بازخورد ویدیویی با رتبه بندی همکار در وضعیت اضطراب طبیعی برای اختلال اضطراب اجتماعی: گزارش اولیه

Abstract The present study aimed to examine how video feedback can affect perceived performance and anticipatory anxiety in various naturalistic social anxiety-provoking situations among clinical patients diagnosed with social anxiety disorder (SAD) and to examine predictors that might influence response to video feedback. Participants were 52 consecutive patients with DSM-IV SAD who participated in a group-based CBT program. Our results demonstrated that video feedback was associated with a decrease in the underestimation of own performance as well as the perception of feared outcomes. Moreover, anticipatory anxiety decreased after video feedback combined with peer feedback. Male sex, comorbidity with other anxiety disorders, and benzodiazepine prn, as well as patients' initial anxiety and avoidance were negative predictors of the effect of video feedback.

. Introduction Video feedback (VF) of one's own appearance and performance is said to be an effective method to modify self-imagery and allow individuals with social anxiety disorder (SAD) to obtain more accurate self-perceptions (Clark, 2001). To date, a number of studies have provided support for the effect of VF (Harvey et al., 2000, Kim et al., 2002, Rapee and Hayman, 1996 and Rodebaugh, 2004). However, there is still some room for further investigation with regard to process of VF. First, most studies have been carried out using analogue populations and most have restricted the procedure to speech tasks rather than other kinds of social tasks (Harvey et al., 2000, Rapee and Hayman, 1996 and Rodebaugh, 2004). Second, at least some research has failed to demonstrate effects of VF with cognitive preparation on speech anxiety despite showing improvements in self-perceptions of performance (Rodebaugh, 2004). Further, whether videotape feedback with cognitive preparation affects other social anxiety symptoms such as anticipatory anxiety and idiosyncratic cognitions in connection with specific role play tasks remains to be investigated. In this connection, Rapee and Hayman (1996) suggested that changes in anxiety may need stronger feedback including the possibility of combining video with other methods of feedback such as input from a therapist, group, or significant other. In a similar fashion, Hirsch and Clark (2007) suggested that it may be therapeutic to obtain objective feedback on the socially anxious individual's social performance from other people by asking them to rate the client's performance and then to have the socially anxious individuals compare these independent ratings with their self-ratings. Given evidence that people high in social anxiety show a bias in the way they interpret and remember feedback provided by others (Edwards, Rapee, & Franklin, 2003), it may be important for socially anxious individuals to get immediate feedback about their performance and to understand that their symptoms are not as noticeable to other people as they thought. Lastly, no research to date has investigated whether any demographic variables and intrapersonal characteristics can affect response to VF. Potential hypotheses may be found in related literature on predictors of response to CBT such as pretreatment symptom severity, comorbid depression, or age of onset (Cameron et al., 1986 and Scholing and Emmelkamp, 1999). Moreover, benzodiazepines used on an as-needed basis may exert particular influence on performance anxiety (Davidson, 2006 and Stahl, 2002). As VF is an important component of CBT which works on beliefs regarding one's own performance, it appears warranted to examine the influence of certain demographic and pretreatment variables on response to VF. The present study aimed to replicate and extend previous research by examining how VF with cognitive preparation can affect perceived performance, feared outcomes and anticipatory anxiety in various naturalistic social anxiety-provoking situations among SAD patients. Furthermore, we also evaluated the influence of several predictors of the effect of VF.

