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Given the strong associations of social anxiety disorder (SAD) with interpersonal problems and insecure attachment, this study sought to examine specific interpersonal problem domains in relation to the outcome of cognitive-behavioral therapy (CBT) for SAD. Ninety-five adults with SAD received individual CBT and completed a measure of attachment style at pretreatment, as well as measures of interpersonal problems and social anxiety at pre- and posttreatment. At baseline, social anxiety was significantly associated with overall interpersonal problems, multiple specific interpersonal problems, as well as insecure attachment. Interpersonal problems decreased significantly over the course of treatment but did not predict a reduction in social anxiety. No specific interpersonal problem predicted changes in social anxiety. The greatest changes from pre- to posttreatment were observed across avoidance-related interpersonal problems. Higher levels of secure attachment predicted lower social anxiety, but individuals with less secure attachment experienced a greater reduction in social anxiety from pre- to posttreatment. However, this interaction was significant for only one of three measures of social anxiety. Our findings suggest that although higher levels of interpersonal problems and lower levels of secure attachment predict greater social anxiety, interpersonal problems and insecure attachment do not predict poorer treatment outcome.

Health anxiety is associated with reassurance-seeking behaviors, including persistent medical care utilization. The current study sought to identify targetable and underlying (transdiagnostic) factors that may influence the relationship between health anxiety and medical care utilization. We examined the role of both anxiety sensitivity (AS; fear of arousal-related sensations) and intolerance of uncertainty (IU; fear of the unknown) in the relationship between health anxiety and likelihood of utilization of general, specialist, and emergency care among 566 adults (Mage = 20.47, SD = 3.54, 79.9% female). A three-way interaction revealed that AS strengthened the association between health anxiety and likelihood of general medical care utilization within the context of higher, but not lower, levels of IU. Only the main effects of AS and IU were significantly associated with odds of emergency care utilization, and there were no significant predictors of odds of specialist care utilization. Future directions and clinical implications are discussed.

Dysfunction in the ability to sustain, shift and broaden attention has been proposed as a mechanism of normative emotion regulation that is a common target of cognitive-behavioral therapies. Attention regulation deficits are central to generalized anxiety disorder (GAD) and may contribute to a generally rigid, avoidant, response style that produces substantial decrements in well-being and functioning. Emotion Regulation Therapy draws upon mindfulness-based regulatory skills to facilitate attentional change during an initial phase of treatment. Two studies examined task-based changes in flexibly shifting attention in response to conflicting emotional contexts and sustaining attention despite distressing emotional contexts. In Study 1, at pre-treatment, patients with GAD, as compared to controls performed significantly more poorly on an emotional conflict adaptation task (i.e., less ability to flexibly shift attention) and improved in conflict adaptation by mid-treatment (when attention regulation skills were being trained). This task-related change predicted increases in mindful observing abilities over the course of acute treatment but was not directly associated with clinical outcomes. In Study 2, a choice reaction time (RT) task was utilized to measure the ability to sustain attention by discriminating between two tones while overcoming the interference of aversive visual stimuli. At pre-treatment, participants with GAD demonstrated slower RTs (i.e., more difficulty sustaining attention on the tonal prompt) compared to controls and demonstrated more rapid RTs from pre- to mid-treatment. This improved task performance was related to clinical improvement and decreased functional impairment. RT change was also associated with greater nonreactivity towards experiences. Overall, these findings suggest that targeting mindful regulation skills improve attention regulation in individuals with GAD and may partially account for efficacious clinical outcomes throughout treatment.

Previous research suggests that individuals with high levels of social anxiety (SA) tend to make negative interpretations of ambiguous social situations but fail to make positive interpretations of such situations. These biases have been shown to occur at both faster (more immediate) and slower (more reflective) levels of processing. Fears of evaluation may play a role in the tendency of individuals with SA to exhibit interpretation biases. As an extension of previous research, we examined the unique variance accounted for by fear of negative evaluation (FNE) and fear of positive evaluation (FPE) in the relationship between SA and interpretation biases, using a paradigm that collected both reaction time and self-report data. FPE accounted for significant variance in the relationship between SA and negative interpretation bias at a faster level of processing (reaction time measure). However, neither FNE nor FPE accounted for significant variance in the relationship between SA and negative interpretation bias at a slower level of processing (self-report measure). Our findings suggest that FPE may play an important role in biased interpretations during more immediate processing, whereas SA may be broadly influential for biased interpretations during more reflective processing.

