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Blushing is an involuntary reddening of the face that typically occurs when people are concerned about making negative impressions on others. Although people typically blush for their mishaps or misdeeds, Darwin observed that some people, and especially children, also blush when they are lavished with praise. We theorize that socially anxious children blush when praised in inflated ways because they believe they do not match the inflated image others hold of them. Such praise-induced blushing might be particularly common in late childhood, when children's worries about their social image escalate. In this randomized experiment, 105 children (ages 8–12, 85% Caucasian) sang in front of an audience. Afterwards, children received inflated praise (“You sang incredibly well!”), noninflated praise (“You sang well!”), or no praise. Children's physiological blushing was assessed through photoplethysmography and a temperature sensor. As predicted, inflated praise—but not non-inflated praise—increased blushing in socially anxious children. This emerged for blood pulse amplitude changes (AC reactivity) and self-reported blushing, not for blood volume (DC reactivity) and temperature changes. Socially anxious children may blush to “apologize” in advance for not being as incredible as others think they are. Thus, blushing may be elicited in situations that seem benign but actually evoke the fear of being evaluated negatively.

We investigated the role of self-focused attention (SFA) in social anxiety (disorder) in an ecologically valid way. In Experiment 1 high ( n = 26) versus low ( n = 25) socially anxious single women between 18 and 30 years had a video (“Skype”) conversation with an attractive male confederate, while seeing themselves and the confederate on-screen. The conversation was divided in four phases: (I) warm-up, (II) positive (confederate was friendly to the participant), (III) critical (confederate was critical to the participant), and (IV) active (participant was instructed to ask questions to the confederate). Participant's SFA was measured by eye-tracked gaze duration at their own image relative to the confederates' video image and other places at the computer screen. Results show that high socially anxious participants were more self-focused in the critical phase, but less self-focused in the active phase than low socially anxious participants. In Experiment 2 women diagnosed with SAD ( n = 32) and controls ( n = 30) between 18 and 30 years conducted the same experiment. Compared to controls participants with SAD showed increased SFA across all four phases of the conversation, and SFA predicted increased self-rated anxiety during the conversation. In conclusion, in subclinical social anxiety SFA is high only when the interaction partner is critical, whereas instructions to ask questions to the confederate reduces subclinical socially anxious’ SFA, while clinical SAD is characterized by heightened self-focused attention throughout the interaction. Results support theories that social anxiety disorder is maintained by SFA, and imply that interventions that lower SFA may help prevent and treat social anxiety disorder, but that SFA can also be adaptive in certain types of interaction, such as when receiving compliments.

Objective: This study investigated the diagnostic utility of the 71-item Screen for Child Anxiety Related Emotional Disorders (SCARED-71), as a screening tool for identifying anxiety disorders in youth aged 8-18 years.Method: The SCARED-71 and the Anxiety Disorder Interview Schedule (ADIS) were administered to clinically referred anxious children (n = 138) and control children (n = 38) as well as their parents.Results: Results showed that the SCARED-71 differentiated clinically anxious from control children on the total score and on all subscales. Girls generally reported higher levels of anxiety symptoms and there were also significant age effects for various anxiety subscales. Further, reliable cut-off scores were established for the child and parent version of the SCARED-71. The parent version displayed better sensitivity and specificity, and therefore seems to be a more optimal screen for anxiety problems in children and adolescents. Finally, evidence for the predictive validity across anxiety disorders was found.Conclusion: The SCARED-71 can be used as a screening tool to detect clinically significant anxiety problems in children and adolescents and discriminates reasonably well among specific anxiety disorders.

Social phobia patients with fear of blushing, trembling, sweating and/or freezing as main complaint (N = 65) were randomly assigned to either task concentration training (TCT) or applied relaxation (AR) both followed by cognitive therapy (CT). Measurements took place before and after wait-list, after TCT or AR (within-test), after CT (post-test), at 3-months and at 1-year follow-up. Effects were assessed on fear of showing bodily symptoms (the central outcome variable), social phobia, other psychopathology, social skills, self-consciousness, self-focused attention, and dysfunctional beliefs. No changes occurred during wait-list. Both treatments were highly effective. TCT was superior to AR in reducing fear of bodily symptoms and dysfunctional beliefs at within-test. This difference disappeared after CT, at post-test and at 3-months follow-up. However, at 1-year follow-up the combination TCT-CT was superior to AR-CT in reducing fear of bodily symptoms, and effect sizes for TCT-CT reached 3. Furthermore, at all assessment moments TCT or the combination TCT-CT was superior to AR-CT in reducing self-consciousness and self-focused attention. The superior long-term effect of TCT on fear of showing bodily symptoms is explained by lasting changes in attentional focus.

Previous research demonstrated that social phobia is characterized by content-specific interpretation and judgmental biases. The present study investigated whether this interpretation bias occurs not only in ambiguous, but also in positive and negative social events, and whether social phobic patients (SPs) are more characterized by a judgmental bias in costs than in probability. Besides, we argued that the judgmental bias observed in former studies could also be attributed to accurate estimations of SPs (of, for example, stuttering). Therefore, we assessed judgmental bias by the ratings of probability and costs of a negative evaluation (e.g. ‘people dislike me’) and not, as in previous studies, of negative social events (e.g. ‘stuttering’). SPs (n=228) and normal controls (n=33) were presented social and non-social events ranging from positive to profoundly negative. They ranked four different interpretations on likelihood to assess interpretation bias, and rated the profoundly negative interpretation on probability and cost to assess judgmental bias. SPs demonstrated content-specific interpretation and judgmental biases that also occurred in positive and negative social events. In contrast with expectations, SPs were characterized by a judgmental bias in both costs and probability.