3. Results 3.1. Demographic and diagnostic characteristics of the patients Table 1 summarizes the demographic and clinical characteristics of the patients. Table 1. Demographic and clinical characteristics of the patients. Age (years), mean (SD) 31.3 (10.1) Age of onset (years), mean (SD) 17.8 (7.2) Gender Male, n (%) 31 (59.6) Female, n (%) 21 (40.4) Comorbidity With comorbidity, n (%) 19 (36.5) Without comorbidity, n (%) 33 (63.5) Medication Benzodiazepine (regular), n (%) 12 (23.1) Benzodiazepine (pro re nata), n (%) 8 (15.4) Antidepressant, n (%) 25 (48.1) Both benzodiazepine and antidepressant, n (%) 10 (19.2) Baseline measures LSAS, mean (SD) 78.3 (25.8) LSAS: the Liebowitz Social Anxiety Scale. Table options 3.2. Internal consistency of mSPRS Calculation of the internal consistency for patients' self-rating before and after VF as well as peer ratings showed the following alphas: self-rating before VF: 0.89; self-rating after VF: 0.92; peer rating: 0.92. 3.3. Perception of overall performance, feared outcome, and anticipatory anxiety Table 2 shows the means and standard deviations of the measures. The change on self-evaluation of performance, perception of feared outcome and anticipatory anxiety from before to after VF demonstrated effect sizes that were moderate to extremely large. Table 2. Means, SDs and Effect sizes for ratings of perception of overall performance, feared outcome, anticipatory anxiety and behavioral assessment before and after video feedback. Measures Before video feedback After video feedback Within-group effect size Perception of overall performance 41.38 (27.13) 54.04 (27.53) 0.46 Perception of feared outcome 63.55 (21.97) 28.66 (28.51) 1.37 Anticipatory anxiety 84.44 (17.65) 64.44 (20.28) 1.05 Table options 3.4. Behavioral assessment by self and peers Calculation of effect sizes for each item of the mSPRS indicated that differences from before to after VF were small to medium (from 0.06 to 0.74), with items on facial expression and body tension displaying moderate effects (0.74 and 0.53 respectively) while the remainder displayed small effects. Furthermore, significant differences between patients' self-ratings and ratings given by peers before and after VF were seen on each item as well as the total score of the mSPRS (Table 3). Table 4 shows the agreement between the peer ratings and the patients' self-ratings before and after the VF. Table 3. Means and SDs for ratings of behavioral assessment by patients and peers before and after video feedback. Behavioral assessment Self-rating before video feedback Peer rating t-Test p value Self-rating after video feedback Peer rating t-Test p value Gaze 2.97 (1.25) 3.84 (0.97) p = 0.001 3.10 (1.30) 3.88 (0.97) p = 0.002 Voice 2.28 (0.88) 3.33 (0.72) p < 0.001 2.37 (0.85) 3.32 (0.71) p < 0.001 Fluency 2.78 (1.25) 3.99 (0.91) p < 0.001 3.22 (1.28) 4.01 (0.93) p < 0.001 Body tension 2.32 (0.98) 3.74 (0.96) p < 0.001 3.00 (1.23) 3.74 (0.98) p = 0.001 Face tension 2.18 (0.97) 3.50 (0.91) p < 0.001 2.86 (1.09) 3.51 (0.90) p = 0.001 Concentration 2.38 (1.07) 3.83 (1.06) p < 0.001 3.09 (1.29) 3.86 (1.08) p < 0.001 Flow 2.86 (0.97) 4.16 (0.69) p < 0.001 3.17 (1.00) 4.19 (0.70) p < 0.001 Total 17.96 (6.14) 26.14 (5.28) p < 0.001 21.00 (7.03) 26.45 (5.39) p < 0.001 Table options Table 4. Intraclass correlation coefficients for peer evaluations and patients' self-evaluation of behavioral assessments before and after video feedback. Before video feedback After video feedback Gaze 0.09 0.26* Voice −0.15 −0.10 Length 0.13 0.48*** Body tension −0.22 0.36** Facial expression −0.12 0.32** Concentration 0.04 0.41*** Flow −0.15 −0.06 Total 0.01 0.36** *p < 0.10, **p < 0.05, ***p < 0.01. Table options 3.5. Predictors of the effect of video feedback The existence of comorbid anxiety disorders was the only significant demographic predictor of the perception of feared outcome after VF whereas no significant predictor was found for the evaluation of overall performance and anticipatory anxiety after VF. In addition, significant relationships between the mSPRS total score and sex (Beta = −0.24, p = 0.04) as well as benzodiazepine (pro re nata; Beta = −0.25, p = 0.03) were found. A further multiple regression analysis using sex and benzodiazepine (pro re nata) as independent variables while controlling the mSPRS total score before VF showed that both of the variables remained statistically significant ( Table 5). Regarding pretreatment severity, significant correlations were shown between the LSAS and the evaluation of overall performance, anticipatory anxiety and the mSPRS total score after VF. Table 5. Predictors of the effect of video feedback. Dependent variable Independent variable B Beta t p Perception of feared outcome after VF (adj. R2 = 0.36, p < 0.01) Perception of feared outcome before VF 0.20 0.39 2.56 0.016 Comorbidity of other anxiety disorder 36.61 0.45 2.95 0.007 mSPRS total score after VF (adj. R2 = 0.72, p < 0.001) mSPRS total score before VF 0.85 0.79 7.19 <0.001 Gender −2.81 −0.22 −2.15 0.041 Benzodiazepine (pro re nata) 3.77 0.24 2.25 0.031 Evaluation of performance after VF (adj. R2 = 0.35, p < 0.01) Evaluation of performance before VF 0.36 0.36 1.98 0.060 Avoidance of performance −1.45 −0.39 −2.12 0.045 Anticipatory anxiety after VF (adj. R2 = 0.41, p < 0.01) Anticipatory anxiety before VF 0.05 0.05 0.18 0.863 LSAS total 0.49 0.66 2.51 0.024 mSPRS total score after VF (adj. R2 = 0.67, p < 0.001) mSPRS total score before VF 0.77 0.71 6.31 <0.001 Avoidance of social interaction −0.20 −0.25 −2.18 0.038 VF: video feedback. LSAS: the Liebowitz Social Anxiety Scale. mSPRS: modified Social Performance Rating Scale.