Seventy-eight undergraduates, 39 with self-reported generalized anxiety disorder (GAD), completed measures of mood and explanatory flexibility (the capacity to assign causes to negative events with a balance of historical and contextual factors) prior to and directly after a musical priming challenge that consisted of listening to negatively-valenced emotional music and thinking about a personally relevant negative event. After the emotion evocation, participants also completed a measure of state emotion regulation. Despite comparable increases in negative affect, GAD analogues evidenced drops in explanatory flexibility whereas non-GAD Controls did not. Drops in explanatory flexibility among GAD analogues covaried significantly with lack of emotional clarity. Findings suggest that for individuals with GAD, emotionally evocative experiences may result in a constricted perspective when apprehending the causes for negative events. This perspective may serve to dampen arousal, but perhaps at the cost of failing to inform one’s actions with important emotional information.

A relationship between social anxiety and a parenting style marked by overprotection and low warmth has been repeatedly demonstrated (e.g., Bruch et al. in Anxiety Reaserch 2:57–65, 1989; Lieb et al. in Arch Gen Psychiatry 57:859–866, 2000). The current study supports the findings in the broader literature of a significant relationship between social anxiety and recollections of overprotective and cold parenting among college students. External locus of control partially mediated the relationship between overprotective parenting and social anxiety. However, these analyses used cross-sectional data, and an alternate mediational model was also significant, highlighting the various ways in which these factors interact. Finally, recollections of maternal overprotection predicted an increase in social anxiety during the first semester of college, suggesting their influence on current functioning.

We propose a cognitive model of social anxiety-related submission based upon psycho-evolutionary accounts of social anxiety and depression and present results of two studies supporting this model. We tested a confirmatory factor model consisting of three latent lower-order factors (fear of negative evaluation, fear of positive evaluation, and depressive cognitions), all of which load onto a single latent higher-order submissive cognitions factor. In essence, we propose that the symptoms associated with social anxiety and depression (in part) served adaptive functions for coping with social threats in the ancestral environment and that the cognitive symptoms associated with these disorders may function collectively as integrated components of a social anxiety-related submission mechanism. Confirmatory factor analysis indicated that the hypothesized model fit well. A score derived from the submissive cognitions factor correlated strongly with social anxiety-related measures and less strongly with measures of generalized anxiety/worry in Studies 1 and 2. Furthermore, this submissive cognitions score correlated in the expected direction with self-report measures of social comparison, negative affect, and positive affect in Study 2, and mediational analyses indicated that submissive cognitions may mediate the relationship between social comparison and submissive behaviors. Findings from both studies provide support for the proposed model.

From an emotion regulation framework, generalized anxiety disorder (GAD) can be conceptualized as a syndrome involving heightened intensity of subjective emotional experience, poor understanding of emotion, negative reactivity to emotional experience, and the use of maladaptive emotion management strategies (including over-reliance on cognitive control strategies such as worry). The current study sought to replicate previous findings of emotion dysregulation among individuals with GAD and delineate which aspects of emotion dysregulation are specific to GAD or common to GAD and another mental disorder (social anxiety disorder). Individuals with GAD reported greater emotion intensity and fear of the experience of depression than persons with social anxiety disorder and nonanxious control participants. Individuals with social anxiety disorder indicated being less expressive of positive emotions, paying less attention to their emotions, and having more difficulty describing their emotions than either persons with GAD or controls. Measures of emotion differentiated GAD, social anxiety disorder, and normal control groups with good accuracy in a discriminant function analysis. Findings are discussed in light of theoretical and treatment implications for both disorders.

Generalized anxiety disorder (GAD) is characterized by excessive anxiety and worry that is difficult to control; but methods of thought control among persons with GAD have not been previously investigated. Forty-two patients with GAD and 55 non-anxious controls (NACs) completed the Thought Control Questionnaire (TCQ; A. Wells & M. I. Davies, 1994). Patients with GAD reported significantly greater use of worry and punishment strategies, and less use of distraction and social control strategies, than NACs. Further, worry and punishment strategies were positively correlated with depressive symptoms and excessive worry, while distraction and social control strategies were negatively correlated with these measures of psychopathology. Higher life satisfaction was associated with greater use of distraction and social control strategies, and lesser use of worry and punishment strategies.