An illusory correlation (IC) experiment examined the presence of a phobia-relevant covariation bias in the context of social anxiety. 60 female college students (28 with low and 32 with high social anxiety) were shown a series of slides comprising pictures of angry, happy, and neutral faces which were randomly paired with either a shock, a siren or nothing. One half of the Ss were shown female faces, whereas the other half were shown male faces. Ss indicated outcome expectancies on a trial by trial basis. After the experiment proper they estimated the contingencies of all slide/outcome combinations. Ss showed both an a priori and an a posteriori IC between angry faces and shock. This covariation bias was similar for men and women faces and independent of prior fear. It is concluded that the pattern of results is consistent with the idea that ICs arise from initial expectancies that survive extinction.

According to cognitive and interpersonal models, safety behaviors in social phobia (e.g., avoiding eye contact, hiding blushing) erroneously induce negative evaluation by interaction partners. Presumably, a bias about the social outcome of safety behaviors causes this negative interaction cycle. Such a bias might be subject to double standard in social phobia (i.e., having more stringent rules for oneself than for others). Female students (n = 81) predicted more negative social outcomes for a prominent type of safety behavior, hiding anxiety, than for the opposite behavior, acknowledgment of anxiety and ongoing behavior (control condition) in scripts of self- and other-target persons. The relation between social anxiety and double standard was robust. Social anxiety did not relate to a cognitive bias regarding hiding ones anxiety, as we expected, but was associated with the belief that acknowledgment of anxiety has negative social outcomes specifically for them. These results are evaluated in light of the interpersonal consequences anxiety-related behaviors have in social interactions.

This study examined the effect of attentional focus on social anxiety in three groups of subjects: high versus low blushing-anxious participants (n=48); high versus low socially anxious participants (n=60); and social phobic patients compared to patients with other anxiety disorders (n=48). Participants were asked to imagine two series of social situations, in which the hero was in the centre of others' attention. In the first series of stories, the type of feedback from the audience (positive, negative and neutral) and the direction of attention of the hero (self- versus task-focused) were manipulated, and in the second series of stories, the presence or absence of blushing and the direction of attention of the hero were manipulated. In line with the expectations, self-focused attention (SFA) led to more social anxiety than task-focused attention (TFA) in all the three experiments, and high blushing-anxious, socially anxious, and social phobic groups reported higher levels of self-awareness than their low-anxious comparison groups. No evidence was found for the idea that self-focusing is specifically detrimental for participants who are already socially anxious, blushing-anxious, or socially phobic. Also, attentional focus did not interact with the valence of social feedback. Finally, results provided some support for the hypothesis that fear of blushing is mediated by self-focusing. The results suggest that irrespective of trait social anxiety, and irrespective of the outcome of a social situation (positive, neutral or negative), SFA increases state social anxiety, or TFA decreases state social anxiety.

Retrospective studies suggest a relationship between parental rearing practices and social phobia. The present study investigated whether socially anxious children perceive their current parental rearing as rejecting, overprotective, and lacking emotional warmth, and as emphasizing the importance of other's opinion, and de-emphasizing social initiatives and family sociability. Furthermore, we examined whether parents of socially anxious children report to rely on such rearing practices, and suffer themselves from social fears. A regression analysis as well as extreme group comparisons were applied. Little support was found for the presumed role of the assessed family rearing aspects in the development of social anxiety in children. Solely family sociability (children's and mothers' report) and children's perception of overprotection of the mother predicted social anxiety in the regression analysis. Given the influence of the mentioned rearing practices, social anxiety of the mother still significantly predicted social anxiety of the child. In the extreme group comparisons, differences in the expected direction were found between socially anxious and normal children on parental rejection, emotional warmth, and family sociability. However, the lack of differences between socially anxious and clinical control children suggests that these variables do not form a specific pathway to social fears.

Two studies, investigating the learning history (i.e. traumatic conditioning experiences, vicarious learning, informational learning) of individuals with and without fear of blushing, are presented. In study 1, individuals high (n = 61) and low (n = 59) in fear of blushing completed the (revised) Phobic Origin Questionnaire [POQ; Ost, L. G., & Hugdahl, K. (1981). Acquisition of phobias and anxiety response patterns in clinical patients. Behavior Research and Therapy, 19, 439-447]. In study 2, individuals who applied for treatment for fear of blushing (n = 31) and a nonfearful, matched control group (n = 31) were interviewed with the same instrument, taking into account only specific memories. High fearful individuals reported more negative learning experiences in connection with blushing than low fearful individuals, irrespective of the type of questioning. Meanwhile, study 1 (written POQ) produced higher percentages of negative learning experiences for both high and low fearful individuals than study 2 (interview). It is concluded that the POQ interview showed a more realistic picture than the written POQ. The possible role of learning history in the acquisition of fear of blushing is discussed.