Shorter communicationFear of blushing: fearful preoccupation irrespective of facial coloration
Introduction
Although blushing is a very common emotional response, the majority of people consider blushing as a highly undesirable reaction (Shields, Mallory & Simon, 1990). Some individuals even experience so much distress as a result of blushing that they develop a blushing phobia and seek treatment (Scholing & Emmelkamp, 1993; Bögels, Mulkens & de Jong, 1997). One of the factors that may facilitate the acquisition and maintenance of such a phobia is individuals' blushing propensity. In line with this, it has been demonstrated that self-reported fear of blushing is associated with self-reported blushing propensity, as indexed with the Blushing Propensity Scale (BPS; Bögels, Alberts & de Jong, 1996).
Apart from a relatively low threshold for blushing, attentional processes may also play a role in this respect. Germane to this possibility, several theorists have mentioned attentional processes as central complicating factors for social phobics who are in a social situation (Daly, Vangelisti & Lawrence, 1989; Hope, Gansler & Heimberg, 1989; Clark & Wells, 1995). That is, interpersonal situations seem to result in heightened self-focused attention (SFA) (Hartman, 1983; Woody, 1996), which, in turn, is assumed to intensify the individual's negative emotional state as well as the perception of their physiological responses (Hope et al., 1989; Bögels et al., 1997; Wells, White & Carter, 1997). The perception of the physiological responses, in its turn, is likely to further enhance the individual's SFA, etc. Pertinent to this suggestion, it has been found that salient physiological arousal serves to focus attention inward (Fenigstein & Carver, 1978; Wegner & Giuliano, 1980), which, in turn, was found to increase individuals' awareness of physiological reactions (see Scheier, Carver & Matthews (1983) for a review). Because blushing is an especially salient physiological reaction (warm cheeks), these processes may be especially prominent in social phobics with fear of blushing as the predominant complaint. Its (presumed) visibility is likely to add further to the SFA eliciting properties of the blush response.
Thus, people with fear of blushing seem to be caught in a vicious circle in which fear of blushing leads to heightened SFA, which increases the awareness of the blush, resulting in a further increase of fear of blushing, etc. Following this, attentional processes may well lead to an overestimation of the actual blush response, which in turn is likely to perpetuate blushing phobics' fear of blushing (cf. McEwan & Devins, 1983).
The present study was designed to investigate further the alleged role of blushing propensity and the overestimation of facial coloration in fear of blushing. Therefore, we exposed individuals with high and low fear of blushing to social predicaments of low and high intensity. Meanwhile, we assessed facial coloration by means of a photoplethysmograph device. Photoplethysmography has been shown to be a reliable and valid method to measure facial blushing (Shearn, Bergman, Hill, Abel & Hinds, 1990, 1992; Mulkens, de Jong & Bögels, 1997). In addition, we recorded temperature changes of the cheek which are thought to serve as interoceptive cues of facial blushing. This was done to investigate possible differential blushing propensity at the interoceptive level, irrespective of its visibility. Furthermore, we recorded changes in skin conductance level as a correlate of general arousal. Finally, participants indicated their own blush intensity, to explore potential differences between high and low fearful individuals with regard to the perceived intensity of their blush response.
The intense social predicament consisted of the individual's watching of her own, prerecorded `sing' video, in the presence of two male confederates. As previous research clearly showed that virtually all people display some facial coloration under such conditions (cf. Shearn et al., 1990), it might be that the `sing' manipulation is too strong to detect subtle between group differences with regard to individuals' blushing propensity. Therefore, we also included a relatively mild social stressor in the present study. The mild stressor consisted of the participants watching a television test card in the presence of two male confederates. As this is a rather unusual activity, it was expected to cause slight feelings of uneasiness, but not extreme discomfort.
Section snippets
Participants
Prior to the experiment, 319 female undergraduate students from Maastricht University completed the `fear of blushing' subscale of the Blushing, Trembling and Sweating Questionnaire (BTS-Q; Bögels & Reith, submitted for publication). From this sample, 57 women were selected on the basis of their scores on this subscale. To create two extreme groups, only women with the most extreme scores in the lowest and highest third of the distribution were randomly approached by phone and invited to
Results
One woman refused further cooperation after she was instructed to sing `Happy Birthday' in the first session. Another participant had an epileptic seizure during baseline II, whereafter the procedure was stopped. Due to technical problems, physiological data were not available completely for an additional participant. This is reflected in the degrees of freedom.
Discussion
The main results of this study can be summarized as follows: (1) Physiological indices of blushing (i.e. blood pooling and cheek temperature) indicated that individuals with high and low fear of blushing responded with equally intense blush responses. (2) For both groups, these responses (i.e. cheek coloration) were significantly higher during the intense social stressor than during the mild social stressor. (3) With respect to self-reports, however, women high in fear of blushing reported that
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