Worry and rumination are cognitive processes, often represented as verbal or linguistic activities. Despite similarities in definition and description, worry has been most closely examined in relation to anxiety whereas rumination has traditionally been related to depression. This distinction remains in spite of high rates of comorbidity between anxiety and depression. This study sought to better understand the distinct and overlapping features of worry and rumination as well as their relationship to anxiety and depression. Seven hundred eighty-four unselected college students completed self-report measures of worry, rumination, anxiety, and depression. Items from the respective worry and rumination scales were submitted to factor analysis, which revealed a four-factor solution comprised of 2 worry factors and 2 rumination factors. A Worry Engagement factor as well as a Dwelling on the Negative factor emerged as distilled measures of worry and rumination, respectively. Scores on these factors were highly correlated with each other and demonstrated equally strong relationships to both anxiety and depression. Findings from this study suggest that worry and rumination represent related but distinct cognitive processes that are similarly related to anxiety and depression.

Previous studies of the modified Stroop Color-Naming Task with social phobics have demonstrated increased latencies for the color-naming of social threat words in comparison to neutral or physical threat words. However, these effects could be partially due to differences in the semantic relatedness of the words in these various categories and/or the blocked format (i.e., all words of one type presented sequentially) in which words have been presented. To examine these issues, color-naming latencies of individuals with social phobia to social threat, semantically related neutral, and unrelated neutral words were examined in both blocked and randomly intermixed formats. Significant differences in color-naming were found for word stimuli presented in the blocked format only. In the blocked format, social phobics were significantly slower to color-name social threat words than related neutral words and significantly slower to color-name related neutral words than unrelated neutral words. Color-naming latencies also increased across trials regardless of word type. There were no effects of word type in the random format. Thus, both presentation format and semantic priming, as well as threat value, may have contributed to color-naming interference for the social threat words. Possible interpretations of our findings along with implications for future Stroop research in persons with social phobia are discussed.

Subjects high and low in perfectionistic concern over mistakes (CM; Frost, Marten, Lahart, & Rosenblate, 1990) monitored their mistakes daily to test several hypotheses about the nature of mistakes among perfectionists. High-CM subjects did not report a greater number of mistakes, nor were the mistakes reported by high- and low-CM subjects different in quality, based on ratings by independent judges. However, there were differences in personal reactions to mistakes, perceptions of the seriousness of mistakes, beliefs about other peoples' reactions to mistakes, and rumination about mistakes. High-CM subjects reacted more strongly and more negatively to their mistakes. The specific nature of these findings and implications for cognitive-behavioral treatment of perfectionism are discussed.

Perfectionistic concern over mistakes refers to the tendency to react negatively to mistakes, to interpret mistakes as equivalent to failure, and to believe that one will lose the respect of others following failure (Frost, Marten, Lahart, & Rosenblate, 1990). In this experiment, the reactions of subjects high and low in perfectionistic concern over mistakes to a task with a high frequency of mistakes and a task with a low frequency of mistakes were examined. People high in perfectionistic concern over mistakes reacted with more negative mood, lowered confidence, and a greater sense that they “should have done better” compared to subjects low in perfectionistic concern over mistakes. Furthermore, high-perfectionistic-concern-over-mistake subjects believed others seeing their performance would perceive them as less intelligent, and they were also less willing to share their performance results. These differences between subjects high and low in perfectionistic concern over mistakes were almost exclusive to the high-mistake-frequency condition. There were few differences in the low-mistake-frequency task.

