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Objectives: Patients with social anxiety disorder (SAD) not only fear social rejection, but accumulating evidence also shows that they are indeed less liked than their non-anxious counterparts. Three factors are hypothesized to play a role in this social anxiety-social rejection relationship: (1) social performance; (2) elicited negative emotions, and (3) perceived similarity.Method: Patients with SAD (N=63) and control participants (N=27) were observed during a 5 minutes `getting acquainted' conversation with a male and female confederate who rated their social performance. Video-observers rated their own negative emotions and perceived similarity with the patients, while other video-observers rated their wish to engage in future contact with them (a measure of social rejection).Results: Analysed by way of structural equation modelling (SEM), the results supported the social anxiety-social rejection relationship. More specifically, poor social performance was associated with perceived dissimilarity ratings and mediated by evoked negative emotions, both of which were in turn associated with social rejection.Conclusion: These results suggest that a sequence of events links social anxiety to social rejection. Treatment should aim to improve social performance and perceived similarity to reverse SAD's vicious, negative interpersonal cycle. [ABSTRACT FROM AUTHOR]

Background: It is well documented that public safety personnel are exposed to potentially traumatic events (PTEs) at elevated frequency and demonstrate higher prevalence of trauma-related symptoms compared to the general population. Lesser studied to date are the organizational consequences of workplace PTE exposure and associated mental health outcomes such as acute/posttraumatic stress disorder (ASD/PTSD), depression, and anxiety., Methods: The present review synthesizes international literature on work outcomes in public safety personnel (PSP) to explore whether and how PTE and trauma-related symptoms relate to workplace outcomes. A total of N = 55 eligible articles examining PTE or trauma-related symptoms in relation to work outcomes were systematically reviewed using best-evidence narrative synthesis., Results: Three primary work outcomes emerged across the literature: absenteeism, productivity/performance, and costs to organization. Across n = 21 studies of absenteeism, there was strong evidence that PTE or trauma-related symptoms are associated with increased sickness absence. N = 27 studies on productivity/performance demonstrated overall strong evidence of negative impacts in the workplace. N = 7 studies on cost to organizations demonstrated weak evidence that PTE exposure or trauma-related mental health outcomes are associated with increased cost to organization., Conclusions: Based on available evidence, the experience of workplace PTE or trauma-related symptoms is associated with negative impact on PSP occupational functioning, though important potential confounds (e.g., organizational strain and individual risk factors) remain to be more extensively investigated., (© 2024 The Authors. American Journal of Industrial Medicine published by Wiley Periodicals LLC.)

What are the major vulnerabilities in people with social anxiety? What are the most promising directions for translational research pertaining to this condition? The present paper provides an integrative summary of basic and applied translational research on social anxiety, emphasizing vulnerability factors. It is divided into two subsections: intrapersonal and interpersonal. The intrapersonal section synthesizes research relating to (a) self-representations and self-referential processes; (b) emotions and their regulation; and (c) cognitive biases: attention, interpretation and judgment, and memory. The interpersonal section summarizes findings regarding the systems of (a) approach and avoidance, (b) affiliation and social rank, and their implications for interpersonal impairments. Our review suggests that the science of social anxiety and, more generally, psychopathology may be advanced by examining processes and their underlying content within broad psychological systems. Increased interaction between basic and applied researchers to diversify and elaborate different perspectives on social anxiety is necessary for progress., Competing Interests: Declaration of competing interest All authors declare that they have no conflicts of interest., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Although numerous studies have reported on PTSD prevalence in high-risk occupational samples, previous meta-analytic work has been severely limited by the extreme variability in prevalence outcomes., Methods: The present systematic review and meta-regression examined methodological sources of variability in PTSD outcomes across the literature on high-risk personnel with a specific focus on measurement tool selection., Results: The pooled global prevalence of PTSD in high-risk personnel was 12.1% [6.5%, 23.5%], and was similar to estimates obtained in other meta-analytic work. However, meta-regression revealed that PTSD prevalence differed significantly as a function of measurement tool selection, study inclusion criteria related to previous traumatic exposure, sample size, and study quality. PTSD prevalence estimates also differed significantly by occupational group and over time, as has also been reported in previous work, though exploratory examination of trends in measurement selection across these factors suggests that measurement strategy may partially explain some of these previously reported differences., Conclusions: Our results highlight a pressing need to better understand the role of measurement strategies and other methodological choices in characterizing variable prevalence outcomes. Understanding the role of methodological variance will be critical for work attempting to reliably characterize prevalence as well as risk and protective factors for PTSD., (© 2022 Wiley Periodicals LLC.)

