شاخص های شناختی اضطراب اجتماعی در جوانان: تحلیل معادلات ساختاری

Previous studies have demonstrated significant relationships among various cognitive variables such as negative cognition, self-efficacy, and social anxiety. Unfortunately, few studies focus on the role of cognition among youth, and researchers often fail to use domain-specific measures when examining cognitive variables. Therefore, the purpose of the present study was to examine domain-specific cognitive variables (i.e., socially oriented negative self-referent cognition and social self-efficacy) and their relationships to social anxiety in children and adolescents using structural equation modeling techniques. A community sample of children and adolescents (n = 245; 55.9% female; 83.3% Caucasian, 9.4% African American, 2% Asian, 2% Hispanic, 2% “other,” and 1.2% not reported) completed questionnaires assessing social cognition and social anxiety symptomology. Three latent variables were created to examine the constructs of socially oriented negative self-referent cognition (as measured by the SONAS scale), social self-efficacy (as measured by the SEQSS-C), and social anxiety (as measured by the SPAI-C and the Brief SA). The resulting measurement model of latent variables fit the data well. Additionally, consistent with the study hypothesis, results indicated that social self-efficacy likely mediates the relationship between socially oriented negative self-referent cognition and social anxiety, and socially oriented negative self-referent cognition yields significant direct and indirect effects on social anxiety. These findings indicate that socially oriented negative cognitions are associated with youth's beliefs about social abilities and the experience of social anxiety. Future directions for research and study limitations, including use of cross-sectional data, are discussed.

The most efficacious method of treatment for social anxiety among children and adolescents is cognitive-behaviorally based treatment (Chambless and Ollendick, 2001, Chambless et al., 1998, Davis et al., 2011, Hodson et al., 2008, Ollendick and King, 2004, Silverman and Ollendick, 2008 and Silverman et al., 2008). Unfortunately, until recently, cognitive variables have been largely overlooked in children (Davis and Ollendick, 2005 and Davis et al., 2011), and cognitive components of treatment have been focused more on skills implementation than thought modification (Melfsen et al., 2011). Although exposure is the most critical component of cognitive behavior therapy (CBT; Davis & Ollendick, 2005), it has been posited that children can benefit from cognitive strategies in therapy, given the appropriate circumstances and modifications (Davis et al., 2011, Melfsen et al., 2011 and Ronen, 1992). Previous studies have implicated specific cognitive variables (e.g., negative self-referent cognitions, self-concept, self-efficacy, and coping beliefs) in the presentation of social anxiety, but questions remain as to the specific role that each cognitive variable plays. The purpose of the present study was to further explore the relationships among socially oriented cognitive variables and social anxiety among children and adolescents using structural equation modeling (SEM) techniques to better delineate the cognitive process of social anxiety in youth and perhaps inform and enhance cognitive-behavioral treatment practices. Although social phobia is known as a clinical disorder that involves an excessive or unreasonable, marked and persistent fear of social situations that invariably provokes an anxiety response (DSM-IV-TR; American Psychiatric Association, 2000), Schlenker and Leary (1982) defined the continuous construct of “social anxiety,” as a broader and more encompassing construct that results from the prospect or presence of personal evaluation along with a fear of social failure and criticism. Two types of situations, interaction anxiety and performance anxiety, have predominantly been identified as anxiety-provoking and distinguishable areas of social anxiety (Mattick & Clarke, 1998). Whereas each of these areas is distinct, both have demonstrated strong relationships with socially oriented cognitive variables. Negative cognition has been linked to the manifestation of social anxiety among youth and adults (Cieslak et al., 2008, Glass and Furlong, 1990, Leary and Atherton, 1986 and Muris, 2002). Children are thought to be capable of perspective taking and recursive thought (i.e., thinking about what another person is thinking about) beginning around 7–8 years of age, with full development of more abstract “other” perspective thinking by age 15 years (Selman, 1980 and Selman and Jaquette, 1977). Similarly, research regarding theory of mind (TOM), the ability to attribute mental states, beliefs, intents, and so on to oneself and others, suggests that perspective taking and metacognition begin to develop as young as 5–7 years with TOM being more fully developed by the middle teenage years (Wellman, Cross, & Watson, 2001). Negative self-evaluations, as well as perceptions of how others view oneself, are thought to heavily impact one’s own anxiety for social situations and performance in those situations (Clark and Wells, 1995 and Leary, 1983). Given this information, onset of childhood social anxiety typically occurs, not surprisingly, between the late childhood and midteenage years (DSM-IV-TR; Davis et al., 2009 and Van Roy et al., 2009). Negative self-referent cognition is classified as internal dialogue that is negative in content, state oriented, and can have a lasting emotional impact on disordered and nondisordered youth (Ronan et al., 1994 and Sood and Kendall, 2007). General negative self-statements are associated with irrational beliefs, fear of negative evaluation, and global behavior ratings of social interactions (Glass & Furlong, 1990), with a greater number of negative self-statements being positively correlated with higher levels of social anxiety in adults (e.g., Glass & Furlong, 1990), children, and adolescents (e.g., Wichmann, Coplan, & Daniels, 2004). However, the content and frequency of negative self-statements tend to differ across different