Empirical studies of the behavioral or cognitive—behavioral treatment of social phobia have appeared with increasing frequency over the last decade, and there is reason for cautious optimism in the evaluation of treatment effectiveness. However, few studies have reported systematic followup data, and there is little information available about the durability of change in treated social phobics. We report on the followup evaluation of cognitive—behavioral group therapy (CBGT) for social phobia. Patients who received CBGT or a credible alternative treatment were recontacted after a period of 4.5 to 6.25 years and completed a battery of self-report questionnaires, an individualized behavioral test, and a structured interview with an independent assessor. Patients who received CBGT remained more improved than alternative treatment patients on measures from all assessment modalities. However, due to the long followup period, only a portion of the original study sample could be assessed, and these patients may have been less severely impaired than patients who did not participate in the long-term followup. Limitations of the current study and issues of sample attrition in the conduct of long-term followup studies are discussed.

Using a thought-listing protocol that directed subjects to separately list their thoughts for self and an interaction partner, this study tested the unique contribution of perceptions of the other person to social anxiety when interacting with a stranger. After viewing a picture of their partner in an upcoming interaction, undergraduate men completed two thought-listing protocols and then engaged in a 5-min conversation with an attractive female confederate. Multivariate hierarchical regression indicated that the percentage of negative self-thoughts was inversely related to self-efficacy ratings collected prior to and early during the conversation and positively related to subjective anxiety at the end of the interaction. After controlling for self-thoughts, perceptions about the partner's positive attributes contributed to prediction of behavioral signs of anxiety, but not self-efficacy or subjective anxiety. The results are consistent with the hypothesis that an attentional focus on positive attributes of the other person may increase one's social anxiety beyond that attributable to negative self-thoughts. Possible mechanisms that may account for this relationship are discussed.

Previous studies of cognitive specificity in social anxiety and depression have not directly compared data from measures of thought content varying in their relevance to either disorder. The current research compared subjects high in both social anxiety and depression (i.e., mixed) to groups high in only social anxiety or depression, or neither affect, on five cognitive content scales. Negative thoughts specific to depression covaried only with dysphoria, while negative thought content specific to social anxiety covaried with both social anxiety and dysphoria, although both dysphoric and socially anxious groups differed from controls. However, on most cognitive measures the mixed group was the most dysfunctional, replicating Ingram's (1989a, 1989b) evidence of confounding between the affective states of social anxiety and depression. In a second study, the significance of affective confounding in a clinical sample was evaluated by assessing differences in thought content specific to social anxiety among social phobics varying in depressive affect. High dysphoric social phobics reported a lower percent of positive thoughts and significantly more negative thoughts than did nondysphoric social phobics. Limitations of the present research as well as implications for future research on cognitive specificity and affective confounding are discussed.

Levenson's (1973) locus of control scale was used to assess perceptions of control in individuals with panic disorder and social phobia, compared to a nonclinical sample. Both anxiety disorder groups showed a lower sense of internal control compared to the normal sample. Furthermore, the two anxiety disorder groups showed contrasting externality orientations. Panic-disordered individuals viewed events as proceeding in a random and uncontrollable way, while social phobics viewed events as controlled by powerful others. Partial correlations confirmed the unique relationship between each disorder and a particular externality orientation and indicated that low internal perceptions of control were strongly influenced by the presence of beliefs in chance and powerful others. These data suggest that perceptions of diminished control may be an affective—cognitive theme of anxiety, and that specific types of control perceptions are uniquely associated with these particular anxiety disorders.

The applicability of Schwartz and Garamoni's (1986, 1989) States of Mind (SOM) model for assessing the influence of cognitive—behavioral therapy on cognitive functioning was evaluated with social phobics. The SOM model states that a positive dialogue (i.e., a 2:1 ratio of positive to negative thoughts) is optimal for effective coping. Social phobics receiving either a cognitive—behavioral or educational—supportive group treatment were compared for SOM change, as were subjects meeting criteria for improvement or nonimprovement. Also the study compared the predictability of the SOM ratio with a ratio based on percent of negative thoughts. Subjects in both treatments evidenced negative monologue (i.e., a preponderance of negative thoughts) at pretreatment. A significant Treatment ×Time interaction showed that, although the groups did not differ at posttreatment, those in the cognitive treatment reached positive dialogue at a 6-month followup while the other group did not. Improvers also attained positive dialogue at followup while nonimprovers did not. The SOM and the negative thought ratios performed similarly in predicting most outcome measures, suggesting that neutral thoughts (the only distinction between the two) serve little function for persons with problems of social phobia.