Objectives: Since 2016, Canada has allowed for euthanasia based on strict criteria under federal medical assistance in dying legislation. The purpose of this study was to determine how Canadian intensivists perceive medical assistance in dying and whether they believe their approach to withdrawal of life-sustaining therapies has changed following introduction of medical assistance in dying., Design: Electronic survey., Setting: Participants were recruited from 11 PICU programs and 14 adult ICU programs across Canada. All program leaders for whom contact information was available were approached for participation., Participants: We invited intensivists and critical care trainees employed between December 2019 and May 2020 to participate using a snowball sampling technique in which department leaders distributed study information. All responses were anonymous. Quantitative data were analyzed using descriptive statistics. Categorical variables were analyzed using Pearson chi-square test., Interventions: Not applicable., Measurements and Main Results: We obtained 150 complete questionnaires (33% response rate), of which 50% were adult practitioners and 50% pediatric. Most were from academic centers (81%, n = 121). Of respondents, 86% (n = 130) were familiar with medical assistance in dying legislation, 71% in favor, 14% conflicted, and 11% opposed. Only 5% (n = 8) thought it had influenced their approach to withdrawal of life-sustaining therapies. Half of participants had no standardized protocol for withdrawal of life-sustaining therapies in their unit, and 41% (n = 62) had observed medications given in disproportionately high doses during withdrawal of life-sustaining therapies, with 13% having personally administered such doses. Most (80%, n = 120) had experienced explicit requests from families to hasten death, and almost half (47%, n = 70) believed it was ethically permissible to intentionally hasten death following withdrawal of life-sustaining therapies., Conclusions: Most Canadian intensivists surveyed do not think that medical assistance in dying has changed their approach to end of life in the ICU. A significant minority are ethically conflicted about the current approach to assisted dying/euthanasia in Canada. Almost half believe it is ethical to intentionally hasten death during withdrawal of life-sustaining therapies if death is expected., Competing Interests: The authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2022 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.)

Background: Professionals working in the emergency department (ED) are regularly exposed to traumatic events. Rates of posttraumatic mental health conditions vary widely in the literature and there is no agreement that rates in ED staff are elevated relative to other populations., Objective: We conducted a systematic review of international literature reporting prevalence of posttraumatic stress disorder (PTSD), depression, and anxiety in ED personnel to determine whether prevalence is elevated compared to the general community, and to evaluate convergent evidence across the literature for predictive factors. To our knowledge, there is no comprehensive review on this topic in the literature at this time., Methods: Seven databases were searched for studies reporting rates of PTSD, depression, and anxiety in ED personnel. Two independent researchers screened studies and assessed quality using Munn's Prevalence Critical Appraisal Instrument. Best-evidence synthesis determined whether conditions demonstrated elevated prevalence compared to the general population of Canada, a conservative benchmark., Results: Twenty-four studies from 12 countries and a combined sample size of 4768 were included. PTSD rates ranged from 0% to 23.6% (mean 10.47%), depression ranged from 0.7% to 77.1% (mean 24.8%), and anxiety rates ranged from 2.4% to 14.6% (mean 9.29%). Each condition was elevated compared to the general population. Sociodemographic variables were not consistent predictors. Elevated PTSD seemed most strongly related to workplace exposure and maladaptive coping., Conclusions: ED professionals have an elevated risk of experiencing PTSD, depression, and anxiety. Identification of organizational and workplace predictors are needed to inform interventions that will reduce risk and provide optimal treatment and management of PTSD, depression, and anxiety in ED settings., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background and Objectives: Safety behaviors display some similarities to coping behaviors, raising questions about whether the two sets of behaviors display distinct associations with anxiety symptoms., Design and Method: To examine this issue, we conducted two cross-sectional studies in which participants ( n  = 243 and 157) completed measures of the safety behaviors associated with social anxiety disorder (SAD) and generalized anxiety disorder (GAD), the Brief Ways of Coping Scale (BWOC), and SAD and GAD symptom measures. In Study 1, extant safety-behavior and coping measures were used. In Study 2, the measures were modified so that they followed the same format and instructions., Results: Both studies indicated that the safety behavior measures displayed strong positive associations with their respective symptoms, as did several dysfunctional coping strategies, most notably wishful thinking., Conclusions: These findings provide preliminary empirical support for the conceptual distinction between safety behaviors and coping, and suggest that assessing both concepts provide a nuanced understanding of responding to anxiety-evoking situations., Highlights • Safety-seeking strategies and coping behaviors have striking similarities• We conducted two studies to compare extant measures of the two constructs• Participants were able to distinguish the two set of behaviors• Both safety behaviors and dysfunctional coping were associated with anxiety symptoms.

Individuals with social anxiety are sensitive to social hierarchies and tend to compare themselves unfavorably with others, perceiving themselves as inferior or lower in social rank. The current study explores patterns of change in these negative perceptions, and their associated emotional outcomes, in an online social context. Undergraduate students (N = 291) browsed the profiles of eight Instagram influencers and completed a measure of social comparison after viewing each profile, yielding multiple ratings of their own perceived social rank. Participants completed measures of affect and state self-esteem before and after the profile browsing task. Higher social anxiety predicted lower, and greater declines in, social rank self-perceptions during browsing. Higher social anxiety also predicted greater decreases in positive affect, increases in negative affect, and decreases in state self-esteem from the beginning to the end of the browsing task. Low baseline rank perceptions contributed to change in all three emotional variables. Decreases in rank perceptions contributed further to decreases in positive affect and appearance-related self-esteem. This study elaborates on cognitive-evolutionary theory, suggesting that the inferiority self-perceptions of socially anxious individuals translate to online social contexts, may be strengthened with increased exposure to such contexts, and may have a detrimental emotional impact. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Firefighting service is known to involve high rates of exposure to potentially traumatic situations, and research on mental health in firefighting populations is of critical importance in understanding the impact of occupational exposure. To date, the literature concerning prevalence of trauma-related mental disorders such as posttraumatic stress disorder (PTSD) has not distinguished between symptomology associated routine duty-related exposure and exposure to large-scale disaster. The present systematic review synthesizes a heterogeneous cross-national literature on large-scale disaster exposure in firefighters and provides support for the hypothesis that the prevalence of PTSD, major depressive disorder, and anxiety disorders are elevated in firefighters compared with rates observed in the general population. In addition, we conducted narrative synthesis concerning several commonly assessed predictive factors for disorder and found that sociodemographic factors appear to bear a weak relationship to mental disorder, while incident-related factors, such as severity and duration of disaster exposure, bear a stronger and more consistent relationship to the development of PTSD and depression in cross-national samples. Future work should expand on these preliminary findings to better understand the impact of disaster exposure in firefighting personnel.

