Academic journal article The Psychological Record

Assessing Deictic Relational Responding in Individuals with Social Anxiety Disorder: Evidence of Perspective-Taking Difficulties

Academic journal article The Psychological Record

Assessing Deictic Relational Responding in Individuals with Social Anxiety Disorder: Evidence of Perspective-Taking Difficulties

Article excerpt

When feelings of discomfort and of lacking confidence in social situations are severe enough to adversely affect daily life functioning (e.g., leading to the avoidance of nearly all social situations), individuals are diagnosed with social anxiety disorder (SAD), or social phobia. Patients with SAD report an overwhelming and intense fear of being judged by others or of being humiliated by their own actions (American Psychiatric Association 1994). SAD is a highly prevalent chronic disorder, and randomized control trials indicate that a large proportion of patients suffering from social anxiety remain symptomatic after receiving adequate treatment (Davidson et al. 2004; Otto et al. 2000).

Comorbid SAD and/or symptoms of social anxiety are present in a variety of psychiatric disorders, including schizophrenia (Achim et al. 2011; Penn et al. 1994), autism spectrum disorders (Bellini 2004; Gillot et al. 2001; Green et al. 2000), bipolar disorder (Kessler et al. 1999), obsessive--compulsive disorder (Weissman et al. 1994), and general anxiety disorder Mennin et al. 2000). Shared characteristics of comorbid SAD, such as difficulties in forming close relationships and interpreting social signs and nuances, as well as low self-esteem, are regularly displayed and may point to a common history of constrained social--cognitive growth. However, although the linkage between social skills and anxiety has been largely acknowledged, the precise nature of this relation remains poorly understood (Bellini 2006).

Dominant cognitive approaches to SAD aim at a better understanding of the mental processes of mind. Often, anxiety is considered as a cause of SAD. However, particularly regarding treatment, it is of equal importance to consider the history of the (maintaining) consequences of social fear. In SAD, a repeating sequence of unsatisfactory interactions may stimulate a person to avoid further social encounters. This fundamental lack of (multiple exemplar) experiences could lead to a systematic underrehearsal of the behavioral repertoires that are necessary for the refinement of social skills (Cartwright-Hatton et al. 2005). The inability to develop adaptive responses in social situations may in turn lead to feelings of anxiety, thereby preventing an individual from effectively coping with a situation. Such an extended history of systematic avoidance, together with one's concerns, may develop into some level of performance deficits. In this view, social withdrawal or avoidance itself could be considered as "the gateway to anxiety" (Achim et al. 2011; Dymond and Roche 2009, p. 11), responsible for the circular pattern between anxiety and social skill deficiencies.

Regular treatments of social phobia aim at the reduction of negative self-focused attention and self-perception (Moscovitch 2009) but are not always successful. Ideally, cognitive restructuring and gradual exposure to feared events should result in a significant reduction of fear and more adequate social behavior. If, however, the fundamental building blocks of socialization are already weak by a lifetime of poorly trained basic skills, some individuals might not be able to benefit from these rather sophisticated interventions without complementary training. In this view, efficacious treatment that aims to alter the environmental consequences that maintain discnabling behavior could thus profit from a better understanding of the deficits in these fundamental processes, for example, in the defining properties of basic skills that facilitate the further refinement of social functioning.

As to the exact relationship between basic social cognitive skills and varying levels of anxiety, research has demonstrated that impaired perspective taking is negatively associated with the display of prosocial behavior and forms the core of social skill deficits that are found, for example, in schizophrenia and autism spectrum disorders. These deficits may contribute to the occurrence of fear and add to both avoidant and paranoid behavior (see, e. …

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