the Turner et al. (1986)–Trower et al. (1978) scales in the following way: (1) We retained the system from Trower et al. (1978) of assigning positive ratings to appropriate levels of behavior and negative ratings to too much (e.g., stares at the conversational partner) or too little of a behavior (e.g., avoids eye contact completely). (2) To enhance reliability, we developed extensive behavioral anchors for each scale point. Further, we tailored anchors to provide finer distinctions between levels of social performance, particularly at the more skilled/less apparently anxious end of the scales. (3) The following items were included: (a) Conversation flow. We redefined the overall rating from Turner et al. (1986) as conversation flow, which includes elements of appropriate self-disclosure as well as turn taking, showing interest in the partner, and tracking the conversation. This includes some of the elements of Monti et al.'s `sense of timing', which was related to global ratings of skill and anxiety in a group of psychiatric patients referred for social skills training ( Monti et al., 1984). Trower (1980) and Trower et al. (1978) showed elements of this rating distinguished socially inadequate from socially adequate psychiatric patients. (b) Voice quality ratings include the categories of Trower et al. (1978) of tonal quality, pitch, clarity, and volume, which discriminated socially adequate vs inadequate psychiatric samples in their research. Further, Monti et al. (1984) found ratings of quality/tone to be associated with global skill ratings for both student and psychiatric samples, and Turner et al. (1986) found ratings of vocal tone distinguished socially phobic patients with and without avoidant personality disorder. (c) Length ratings overlap to some degree with the `speech rate/pressure' item from Monti et al. (1984) which was related to global ratings of anxiety and skill in their patient population. Similarly, Dow (1985) demonstrated `talk time' and `pauses' to be consistent problems for a sample of socially anxious undergraduates across several social interactions; Conger and Farrell (1981) found longer talk time to be correlated with lower anxiety ratings and higher skill ratings in an undergraduate sample; and Trower (1980) and Trower et al. (1978) reported talk time discriminated socially competent from incompetent psychiatric patients. In our rating system, like that of Trower et al. (1978), both monosyllabic responses and responses so long as to prevent discourse are rated as poor. (d) Gaze or eye contact has been long taught as an element of assertion and social skill training. Combined with body orientation, gaze was related to global ratings of anxiety and skill for psychiatric patients in the sample from Monti et al. (1984). Similarly, gaze distinguished between socially adequate and inadequate psychiatric patients in the research from Trower (1980) and Trower et al. (1978). In undergraduate samples, Conger and Farrell (1981) found gaze was correlated with anxiety ratings, and Dow (1985) identified gaze as consistently problematic in his socially anxious participants. Finally, Turner et al. (1986) found that patients with avoidant personality disorder had significantly lower scores on ratings of appropriate gaze than did socially phobic patients without avoidant personality. (e) Discomfort ratings include most elements of the items of Monti et al. (1984) for `extremity movements', `self-manipulations', `facial expression', `posture', and `gestures'. These items all appear to evince discomfort and, on the whole, were found to be significantly inter-correlated in both student and psychiatric samples ( Monti et al., 1984). All were correlated with global ratings of anxiety for the patient population, and most for the student population. Similarly, Dow (1985) found stammering, trembling, and fidgeting to be a consistent problem for socially anxious undergraduates across several conversations, and Trower (1980) reported that socially competent patients gestured more and were less rigidly immobile in posture than socially incompetent patients. However, anxiety ratings did not distinguish socially phobic patients with and without avoidant personality disorder in the sample from Turner et al. (1986). This system, the Social Performance Rating Scale (SPRS), is designed to be applied to observations of videotaped or live conversations between two people. Thus, in contrast to the midi-level assessment used by Monti et al. (1984), the present codes are designed to be used to rate the subject's interaction with another person, whether a confederate or another subject. Although this approach has the disadvantage of being less precisely structured than the Simulated Social Interaction Test (Monti et al., 1980) or the procedure of Monti et al. (1984) of taping participants while they spoke to a person who did not respond, its positive features include allowing coding of features of interactive behavior (e.g., responsiveness to the partner's comments) that are almost certainly important in social discourse. The purpose of the present study was to evaluate the inter-rater reliability and convergent, divergent, and criterion-related validity of this revised Social Performance Rating Scale for use with a socially phobic population. Criterion-related validity was examined by comparing conversation performance ratings for people with generalized social phobia to those of people with other anxiety disorders and to a non-anxious control group. Convergent validity was tested via correlations with measures of social phobia and shyness, and divergent validity via correlation with a measure of general anxiety. The latter is a particularly stringent test of divergent validity in that the question posed is whether the SPRS is more highly related to measures of a specific type of anxiety (social anxiety) vs. a more general type of anxiety. If the SPRS is to be useful in research and treatment of social phobia, it is important that it detect differences in social performance apart from those induced by depression. Because people with generalized social phobia are often somewhat depressed (e.g., Tran and Chambless, 1995; Feske et al., 1996), and episodes of depression are marked by poor social functioning (see Gotlib and Hammen, 1992), we excluded people with clinical diagnoses of depression from this study.