Objective: Public transportation workers are exposed to higher levels of stress related to accidents, injuries, and person-under-train events when compared to other workers. This systematic review integrates the existing literature on mental health among high-risk public transportation workers to estimate the prevalence of post-traumatic stress disorder (PTSD), major depressive and anxiety symptoms following critical incidents while on duty., Methods: This systematic review is part of a larger systematic review which examines mental health and work outcomes of individuals working in professions at high risk of critical incident exposure, i.e., high-risk professions. Articles were included if they measured the prevalence of PTSD, Major Depressive Disorder (MDD) and Anxiety Disorder (AD) in a transportation population following exposure to a major incident, for example, a person-under-a-train., Results: Among the ten articles, all reported prevalence of PTSD which ranged from 0.73 to 29.9%. Four articles reported prevalence of depression among transportation workers exposed to a critical incident and prevalence outcomes ranged from 0.05 to 16.3%. Only two reported prevalence of anxiety from 1.3 to 13.9%., Conclusions: This literature reports that transportation workers are prone to involvement in traumatic accidents leading to higher rates of PTSD compared to the general population. Strategies to reduce transportation accidents and to provide transportation workers follow-up mental health support is needed for this vulnerable population.

The current studies examined whether self-attributes can come to elicit anxiety after being paired with negative evaluation. Results from Study 1 suggested that appearing unintelligent and appearing nervous were partially distinct attributes of concern related to social anxiety and validated stimuli used in the subsequent study. In Study 2, participants completed a differential associative learning task in which either words related low intelligence or appearing nervous were paired with negative evaluation. Results suggested that participant anxiety and expectancy ratings increased for words belonging to the attribute category paired with negative evaluation but not the other. Participant social anxiety was not associated with the effects.

Clinical researchers suggest that post-event thinking functions to negatively bias event recall for socially anxious participants. We used a repeated retrieval paradigm to examine the effects of post-event retrieval on memory for social information. Undergraduate participants ( n  = 214) engaged in an impromptu public speaking task and received a standardised mixture of positive and negative feedback on their speech. Participants in the experimental condition were instructed to repeatedly retrieve the negative feedback items whereas participants in the control condition completed a control task. Both groups were asked to recall the feedback after five minutes and after one week. Results indicated that the experimental group displayed the hypothesised retrieval-induced forgetting effect. In addition, repeated retrieval predicted valence change in that participants recalled the non-retrieved positive feedback items less positively over time. The retrieval-practice effects were distinct from self-reported post-event processing. Contrary to clinical theories, social anxiety did not moderate retrieval-induced forgetting or recall bias. Instead, all participants displayed retrieval-related negatively biased recall.

Background: The prevalence of PTSD in police officers has been the subject of a large and highly variable empirical literature. The present systematic review evaluates the extant literature on PTSD in police officers using an international dataset., Methods: We employed best-evidence narrative synthesis to evaluate whether PTSD prevalence in police is elevated in comparison to the general population of Canada (8%), which itself has a higher lifetime PTSD prevalence than many other regions and thus serves as a conservative standard of comparison., Results: PTSD prevalence in police varied considerably across studies from 0% - 44% (M = 14.87%, Median = 9.2%). Despite this variability, strong evidence exists to suggest PTSD prevalence is elevated in police officers. Examination of possible sources of variability in prevalence outcomes highlighted substantial variability in outcomes due to the selection of measurement tool for assessing PTSD (e.g., DSM vs. IES). Examination of commonly-assessed predictive factors for PTSD risk across the literature showed that individual-difference factors (e.g., age, years of service) bear weak-to-nonexistent relationships with PTSD risk, while incident-specific factors (e.g., severity of exposure) are more strongly and consistently associated with PTSD prevalence. Organizational factors (e.g., low support from supervisor) are at present understudied but important possible contributors to PTSD risk., Conclusions: PTSD prevalence is elevated in police officers and appears most strongly related to workplace exposure. Measurement variability remains a critical source of inconsistencies across the literature with drastic implications for accurate detection of officers in need of mental health intervention., (© 2020 Wiley Periodicals LLC.)

Clinical theorists postulate that individuals with social anxiety disorder (SAD) display memory biases such that recall of social events becomes more negative with time; however, alternative memory models have also been proposed. Research has focused predominantly on selective recall of negative information with inconsistent findings. The goal of the current study was to examine potential biases in recall of positive social feedback. Individuals with SAD (n = 59) and nonanxious community controls (n = 63) engaged in an unexpected public speaking task and received standardized positive or neutral feedback on their speech. Participants were asked to recall the feedback after 5 minutes and after 1 week. Results indicated that at delayed recall, individuals with SAD recalled positive feedback as less positive than it had been. The findings support cognitive models of SAD and extend the model to positive social information. Research is needed to understand the mechanisms that underlie fading positivity. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Objective: Despite the social impairment associated with social anxiety disorder (SAD), little research has examined the impact of treatment on positive relational functioning. Accordingly, the authors conducted a treatment outcome study to evaluate a cognitive behavior therapy (CBT) regimen augmented by a relational focus (CBT-R) relative to a graduated exposure-applied relaxation (GEAR) regimen and wait list (WL) control. To examine the mechanism(s) that underlies treatment effects, they used structural equation modeling (SEM) to evaluate two potential mediators, change in judgment biases and in safety behaviors., Method: Treatment-seeking adults who met SAD diagnostic criteria (n = 100; 50% women; mean age = 32.9 years.; 36% ethnic minority) were randomly assigned to CBT-R, GEAR, or WL. CBT-R and GEAR participants received 14 group treatment sessions. Social initiation, relationship satisfaction, and a SAD symptom composite were assessed at pre- and postassessment, and 6- and 12-month follow-ups., Results: Intent-to-treat multilevel modeling analyses indicated that the CBT-R regimen resulted in significantly greater improvement relative to GEAR on relationship satisfaction and SAD symptoms. SEM results revealed that change in safety behaviors partially mediated the superior performance of CBT-R on both variables with confidence intervals set at .90., Conclusions: These findings indicate that CBT-based regimens can improve social approach processes in individuals with SAD and that safety behavior reduction contributes to positive outcomes. (PsycINFO Database Record, ((c) 2018 APA, all rights reserved).)

