Cognitive biases in social phobia

doi:10.1016/j.mppsy.2007.02.006

Psychiatry

Volume 6, Issue 5, May 2007, Pages 204-210

https://doi.org/10.1016/j.mppsy.2007.02.006 Get rights and content

Abstract

Social phobia involves a persistent fear of negative evaluation by others and is associated with significant functional impairment. This contribution presents an introduction to the various cognitive processes (i.e., ways of thinking) that contribute to the maintenance of social phobia. The following areas of cognitive processing are discussed: attention; interpretation; memory; and imagery. Individuals with social phobia exhibit increased attention to potentially threatening social information. They also tend to interpret ambiguous social information as negative and fail to generate positive interpretations of social information. Initial research regarding memory processes suggests that people with social phobia exhibit increased memory for information that is related to negative evaluation from others and to negative self-related information. Negative self-imagery is often evoked in social situations. Such imagery has been associated with increased anxiety and poorer performance in social situations. The spontaneous imagery of people with social phobia is not simply negative in nature but is also viewed from the observer perspective; in other words, it comprises constructed images of the person as he or she may appear to others. Finally, support is emerging for the combined cognitive bias hypothesis, which proposes that these various cognitive biases do not work in isolation but rather combine and amplify the effects of each on social anxiety.

Section snippets

Cognitive–behavioural models of social phobia

Cognitive–behavioural models of social phobia propose biased cognitive processes (i.e., ways of thinking) that contribute to the maintenance of the disorder (see Figure 1 for a schematic presentation of Rapee and Heimberg’s model).5, 6 These models propose that the anticipation of a social situation (or the situation itself) activates certain assumptions in individuals with social phobia.

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They believe they will act in a socially unacceptable way, leading to catastrophic social consequences.
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They

Biases of attention

Cognitive–behavioural models suggest that increased attention to perceived negative information contributes to social anxiety. The Stroop task and the dot-probe paradigm are commonly used to study attention and attentional bias – the degree to which people focus attention disproportionately on selected aspects of a situation. Research using these techniques generally indicates that individuals with social phobia direct more attention towards negative or threat-related information than towards

Biases of interpretation

Social information is often ambiguous, and so the interpretation of such information may be particularly relevant to social phobia. People with social phobia may interpret ambiguous information as negative or dangerous while trying to make sense of their environment. Furthermore, they may interpret information that others may judge as threatening in a more extreme or catastrophic manner. Therefore, biased interpretation of social stimuli may fuel their anxiety and distress.

Stopa and Clark

Biases of memory

While cognitive–behavioural models imply a memory bias for threatening information, the support for such a bias has been inconsistent. Rapee and Heimberg state that after attention in social situations is focused both on the perceived self and on threatening information in the environment, this perceived negative information is then integrated into the person’s self-image.⁶ This self-image and recollections of previous negative social situations are subsequently drawn upon to inform and make

Imagery

Individuals with social phobia report experiencing negative self-images in social situations that appear to reflect the individual’s feared outcome (i.e., imagining oneself going blank in front of an audience). These findings are consistent with the cognitive models which suggest that individuals with social phobia will often construct a negative self-image when forming expectations about what will happen in a social situation. Furthermore, the reported images are often related to past negative

Interaction of cognitive biases

Hirsch et al.¹⁹ have proposed a combined cognitive bias hypothesis: cognitive biases do not operate is isolation; rather, they influence each other and interact to influence social anxiety. The combination of biases is proposed to have a greater impact on sustaining social phobia, as compared to the contribution of each bias on its own. They outline support for this hypothesis, using evidence of a reciprocal relationship between biases in interpretation and imagery.

The combination of biased

Conclusion

There are various cognitive processes at work in the maintenance of social phobia (summarized in Table 1). Individuals with social phobia are more likely to attend to negative or threatening information in the environment, which decreases their ability to recognize and process information that may disconfirm the perception of threat. They also display an interpretation bias: they are more likely to interpret ambiguous information as negative, and they interpret the costs of slightly negative