Two studies were conducted evaluating aspects of the States of Mind (SOM) Model proposed by Schwartz (1986; Schwartz & Garamoni, 1986, 1989) with a sample of social phobic subjects. First, the SOM ratio [positive thoughts/(positive + negative thoughts)] based on a thought listing task was compared to a ratio based on Kendall and Hollon's (1981) “power-of-nonnegative-thinking” model [negative thoughts/(positive +negative +neutral thoughts)], and the relationship of each ratio to criterion measures was assessed. The two ratios were highly correlated and related to several criterion measures, raising questions about the role of neutral thoughts in the internal dialogue. Second, SOM ratios derived from a thought listing task and from the Social Interaction Self-Statement Test (SISST) were compared to assess the reactivity of the SOM ratio and classification scheme to method of cognitive assessment. In that study, large differences were detected. SISST SOMs were less likely to classify subjects in the more pathological SOM categories and more likely to be significantly related to criterion measures. Findings are discussed in the context of the validity of the SOM model and the effects of cognitive assessment methodology on the magnitude of derived self-statement ratios.

A revised Stroop color-naming task was used to test hypotheses derived from Beck's cognitive theory of anxiety disorders which proposes that social phobics are hypervigilant to social-evaluative threat cues. Color-naming latencies for social and physical threat words were compared to matched neutral words for both social phobics and individuals with panic disorder. As predicted, social phobics showed longer latencies for social threat words, and panickers had longer latencies for physical threat words. Latency for color-naming social threat words correlated with self-reported avoidance among social phobics. These results are consistent with Beck's notion of self-schemata which facilitate the processing of threat cues. Methodological issues and clinical implications are discussed.

Forty-nine patients participated in a study comparing cognitive-behavioral group treatment (CBGT) for social phobia with a credible placebo control. CBGT consisted of exposure to simulated phobic events, cognitive restructuring of maladaptive thoughts, and homework for self-directed exposure and cognitive restructuring between sessions. Control patients received a treatment package consisting of lecture-discussion and group support that was comparable to CBGT on measures of treatment credibility and outcome expectations. At pretest, posttest, and 3- and 6-month follow-ups, patients completed assessments that included clinician ratings, self-report measures, and behavioral, physiological, and cognitive-subjective measures derived from a behavioral simulation of a personally relevant phobic event. Both groups improved on most measures, but, at both posttest and follow-up, CBGT patients were rated as more improved than controls and reported less anxiety before and during the behavioral test. At follow-up, CBGT patients also reported significantly fewer negative and more positive self-statements than controls on a thought-listing task following the behavioral test. Regardless of treatment condition, follow-up changes in clinician-rated phobic severity were significantly related to changes on the thought-listing measure.

The effects of variations in procedures for the administration of the thought-listing technique were examined. Test-anxious subjects imagined themselves in test-taking situations of increasing stressfulness and participated in similarly designed behavioral test-taking tasks. Subjects were requested to list the self-statements that occurred to them after each stimulus, recording either all thoughts (general instructions) or only those specific thoughts that reflected what they were thinking and feeling in response to each stimulus (focused instructions). Anxiety elicited by each stimulus was also assessed, and the utility of scoring variations was examined. Behavioral test-taking stimuli failed to produce expected differences in stressfulness. However, in response to increasingly stressful imaginal stimuli, subjects reported more frequent negative self-statements and less frequent positive self-statements. Also, as stimulus intensity increased, the number of thoughts listed by subjects receiving focused instructions decreased. Frequency counts of specific thought categories and a scoring procedure incorporating ratings of thought salience produced nearly identical patterns of cognitive response. Limitations of the study are discussed, and implications of the results for the conduct of cognitive assessment are examined.

Male and female college students were classified into assertive and nonassertive groups on the basis of self-report and behavioral criteria. Each subject then role-played a series of situations in which the role-play partner made requests of varying degrees of unreasonableness. Utilizing Meichenbaum's postperformance videotape reconstruction procedure, subjects viewed videotaped recordings of their role-play performances and provided audiotaped recordings of the cognitions they experienced while role-playing. In contrast to the findings of previous investigations that have studied assertion-relevant cognitions through the use of structured self-statement questionnaires, few differences occurred between assertive and nonassertive subjects. However, several significant findings occurred as a function of the rated legitimacy of the requests. Implications of these data for both cognitive assessment and understanding of assertive behavior are discussed.