Cognitive theorists hypothesize that individuals with social anxiety are prone to memory biases such that event recall becomes more negative over time. With few exceptions, studies have focused primarily on changes in negative self-judgments. The current study examined whether memory for positive social events is also subject to recall bias. Undergraduate participants (N = 138) engaged in an unexpected public speaking task and received standardized positive or neutral feedback on their performance. They rated their memory of the received feedback following a 5-minute delay and again 1 week later. Results revealed that higher scores on social anxiety symptoms predicted significant reductions in the recalled valence of positive feedback over time, whereas no changes were observed for neutral feedback. The results suggest that social anxiety may lead to erosion in memory of positive events., (Copyright © 2016. Published by Elsevier Ltd.)

Social rejection has been consistently linked to the development of social anxiety. However, mechanisms underlying the relation have been largely unexplored, which presents an obstacle to fully understanding the origins of social anxiety and to the development of effective prevention and treatment strategies. Two studies were conducted to test the hypothesis that the emotion of social pain following rejection promotes the development of social anxiety in subsequent situations. In Study 1, undergraduate participants were exposed to 2 social situations (Cyberball) 2 days apart. Participants who were rejected in the first situation reported higher social anxiety before and during the second situation relative to those who were included. This effect was fully mediated by initial social pain intensity. In Study 2, all participants were initially rejected. Using double-blinded drug administration, participants were randomly assigned to ingest acetaminophen to alleviate the social pain from rejection, or a sugar placebo. As predicted, the acetaminophen group reported lower social anxiety before and during the second situation. Approximately half of the effect was mediated by reduction in social pain. Notably, the immediate effect of acetaminophen was specific to social pain rather than social anxiety. Results were discussed in the context of literature on the etiology of social anxiety and social pain. Future directions were suggested. (PsycINFO Database Record, ((c) 2017 APA, all rights reserved).)

Discrete forms of repetitive thought (RT), such as worry and reflection, can be characterized along basic dimensions of valence (positive vs. negative) and purpose (searching vs. solving). In addition, people can be characterized as high or low in their tendency to engage in RT. This dimensional model has been demanding to assess, and a smaller number of items that could stand in for a large battery would make measurement more accessible. Using four samples (N = 1,588), eight items that assess RT valence, purpose, and total in a circumplex model were identified. Across these and other samples, the dimensions were adequately reliable and valid with regard to assessment via large RT battery, other measures of RT, and depressive symptoms. The accessibility of dimensional assessment of RT using this smaller number of items should facilitate work on questions about the qualities of RT that predict mental and physical health., (© The Author(s) 2015.)

First responders routinely experience work-related events that meet the definition of a traumatic stressor. Despite the high exposure to traumatic events, prevalence rates of posttraumatic stress disorder (PTSD) are relatively low. This discrepancy points to the potential value of identifying factors that distinguish those traumatic stressors that produce ongoing traumatic stress symptoms from those that do not. The present study surveyed 181 first responders from rural settings. A repeated-measures design was used to compare characteristics of traumatic stressors that were or were not associated with ongoing PTSD symptoms. A factor analysis revealed that distressing events were characterized by chaos and resource limitations. Consistent with contemporary models, two mediational analyses revealed that each event characteristic predicted peritraumatic dissociation and posttraumatic cognitions, which in turn predicted PTSD symptoms. Moreover, the effect of each event characteristic on PTSD symptoms was partially mediated by these cognitive processes., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Following initial interactions, some people are less willing to pursue ongoing contact with socially anxious individuals than with those who are not socially anxious. To better understand this process, we conducted two studies that examined peers' first impressions of target individuals. Unacquainted individuals (N=104 and 114) participated in round robin, unstructured interactions in groups of 3 to 10 and then rated each partner and themselves on items reflecting the Big Five personality dimensions. The ratings were analyzed according to Biesanz's (2010) social accuracy model of interpersonal perception, which distinguishes the positivity from the accuracy of social judgments. Study 1 revealed that perceivers did not view socially anxious targets more negatively or as less likable than non-socially anxious targets but were less able to recognize their unique personality features. Study 2 replicated those findings and indicated that perceivers' difficulties recognizing socially anxious targets' unique features were not due to negative biases in the socially anxious targets' self-ratings or to general psychological maladjustment. The findings are consistent with cognitive models, which underscore the role of self-concealment in social anxiety disorder., (Copyright © 2014. Published by Elsevier Ltd.)