anxiety-provoking situations (King et al., 1995, Prins, 1986 and Sood and Kendall, 2007), and therefore, it may be more appropriate to examine the impact of more situationally specific negative self-referent cognition in social anxiety. Rudy and Davis (2013) created a measure designed specifically to address negative self-referent cognition among the two types of social anxiety (performance anxiety and interaction anxiety). Preliminary investigations indicated that situationally constrained (socially oriented) negative cognitions were highly associated with the increased self-report of social anxiety among youth (Rudy & Davis, 2013). Melfsen and colleagues (2011) demonstrated similar findings with a similar assessment measure (i.e., the SAKK; Graf, Gerlach, & Melfsen, 2007) designed for assessment of German youth. Using vignette-based social scenarios, Prinstein, Cheah, and Guyer (2005) found that their parallel construct, critical self-referent attributions were positively associated with increased internalizing symptoms such as depression, social anxiety, and loneliness. Further, Clark and Wells’s (1995) cognitive model of social anxiety indicated that negative social cognitions and self-focused attention play a crucial role in the manifestation of social anxiety, a finding that has been corroborated with youth by multiple researchers (e.g., Hodson et al., 2008 and Johnson and Glass, 1989). The construct of self-efficacy has also been established as an important cognitive component of the experience of social anxiety. Bandura, 1977 and Bandura, 1997 described self-efficacy as the belief in one’s own capability to do something. This construct is also thought to be best understood as situationally specific in nature (Bandura, 1977, Bandura, 1997 and Leary and Atherton, 1986) but is likely somewhat more stable or trait based than negative self-statements (Bandura, 2001). Socially oriented self-efficacy, or “social self-efficacy,” is best described as a person's belief in his or her ability to accurately execute social situations. For instance, if a person does not believe that he or she can accurately perform a social situation, the lack of confidence is likely to heighten anxiety and decrease the probability of competently handling the situation (Leary & Atherton, 1986). In youth, researchers have repeatedly demonstrated the connection between social self-efficacy and social anxiety, with social self-efficacy being highly associated with the experience of feelings of social anxiety (Muris, 2002, Smári et al., 2001, Spence et al., 1999 and Wheeler and Ladd, 1982). Further, social self-efficacy has been determined as distinct among different relationships (i.e., peers, strangers, adults), and may differentially impact anxiety within those relationships (Hannesdóttir & Ollendick, 2007). Specifically how this construct affects social anxiety, however, is poorly understood. To better comprehend the cognitive aspect of social anxiety in youth, it is important to understand associated cognitive variables in the context of one another, rather than just their singular associations with social anxiety. Negative self-referent cognition has been found to be highly associated with self-efficacy (Rudy et al., 2012 and Rudy et al., 2013). In referencing the theory of self-reflectiveness, Bandura (2001) discussed that self-reflectiveness is considered to be a multitier process in which thoughts may lead to beliefs, which lead to future actions or agency. Self-reflectiveness influences a person’s beliefs, and in turn, his or her competency and life choices. Taking into consideration the situationally specific nature of these constructs, it is likely that socially oriented negative self-referent cognition (more state based) influences social self-efficacy (more trait based), rather than vice versa, which in turn influences social anxiety. This specific model for variable relationships has been demonstrated in other contexts such as coping and PTSD (see Cieslak et al., 2008). Rudy and colleagues (2012) demonstrated that global self-efficacy mediated the relationship between global negative self-referent cognition and social anxiety; however, social self-efficacy did not fully mediate the relationship between global negative cognition and social anxiety. The question remains as to whether social self-efficacy was too specific to encompass the effects of broad negative cognitions (i.e., a method effect—constructs poorly matched) or if even socially oriented negative self-statements (a more situationally specific and contextually appropriate construct) are powerful enough to influence social anxiety beyond their effect on social self-efficacy. Melfsen and colleagues (2011) demonstrated that cognitive therapy targeting negative cognitions and coping/efficacy in social situations significantly decreased socially related negative self-evaluations and overall levels of social anxiety as compared with controls; however, coping/efficacy beliefs for social situations remained the same. Also, while significant decreases in social anxiety were demonstrated, only 36% of the sample no longer met criteria for social phobia at treatment completion ( Melfsen et al., 2011). Understanding the relationship among these three variables could have important implications in identifying treatment channels and target variables. As stated before, CBT has been demonstrated as a well-established, best-practice technique for treating social anxiety in youth (e.g., Chambless and Ollendick, 2001, Chambless et al., 1998, Ollendick and King, 2004 and Silverman et al., 2008). Although exposure is likely the most critical component of treatment ( Chorpita and Daleiden, 2009 and Davis and Ollendick, 2005), a basic premise of the utility of CBT lies in the idea that through cognitive restructuring, altering cognitions can change core beliefs ( Chorpita, 2007 and Kendall, 1993). If, in this way, negative cognitions (i.e., negative self-statements) are suspected theoretically to influence core beliefs (e.g., self-efficacy), targeting these variables more specifically in a stepwise progression as a part of exposure-based CBT may lead to enhanced treatment outcomes.