The current study investigates an experimental anxiety reduction intervention among a highly socially anxious sample (N = 108; n = 36 per Condition; 80 women). Using a conditioning paradigm, our goal was to modify implicit social anxiety associations to directly test the premise from cognitive models that biased cognitive processing may be causally related to anxious responding. Participants were trained to preferentially process non-threatening information through repeated pairings of self-relevant stimuli and faces indicating positive social feedback. As expected, participants in this positive training condition (relative to our two control conditions) displayed less negative implicit associations following training, and were more likely to complete an impromptu speech (though they did not report less anxiety during the speech). These findings offer partial support for cognitive models and indicate that implicit associations are not only correlated with social anxiety, they may be causally related to anxiety reduction as well.
Social phobia, also known as social anxiety disorder, is an impairing condition characterized by excessive avoidance and fear of social situations (Diagnostic and Statistical Manual of Mental Disorders; APA, 1994). Although cognitive-behavioral interventions have received a great deal of empirical support, nearly half of the patients who seek treatment for social anxiety fail to fully respond (Turner, Beidel, Wolff, Spaulding, & Jacob, 1996). Clearly, additional research is necessary in order to better understand the mechanisms underlying symptom improvement.
In the current study, we developed an experimental intervention based on cognitive models of anxiety, and tested it among a highly socially anxious sample. Using a cognitive training paradigm, we sought to modify implicit social anxiety associations, which are automatic evaluations that reside outside conscious control (see Greenwald, McGhee, & Schwartz, 1998). These associations are thought to share some similarities with anxious schemas (see Teachman, Marker, & Smith-Janik, 2008). Thus, by training implicit associations and evaluating the impact on social behavior, our goal was to more directly test the causal premise underlying cognitive theories of social phobia—that maladaptive self-schemas contribute to the maintenance of social anxiety and avoidance behaviors (Clark & Wells, 1995).
1. Cognitive processing models of social anxiety
General cognitive models of anxiety propose that maladaptive schemas (i.e., cognitive scripts or frameworks) guide cognitive processing such that anxious individuals pay attention to, interpret, and remember information that is relevant to fear and anxiety (Beck & Clark, 1997). These biases theoretically maintain social anxiety by reinforcing the idea that social situations are threatening (Clark & Wells, 1995). When giving a speech, for example, individuals with social anxiety may initially notice the only negative facial expression in a large audience, and interpret this as a sign that they are failing miserably.
There is abundant evidence that cognitive biases are correlated with pathological anxiety, but many researchers theorize that there is also a causal relationship between cognitive processing and anxious responding ( MacLeod, Rutherford, Campbell, Ebsworthy, & Holker, 2002). In our earlier example, initially attending to a negative facial expression and interpreting it in a biased way (e.g., “I’m a failure”) would be expected to cause elevated levels of anxiety and future avoidance behavior. However, experimental approaches to establish this causal relationship have been limited, so the direction or existence of causality remains unclear.
More recently, researchers have begun to manipulate cognitive biases to directly test causality. For instance, Amir et al. found that when participants were trained to attend away from threatening information, this not only resulted in reduced symptoms of social anxiety as assessed by an independent rater ( Amir, Weber, Beard, Bomyea, & Taylor, 2008), but the benefits of training were evident for up to a year after the study (personal communication with N. Amir; July 2008). Similar demonstrations have been shown in interpretation bias training within the context of social anxiety (e.g., Beard and Amir, 2008 and Murphy et al., 2007).