Social anxiety is associated with low positive affect (PA), a factor that can significantly affect psychological well-being and adaptive functioning. Despite suggestions that individuals with high levels of social anxiety would benefit from PA enhancement, the feasibility of doing so remains an unanswered question. Accordingly, in the current study, individuals with high levels of social anxiety (N = 142) were randomly assigned to conditions designed to enhance PA (Kind Acts), reduce negative affect (NA; Behavioral Experiments), or a neutral control (Activity Monitoring). All participants engaged in the required activities for 4 weeks and completed prepost questionnaires measuring mood and social goals, as well as weekly email ratings of mood, anxiety, and social activities. Both the prepost and weekly mood ratings revealed that participants who engaged in kind acts displayed significant increases in PA that were sustained over the 4 weeks of the study. No significant changes in PA were observed in the other conditions. The increase in hedonic functioning was not due to differential compliance, frequency of social activities, or an indirect effect of NA reduction. In addition, participants who engaged in kind acts displayed an increase in relationship satisfaction and a decrease in social avoidance goals, whereas no significant changes in these variables were observed in the other conditions. This study is the first to demonstrate that positive affect can be increased in individuals with high levels of social anxiety and that PA enhancement strategies may result in wider social benefits. The role of PA in producing those benefits requires further study., (PsycINFO Database Record (c) 2013 APA, all rights reserved.)

Background and Objectives: Individuals with posttraumatic stress disorder (PTSD) are hypothesized to have a "sense of current threat." Perceived threat from the environment (i.e., external threat), can lead to overestimating the probability of the traumatic event reoccurring (Ehlers & Clark, 2000). However, it is unclear if external threat judgments are a pre-existing vulnerability for PTSD or a consequence of trauma exposure. We used trauma analog methodology to prospectively measure probability estimates of a traumatic event, and investigate how these estimates were related to cognitive processes implicated in PTSD development., Methods: 151 participants estimated the probability of being in car-accident related situations, watched a movie of a car accident victim, and then completed a measure of data-driven processing during the movie. One week later, participants re-estimated the probabilities, and completed measures of reexperiencing symptoms and symptom appraisals/reactions., Results: Path analysis revealed that higher pre-existing probability estimates predicted greater data-driven processing which was associated with negative appraisals and responses to intrusions. Furthermore, lower pre-existing probability estimates and negative responses to intrusions were both associated with a greater change in probability estimates. Reexperiencing symptoms were predicted by negative responses to intrusions and, to a lesser degree, by greater changes in probability estimates., Limitations: The undergraduate student sample may not be representative of the general public. The reexperiencing symptoms are less severe than what would be found in a trauma sample., Conclusions: Threat estimates present both a vulnerability and a consequence of exposure to a distressing event. Furthermore, changes in these estimates are associated with cognitive processes implicated in PTSD., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Models of self-regulation suggest that social goals may contribute to interpersonal and affective difficulties, yet little research has addressed this issue in the context of social anxiety. The present studies evaluated a hierarchical model of approach and avoidance in the context of social interaction anxiety, with affect as a mediating factor in the relationship between motivational tendencies and social goals. This model was refined in one undergraduate sample (N = 186) and cross-validated in a second sample (N = 195). The findings support hierarchical relationships between motivational tendencies, social interaction anxiety, affect, and social goals, with higher positive affect predicting fewer avoidance goals in both samples. Implications for the treatment of social interaction anxiety are discussed.

Clinical observations indicate that individuals with Social Anxiety Disorder (SAD) use a variety of safety behaviours; however, virtually no research has examined the functional effect of different safety-seeking strategies. Accordingly, we conducted two studies to address this issue. Study 1 measured global patterns of safety behaviour use in a large analogue sample. Factor analysis revealed two primary safety behaviour categories, avoidance and impression management. Study 2 assessed situational use of safety behaviours during a controlled social interaction in a clinical sample of 93 patients with Generalised SAD. Factor analysis again revealed support for avoidance and impression-management subtypes. Notably, the two types of safety behaviours were associated with different social outcomes. Avoidance safety behaviours were associated with higher state anxiety during the interaction and negative reactions from participants' interaction partners. Impression-management strategies appeared to impede corrections in negative predictions about subsequent interactions. These findings suggest that it may be beneficial to consider the unique effects of different safety-seeking strategies when assessing and treating SAD., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

The current study compared the predicted social and career impact of socially withdrawn and reticent behaviors among participants from Western and East Asian countries. Three hundred sixty-one college students from 5 Western countries and 455 students from 3 East Asian countries read hypothetical vignettes describing socially withdrawn and shy behaviors versus socially outgoing and confident behaviors. Participants then answered questions following each vignette indicating the extent to which they would expect the subject of the vignette to be socially liked and to succeed in their career. Participants also completed measures of their own social anxiety and quality of life. The results indicated significant vignette-by-country interactions in that the difference in perceived social and career impact between shy and outgoing vignettes was smaller among participants from East Asian countries than from Western countries. In addition, significant negative correlations were shown between personal level of shyness and experienced quality of life for participants from both groups of countries, but the size of this relationship was greater for participants from Western than East Asian countries. The results point to the more negative impact of withdrawn and socially reticent behaviors for people from Western countries relative to those from East Asia., (Copyright © 2011. Published by Elsevier Ltd.)