College students, psychiatric inpatients, and normal adults served as subjects in a study of cognitive self-statement patterns and their relationship to self-reported assertiveness. Subjects completed a series of behavioral role-plays and responded to a revised version of Schwartz and Gottman's (1976) Assertion Self-Statement Test. Subjects' positive and negative self-statement scores were then examined to test the generality of Schwartz and Gottman's (1976) “internal dialogue of conflict” explanation of nonassertive behavior. Nonassertive subjects reported a higher frequency of negative self-statements than did assertive subjects, regardless of their psychiatric or student status. Subject sample exerted an additional, but independent, effect on both positive and negative self-statements. Schwartz and Gottman's hypothesis may hold promise for the explication of assertive and nonassertive behavior in clinical populations.

This study examined the specificity to depression of the attributional style hypothesized by the reformulated model of learned helplessness. Scores on a modified version of the Attributional Style Questionnaire of patients with dysthymic disorder were compared with those of anxiety disorder patients (social phobic, agoraphobic, and panic disorder) and normal subjects. While dysthymic patients demonstrated more internal, global, and stable attributions for negative events than normals, they did not systematically differ from social phobic or agoraphobic subjects. All groups differed from all the other groups on the Beck Depression Inventory. Analysis of covariance that controlled for depression scores suggested that depression contributed substantially to attributional style, but anxiety disorder diagnosis also exerted a significant effect on some attributional measures. These findings are discussed in terms of their meaning for the reformulated model of learned helplessness and the role of attributional processes in anxiety disorders.

The convergent and discriminant validity of the Social Interaction Self-Statement Test (SISST) were evaluated in a sample of men and women awaiting treatment for fear and avoidance of social interactions. Partial correlations revealed that negative, but not positive, self-statement scores were generally related to self-report measures of anxiety and depression. Heart rate and subjective anxiety ratings derived from a behavioral simulation of a personally relevant anxiety-provoking situation were unrelated to SISST scores. However, subjects' reports of negative thoughts obtained via the thought-listing procedure were related to the SISST negative self-statement scores, suggesting that the negative subscale of the SISST and the thought-listing procedure tap similar dimensions. Finally, the negative subscale of the SISST discriminated between social phobics whose primary fear involved social interactions and social phobics whose anxiety was confined to public-speaking situations. The findings support the use of the SISST with clinically socially anxious patients.

The reformulated model of learned helplessness and depression postulates that depressed patients will attribute the causes of negative outcomes to internal, global, and stable factors. They may also make maladaptive attributions about the causes of positive outcomes. In the present study, the specificity of these attributional patterns to depressed patients was examined by comparing Attributional Style Questionnaire scores of samples of depressed patients (diagnosed as dysthymic disorder), anxiety disorder patients, and normals. Support for the reformulated model was evident for attributions of negative outcomes. Dysthymic patients demonstrated the hypothesized attributional pattern for negative outcomes, but anxiety patients did so only if they were also depressed. The attributions of dysthymic patients for positive outcomes did not differ from those of normal subjects, but several differences arose between the attributions for positive outcomes of highly depressed dysthymic patients and those of nondepressed anxious patients. Findings are compared to previous research, and implications of these results for the study of cognitive factors in anxiety disorders are discussed.

Socially anxious and nonanxious college students provided detailed personal information and were led to believe that they would soon interact with a person of the opposite sex who was either similar or dissimilar to them in terms of background, experience, and other attributes. In accord with the social psychological literature, nonanxious students greatly preferred similar to dissimilar partners. Socially anxious students showed no difference between their ratings of similar and dissimilar partners and assigned much less extreme ratings to both partners than did nonanxious subjects. Subjects' predictions about partners' likely anxiety and how partners would evaluate subjects' anxiety also differed according to subjects' anxiety levels, but these differences did not parallel attraction scores. Results are compared with other research on social anxiety and contrasted to past research on social anxiety, attitude similarity, and attraction. Directions for future research are addressed, and questions about the validity of the thought-listing technique are discussed.