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In this chapter on social anxiety disorder (SAD), we overview its criteria, epidemiology, and current findings regarding its etiology, maintenance, and treatment. We use case examples throughout to highlight the heterogeneity of SAD. We emphasize the need to better understand cultural factors in SAD both in its development and treatment. Although some factors have clear support as being related to SAD (e.g., neuroticism/negative affect and extraversion/positive affect), we highlight the questionable empirical foundation for many proposed risk and maintenance factors for the disorder. Treatment that includes social practice (via behavioral or cognitive framework) is recommended.
Can mindfulness modify your thoughts? A study in the context of social phobia
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Mindfulness encourages the individual to pay attention to the present moment with a non-judgmental attitude (Kabat-Zinn, 1994). It has been suggested that, in social phobia, unrealistic standards regarding performance and overestimation of negative consequences hampers the performance of the individual by allocating increased attention toward oneself and limiting the attentional resources for tasks in hand (Spokas et al., 2007). Attentional bias to social threat has also been implicated (Hallion & Ruscio, 2011; Mogg et al., 2004).
Social phobia is said to be the commonest anxiety disorder (Furmark, 2002). Cognitive Behavior Therapy appears to be the most recommended form of psychological treatment for this condition (Federoff & Taylor, 2001; Willutzki et al., 2012). Dismantling studies have raised doubts regarding the utility of cognitive restructuring in bringing about decrease in symptoms (Barrera et al., 2016; Pompoli et al., 2018). Mindfulness, a ‘third-wave’ concept, seems to contradict the philosophy of ‘restructuring’ with its apparent stress on non-judgmental observation (Hayes, 2004). This approach postulates that acceptance of cognitions and emotions as therapeutic in contrast to traditional cognitive behavior therapy approach, which advocates restructuring and modifications of cognitions.
The current study attempted to study the ‘restructuring’ effects of mindfulness in persons with social phobia.
Thirty-nine clients with a primary diagnosis of social phobia (ICD – 10) participated in the Mindfulness Integrated Cognitive Behavior Therapy (MICBT) program, which consisted of eight sessions. MINI International Neuropsychiatry Interview Plus, Liebowitz Social Anxiety Scale, Fear of Negative Evaluation, Meta Cognitions Questionnaire and Five-Facet Mindfulness Questionnaire were administered pre and post of the therapeutic program.
The results demonstrated that MICBT had a significant effect on reducing the scores on fear of negative evaluation and bringing about changes in metacognitions.
Mindfulness could be sufficient as a therapeutic strategy to bring about changes in the cognitions of clients with social phobia without using cognitive restructuring.
La phobie sociale serait le trouble d’anxiété le plus courant (Furmark, 2002). La thérapie cognitivo-comportementale semble être la forme de traitement psychologique la plus recommandée pour cette maladie (Federoff & Taylor, 2001 ; Willutzkiet al., 2012). Des études de démantèlement ont soulevé des doutes quant à l’utilité de la restructuration cognitive pour provoquer une diminution des symptômes (Barrera et al., 2016 ; Pompoli et al., 2018). La pleine conscience, un concept de « troisième vague », semble contredire la philosophie de la « restructuration » avec son accent apparent sur l’observation sans jugement (Hayes, 2004). Cette approche postule que l’acceptation des cognitions et des émotions contraste avec l’approche traditionnelle de la thérapie cognitivo-comportementale qui préconise la restructuration et les modifications des cognitions.
La présente étude a tenté d’étudier les effets de « restructuration » de la pleine conscience chez les personnes atteintes de phobie sociale.
Trente-neuf clients avec un diagnostic primaire de phobie sociale (CIM – 10) ont participé au programme de thérapie cognitivo-comportementale intégrée de la pleine conscience (MICBT), qui comprenait huit séances. Le International Neuropsychiatry Interview Plus, Liebowitz Social Anxiety Scale, Fear of Negative Evaluation, Meta Cognitions Questionnaire et Five-Facet Mindfulness Questionnaire ont été administrés avant et après le programme thérapeutique.
Les résultats ont démontré que le MICBT avait un effet significatif sur la réduction des scores sur la peur d’une évaluation négative et entraînant des changements dans les métacognitions.
La pleine conscience pourrait être suffisante comme stratégie thérapeutique pour provoquer des changements dans les cognitions des clients atteints de phobie sociale sans recourir à la restructuration cognitive.
Biased estimations of interpersonal distance in non-clinical social anxiety
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Individuals with social anxiety are characterized by avoidance of social interactions, manifested by a preference for greater interpersonal distance – specifically from strangers (Asnaani, Rinck, Becker, & Hofmann, 2014; Perry, Rubinsten, Peled, & Shamay-Tsoory, 2013; Cohen, Perry, Mayseless, Kleinmintz, & Shamay-Tsoory, 2018; Clark & Wells, 1995). There is also evidence that social anxiety is accompanied by cognitive symptoms, including biases in attention (Bantin, Stevens, Gerlach, & Hermann, 2016; see review by Kuckertz & Amir, 2014), interpretation (Mobini, Reynolds, & Mackintosh, 2013; Spokas, Rodebaugh, & Heimberg, 2007), memory (Amir & Bomyea, 2011; Clark & Wells, 1995; Rapee & Heimberg, 1997; Yoon, Kutz, LeMoult, & Joormann, 2017;) and imagery (Ng, Abbott, & Hunt, 2014; (Brozovich & Heimberg, 2013; see review: Norton & Abbott, 2016). In a related vein, there is also evidence that individuals with social anxiety show biased estimations of social elements.
Previous studies have indicated that socially-anxious individuals prefer to maintain a greater interpersonal distance from others, specifically from strangers. Notwithstanding, it has yet to be examined whether this preference for distance is associated with estimating the physical interpersonal distance in a distorted manner. In the current study, 100 participants performed a computerized task that measured estimated distance (Study 1). An additional sample of 75 participants performed the same task for the purpose of replication, and further took part in a new task that measured estimated distance from a stranger in a real-life setting (Study 2). In both studies social anxiety correlated with estimating the interpersonal distance from strangers as shorter. Furthermore, ones' preferred distance from a stranger was predicted by this distance estimation bias. Taken together, our findings are the first to reveal distance estimation bias in social anxiety, suggesting a role for distorted distance estimation in avoidance behavior.
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Social phobiaCognitive biases in social phobia

Abstract

Section snippets

Cognitive–behavioural models of social phobia

Biases of attention

Biases of interpretation

Biases of memory

Imagery

Interaction of cognitive biases

Conclusion

Psychiatry Res

Behav Res Ther

Behav Res Ther

Behav Res Ther

Behav Res Ther

Behav Res Ther

Behav Res Ther

Behav Res Ther

Behav Res Ther

Behav Res Ther

Social phobia
Cognitive biases in social phobia