We incorporated strategies based on relational and interpersonal circumplex research within a standard cognitive-behavioral regimen for Generalized Social Anxiety Disorder (GSAD, Generalized Social Phobia) to determine whether these techniques increased the social approach behaviors that facilitate relationship development. Individuals seeking treatment for GSAD were randomly assigned to either the integrated interpersonal cognitive-behavioral group treatment (ICBT) or a wait list condition (WL). Results revealed that the interpersonal techniques were readily implemented by the majority of patients. ICBT produced significant increases in frequency of social approach behaviors and relationship satisfaction, in addition to GSAD symptom reductions comparable to other group CBT regimens. The current research highlights the feasibility and potential benefit of incorporating strategies based on relational and circumplex theories into cognitive-behavioral regimens for GSAD., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

The current study investigated the mechanism through which safety behaviors perpetuate perceived and actual negative social outcomes hypothesized to maintain social anxiety disorder (SAD). Eighty individuals diagnosed with generalized SAD took part in a "getting acquainted" conversation with a trained experimental confederate. Participants were then randomly assigned to either a safety behavior reduction plus exposure condition (SB + EXP) or a graduated exposure (EXP) control condition and completed a 2nd conversation with the same interaction partner. Mediation analyses revealed that participants instructed to reduce their idiosyncratic safety behaviors displayed significantly greater increases in both perceived and actual positive interpersonal outcomes relative to the EXP group. However, whereas the safety behavior manipulation influenced participants' appraisals of their partner's reaction to them through reducing self-judgments about the visibility of anxiety-related behaviors, in reality, the SB + EXP group elicited more positive partner reactions because they displayed a greater increase in social approach behavior. Thus, although both parties recognized positive changes in the social exchange following the safety behavior manipulation, different sources of social information accounted for participant versus partner interpersonal judgments. The current findings point to the potential value of considering both the intra and interpersonal consequences of safety behaviors in SAD., ((c) 2010 APA, all rights reserved.)

Two experiments were conducted to examine the link between safety behaviors and social judgments in social anxiety disorder (SAD). Safety behaviors were manipulated in the context of a controlled laboratory-based social interaction, and subsequent effects of the manipulation on the social judgments of socially anxious participants (N = 50, Study 1) and individuals meeting diagnostic criteria for generalized SAD (N = 80, Study 2) were examined. Participants were randomly assigned to either a safety behavior reduction plus exposure condition (SB + EXP) or a graduated exposure (EXP) control condition, and then took part in a conversation with a trained experimental confederate. Results revealed across both studies that participants in the SB + EXP group were less negative and more accurate in judgments of their performance following safety behavior reduction relative to EXP participants. Study 2 also demonstrated that participants in the SB + EXP group displayed lower judgments about the likelihood of negative outcomes in a subsequent social event compared to controls. Moreover, reduction in safety behaviors mediated change in participant self-judgments and future social predictions. The current findings are consistent with cognitive theories of anxiety, and support the causal role of safety behaviors in the persistence of negative social judgments in SAD., (2009 Elsevier Ltd. All rights reserved.)

Anger and the way that anger is expressed have been linked to attrition and poorer treatment outcomes in patients with Social Anxiety Disorder (e.g., Erwin, B. A., Heimberg, R. G., Schneier, F. R. & Liebowitz, M. R. (2003). Anger experience and expression in social anxiety disorder: Pretreatment profile and predictors of attrition and response to cognitive-behavioral treatment. Behavior Therapy, 34, 331-350). Understanding the connection between social anxiety and anger may be one way to improve outcomes in this population. A cross-sectional regression design was used in a sample of 363 undergraduates to examine the suggestion that ruminative thought is a critical factor linking social anxiety to anger. In support of this hypothesis, brooding fully mediated the relationship between social anxiety and trait anger and partially mediated the relationship between social anxiety and outward anger expression. The relationship between brooding and anger suppression became non-significant after depression was controlled. In contrast, reflective pondering partially mediated the relationship between social anxiety and anger suppression. These results suggest that addressing rumination may be useful in the treatment of socially anxious patients who struggle with anger. They also support the utility of considering multiple forms of rumination and multiple anger outcomes in a single study.

Background: Structural equation modeling was used to develop and test an integrated model of how emotional and cognitive factors contribute to the development of intrusive memories after a distressing event., Methods: The emotional constructs included preexisting emotion and emotional reactivity to the distressing event. Cognitive constructs included peritraumatic cognitive processing and maladaptive coping strategies., Results: Using a prospective design, 148 undergraduate students viewed a distressing film and recorded their film-related intrusive memories over the following week., Results: The results indicated that emotional reactivity and, to a lesser extent, preexisting emotion, predicted peritraumatic cognitive processing during the film, which in turn predicted the use of maladaptive coping strategies (i.e., rumination, thought suppression, and safety behaviors). Furthermore, emotional reactivity and maladaptive coping strategies directly predicted intrusive memories., Conclusions: The observed model supported the importance of cognitive variables central to cognitive models, placing them in a broader context., ((c) 2009 Wiley-Liss, Inc.)

This study examined how pre-existing emotional and personality vulnerability factors affect responses to an analogue trauma experience. Sixty-eight undergraduate participants viewed a distressing film and completed measures of trait anxiety, intelligence, depression, trait dissociation, as well as changes in state anxiety, then recorded intrusions over the following week. Results revealed that trait anxiety, depression, trait dissociation, change in anxiety, and post-state anxiety were associated with intrusion frequency. Post-state anxiety mediated the relationship between trait anxiety, depression and trait dissociation, and intrusions. Implications for PTSD theories and laboratory trauma analogue research examining specific elements of cognitive models of PTSD are discussed.

