Relationships among Social Anxiety, Self-Focused Attention, and Experiential Distress and Avoidance
Glick, Debra M., Orsillo, Susan M., Journal of Evidence-Based Psychotherapies
Self-focused attention is a notable feature of social anxiety, yet research has not established its function. We hypothesized that self-focused attention may reflect attempts to control or alter internal experiences (i.e., experiential avoidance). Undergraduates high in social anxiety reported more fear of losing control over emotions, more thought suppression, more distress about emotions, and less perceived control over emotions than did those low in social anxiety. Finally, experiential distress and avoidance was a partial mediator of the relationship between self-focused attention and scores on a measure of social anxiety. Implications for the treatment of social anxiety are discussed.
Keywords: social anxiety, social phobia, acceptance, experiential avoidance
Social Phobia, or Social Anxiety Disorder1 is characterized by excessive fear and avoidance of social or performance-based situations in which one could be scrutinized by others (DSM-IV-TR, 2000). Social phobia affects up to 12% of people (Kessler, Berglund, Demler, Jin, Merikangas, & Walters, 2005) and has a significant negative impact on vocational and social functioning (e.g., Turk, Heimberg, & Magee, 2008).
Contemporary theories of social phobia suggest the involvement of cognitive biases in its development and maintenance. For example, Clark and Wells (1995) propose that individuals with social phobia hold excessively high standards for their social performance, conditional beliefs about the consequences of their social behavior, and unconditional negative beliefs about themselves. From a cognitive-behavioral perspective, these cognitions increase fear, leading to behavioral avoidance (Butler & Wells, 1995). Although negatively reinforcing in the short-term, this avoidance interferes with long term habituation and maintains anxiety (Heckelman & Schneier, 1995). Drawing from this theory, cognitivebehavioral treatments attempt to dispute fear-related cognitions and reduce behavioral avoidance (e.g., Cognitive Behavioral Group Therapy; CBGT; Heimberg & Becker, 2002). However, in a recent review of the literature (Hofmann and Bögels(2006) found that 40 to 50% of participants who receive conventional CBT for social phobia show little or no improvement and concluded that research aimed at improving and refining CBT are needed.
One approach to improving treatments may be to target other characteristics of the disorder. For instance, there is a large literature supporting the potential role of attentional processes in maintaining social phobia (e.g., Bögels & Mansell, 2004). Individuals with social phobia tend to shift their attention internally during social situations (Clark & Wells; 1995), which increases self-reported anxiety (Bögels & Lamers, 2002; Woody & Rodriguez, 2000; Woody, 1996) and likely interferes with the disconfirmation of negative beliefs. Alternatively, directing attention externally during exposure to feared social situations has been shown to be more effective than exposure alone in reducing anxiety and negative cognitions (Wells & Papageorgiou, 1998).
Given the potentially negative cycle among anxiety, attention, and performance (Clark & Wells, 1995), it is important to understand why socially anxious individuals engage in self-focused attention, as this knowledge may aid in developing and refining treatments (Hope, Gansler, & Heimberg, 1989). It is unclear whether self-focused attention is an automatic response to the increased physiological arousal socially anxious individuals experience in anxietyprovoking situations (Hope et al., 1989) or if it is a more deliberate coping strategy aimed at preventing embarrassment (Wells, Clark, Salkovskis, Ludgate, Hackmann, & Gelder, 1995) and negative evaluation (Rapee & Heimberg, 1997). We propose that self-focused attention may be best conceptualized as an attempt to suppress, control, or alter uncomfortable internal experiences (i. …