We compared post-traumatic stress disorder (PTSD) symptom severity and symptom cluster profiles in hospital emergency department (ED) medical staff (N=100) who experienced an emotionally distressing work event that presented either a direct threat to themselves or a witnessed threat to patients. The two groups displayed similar levels of PTSD symptoms, however, they differed on symptom profiles and work consequences. The direct threat group experienced significantly greater fear during the event, more ongoing arousal symptoms, and more job dissatisfaction than the witnessed threat group. The witnessed threat group was more likely to appraise their PTSD symptoms as reflecting personal weakness. Overall, the results point to the need for further research to identify distinctive features of responses to different types of traumatic stressors.

We examined culture-related influences on willingness to seek treatment for social anxiety in first- and second-generation students of Chinese heritage (Ns=65, 47, respectively), and their European-heritage counterparts (N=60). Participants completed measures that assessed their willingness to seek treatment for various levels of social anxiety. Results showed that participants were similar on willingness to seek treatment at low- and high-severity levels of social anxiety; however, at moderate levels, first-generation Chinese participants were significantly less willing to seek treatment compared to their European-heritage counterparts. The reluctance of first-generation Chinese participants to seek treatment was associated with greater Chinese-heritage acculturation, and was not related to perceiving symptoms of social anxiety as less impairing. The findings support the general contention that Asians in North America tend to delay treatment for mental health problems., (Copyright (c) 2008 APA, all rights reserved.)

We report four independent studies that examined the relationship between social interaction anxiety and the tendency to interpret positive social events in a threat-maintaining manner. Study 1 described the development of a scale that measures negative interpretations of positive social events, the interpretation of positive events scale (IPES). Study 2 cross-validated the structure of the IPES and established that social interaction anxiety explained significant variance in negative interpretations of positive social events beyond negative affect in general. Study 3 demonstrated that negative interpretation of positive events was significantly greater in a clinical sample of patients with generalized social anxiety disorder (GSAD) than a matched group of non-anxious community controls. In addition, within the GSAD group, the IPES was associated with negative social predictions following a positive interaction. Finally, study 4 confirmed that negative interpretations of positive social events mediated the relationship between social interaction anxiety and low positive affect.

In this article, the authors describe our clinical observations about the process of delivering a Cantonese-language cognitive- behavioral therapy program to treat depression in Hong Kong immigrants to Vancouver, Canada. Our experiences indicated that standard referral and assessment procedures were not optimal for this population. Other factors that required consideration were how to convert Cantonese terms for dysphoric affect into English equivalents and how to implement cognitive modification strategies when dealing with culture-syntonic beliefs about social relationships. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

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.

According to cognitive theorists, intrusive trauma memories have their origin in how information during the event is processed. Two studies investigated functional cognitive strategies during medical crises that might protect against intrusions. In Study 1, interviews with health-care professionals were used to identify cognitive strategies judged to be effective in controlling emotions and dealing with medical crises. Study 2 systematically manipulated the use of those strategies in a trauma analogue film paradigm. Experimental participants reported fewer intrusions, and less fear and avoidance of film-related stimuli during the subsequent week than controls. The manipulation did not affect anxiety during the film or memory disorganization. Implications for cognitive theories of intrusion development are discussed.

Forty-one people with generalized social phobia (GSP) and 42 community controls completed a measure of social developmental experiences and then participated in a social interaction with an experimental assistant whose behavior was either friendly or ambiguous. Following the interaction, confederates rated participants' behavior and their desire to interact with their partner again. In people with social phobia, but not controls, perceptions of parental overprotection were associated with less responsiveness to partner behavior. Moreover, failure to reciprocate the friendly partner's behavior led to social rejection. The results support the value of incorporating social developmental concepts into cognitive-behavioral models of social phobia and highlight the contribution of social learning experiences to the development of maladaptive interpersonal behavior in these individuals.

Patients with generalized social phobia (N = 42) and non-phobic community controls (N = 42) engaged in a social interaction with an experimental assistant whose behavior was used to create either a positive or an ambiguous social environment. Participants then rated their own performance and their partner's behavior. As a group, social phobic patients displayed negatively biased self-judgments, but failed to display biased social interpretations. Among the social phobia group, a social developmental history marked by parental hostility was associated with negative interpretations of partner behavior and a history of parental overprotection was associated with less sensitivity to partner behavior. The results supported cognitive models of social phobia, which implicate negative learning experiences in the development of information processing biases.

Although social avoidance is a defining feature of avoidant personality disorder (APD), some theorists posit that APD is characterized by a broader pattern of avoidance that extends beyond social situations. This paper describes a series of four studies that examined the different types of nonsocial avoidance hypothesized to characterize APD in three undergraduate student samples and a clinical sample of adults with APD. Overall, the findings revealed low to moderate associations between APD and emotional and novelty avoidance, as well as avoidance of various nonsocial events. The results provide support for contemporary models of APD.

Social phobia is a condition in which anxiety impairs the person's ability to relate to others. Here, we draw on concepts from interpersonal theory to examine the literature on the role of interpersonal processes in creating and maintaining this disorder. Studies that examine interpersonal interactions with significant others and strangers are reviewed. We next consider topics of particular relevance to relationship impairment, such as the effect of anxiety on cognitive processing of social information, and the social developmental pathways to social phobia. The impact of interpersonal factors on the process and outcome of cognitive-behavioral treatment is also discussed. Finally, we identify emerging themes in the research literature and consider directions for future work. Throughout the paper we highlight topics central to the interpersonal perspective, such as the self-perpetuating interpersonal cycle, interpersonal variability in social phobia, and the relational nature of self-related information.

Patients with generalized social phobia (GSP, N = 33) and matched community controls (N = 31) engaged in a social interaction that was constructed to go well, and then received feedback that framed social cues reflecting either the absence of negative outcomes or the presence of positive outcomes. Following feedback that framed positive social cues, the GSP group predicted they would experience more anxiety in a subsequent interaction than did non-phobic controls. In contrast, following feedback framing the absence of negative outcomes, the GSP group did not differ from controls in their anxiety predictions. The results demonstrated that framing paradigms and methods can be usefully applied to the study of cognitive processes in social phobia and indicated that research to examine how GSP patients process specific types of social information is needed.

Individuals with Generalized Social Phobia (GSP, N = 25) and community controls (N = 26) participated in a social interaction task. They then rated how well they had performed in the situation and assigned weights and valences to the different types of information they used to arrive at this judgment. The GSP group weighed anxiety-related self-information more heavily than did the Control group. In contrast, their conversational partners weighed verbal behavior more heavily. These findings are generally supportive of cognitive models of social phobia and point to the negative interpersonal implications of relying on different social information than others.

Although repetitive thought (RT) styles such as worry, rumination, and processing correlate positively, they have divergent effects on well-being, suggesting important dimensional variation. In Study 1, multidimensional scaling identified 2 dimensions--positive versus negative content valence and searching versus solving purpose--among students (N=978) who completed standard RT measures. In Study 2, students (N=100) sorted 25 descriptions of RT. Multidimensional scaling identified 4 dimensions, including valence and purpose. Content valence associated with valenced affect; solving associated with less aroused affect and less polarized appraisals of thought topics. In Study 3, valence and purpose of RT descriptions by women in a breast cancer prevention trial (N=62) predicted concurrent affect and psychological and physical well-being.

Introduction: Work-related stress in the emergency department previously has been linked to depression and burnout; however, these findings have not been extended to the development of anxiety disorders, such as posttraumatic stress disorder (PTSD). Three sets of factors have been shown to contribute to stress in ED personnel: organizational characteristics, patient care, and the interpersonal environment. The current study addressed whether an association exists between sources of workplace stress and PTSD symptoms., Method: Respondents were 51 ED personnel from a hospital in a large Canadian urban center. The majority of respondents were emergency nurses. Respondents completed questionnaires measuring PTSD and sources of work stress and answered a series of questions regarding work-related responses to stress or trauma., Results: Interpersonal conflict was significantly associated with PTSD symptoms. The majority of respondents (67%) believed they had received inadequate support from hospital administrators following the traumatic incident and 20% considered changing jobs as a result of the trauma. Only 18% attended critical incident stress debriefing and none sought outside help for their distress., Discussion: These findings underscore the need for hospital administrations to be aware of the extent of workplace stress and PTSD symptoms in their employees. Improving the interpersonal climate in the workplace may be useful in ameliorating PTSD symptoms.

Ehlers and Clark (Behav. Res. Ther., 38 (2000) 319) recently proposed a cognitive model of posttraumatic stress disorder (PTSD). In this study, we examined two facets of this model, appraisal and peritraumatic dissociation, in the context of a hospital emergency room. Fifty-one emergency room personnel completed questionnaires measuring posttraumatic stress symptoms, interpretations of traumatic events experienced while working in the emergency room and subsequent intrusive recollections, and peritraumatic dissociation. Twelve percent of participants met formal diagnostic criteria for PTSD, and 20% met PTSD symptom criteria. As predicted, both negative appraisals of the trauma and of intrusive recollections were associated with increased PTSD severity. Although peritraumatic dissociation did not correlate with overall PTSD symptom severity, it was associated with the reexperiencing symptom cluster. Discussion focuses on the factors associated with PTSD in emergency room professionals and implications for intervention.

Avoidant Personality Disorder (APD) is the topic of a growing body of research literature. In this article, we review empirical studies of APD with the goals of identifying the themes that underlie this work and pointing to new directions for future research. In particular, we recommend that future studies evaluate several unique factors postulated by personality theorists to be central to this condition.

The unidimensional model of acculturation posits that heritage and mainstream culture identifications have a strong inverse relation, whereas the bidimensional model posits that the 2 identifications are independent. The authors compared these models in 3 samples of ethnic Chinese (ns = 164, 150, and 204), 1 sample of non-Chinese East Asians (n = 70), and one diverse group of acculturating individuals (n = 140). Although the unidimensional measure showed a coherent pattern of external correlates, the bidimensional measure revealed independent dimensions corresponding to heritage and mainstream culture identification. These dimensions displayed patterns of noninverse correlations with personality, self-identity, and psychosocial adjustment. The authors conclude that the bidimensional model is a more valid and useful operationalization of acculturation.

We examined three cognitive processes hypothesized to contribute to biases in judgments about and memory for social events: self-focused attention, post-event rumination, and anticipatory processing. Socially anxious (N = 58) and nonanxious (N = 58) subjects participated in a social interaction and then completed measures of self-focused attention and anxiety-related physiological sensations and behavior. The next day, subjects completed measures that assessed frequency of post-event processing and recall of the interaction. The results indicated that selective attention to negative self-related information led to biases in social judgments and recollections and that post-event processing contributed to the recall of negative self-related information. No evidence was found for selective retrieval of negative self-related information prior to a second social interaction. The results reconcile inconsistent previous findings related to memory bias in social anxiety.