Introduction
Social anxiety disorder (SAD) is very common in young people (Epkins & Heckler,
2011). The lifetime prevalence rates are estimated to be around 7% in European countries (Fehm et al.,
2005), and the highest incidence rates are suggested to be found in childhood and early adolescence (Knappe et al.,
2015). Social anxiety is often associated with interpersonal difficulties, including fewer friendships (La Greca & Lopez,
1998; Van Zalk et al.,
2011), poorer friendship quality (Biggs et al.,
2012; La Greca & Harrison,
2005), poorer social skills (Miers et al.,
2010), dysfunctional interpersonal styles (Darcy et al.,
2005; Swee et al.,
2021), lower levels of assertiveness and greater conflict avoidance (Mufson et al.,
2015). Importantly, interpersonal difficulties are associated not only with social anxiety but also with depression (La Greca & Harrison,
2005; Mufson et al.,
2015) and have been discussed as an important mediator (Cummings et al.,
2014; Erath et al.,
2010; Jacobson & Newman,
2016; Mufson et al.,
2015; Schleider et al.,
2014) in light of the high comorbidity rates (28–50%) of SAD and depression in adolescents (Beesdo et al.,
2007; Epkins & Heckler,
2011). Besides bidirectional associations (Belmans et al.,
2019), early-onset social anxiety appears to be more predictive of secondary depression than vice versa, making it a relevant risk factor for depression in youth (Beesdo et al.,
2007; McLaughlin & King,
2015; Schleider et al.,
2014; Van Zalk & Van Zalk,
2019).
Adolescence is a sensitive period in which interpersonal experiences significantly impact affect and behavior. This period is characterized by an increased desire to separate from parents and to gain more autonomy and independence. Peer relationships and close friendships become increasingly important, including social and emotional support (Mufson et al.,
2015). However, in socially anxious individuals, safety behaviors and avoidance, as well as anticipatory and post-event processing, not only contribute to the maintenance of anxiety, but also impair effective engagement in social situations and increase the likelihood of negative evaluations by others (Wong & Rapee,
2016). Socially anxious adolescents have been found to have more negative experiences with peers and fewer friends, which can become a vicious cycle that contributes not only to social anxiety but also to depression (Mufson et al.,
2015). A cumulative interpersonal risk model suggests that negative peer experiences promote social withdrawal, worry, and rumination, which contribute to loneliness and risk for depression, especially in the absence of close friends (Epkins & Heckler,
2011; Schleider et al.,
2014). With this in mind, it is particularly important to examine the interpersonal behavior of people with SAD during the sensitive period of adolescence, when the risk of developing a secondary depression increases (Beesdo et al.,
2007).
The everyday interpersonal behaviors of socially anxious adolescents and their impact on mood and depression are best studied using ecologically valid measures of everyday life, such as experience sampling methods (ESM) or ecological momentary assessment (EMA), to minimize retrospective bias and to assess time- and situation-dependent fluctuations (Walz et al.,
2014). However, to our knowledge, there has been little research in this area using these methods and, so far depressive mood has not been explicitly considered (Doorley et al.,
2020; Goodman et al.,
2021; Hur et al.,
2019; Morgan et al.,
2017). Consistent with retrospective data (Cummings et al.,
2014; Mufson et al.,
2015), Hur and colleagues (
2019) found that socially anxious adolescents had less contact with close companions and exhibited overall higher levels of negative and lower levels of positive affect than non-anxious adolescents. In addition, their EMA results provide information on the variability of affect and show that the social context may have a differential impact on the current affect. Socially anxious adolescents appear to benefit even more from the company of close companions in terms of greater reductions in negative affect, anxiety, and depression than non-socially anxious adolescents (Hur et al.,
2019). However, Goodman and colleagues (
2021) found contradictory results, with changes in affect across different social situations being quite similar between individuals with SAD and healthy controls. Furthermore, findings from Morgan and colleagues (
2017) suggest that emotional closeness with the interaction partner is particularly important for adolescents with SAD. Positive events with less close peers were associated with lower positive affect in youths with SAD compared to healthy youths, whereas positive events with close peers were associated with similar levels of positive affect (Morgan et al.,
2017). Besides perceived emotional closeness to interaction partners, the intensity of positive events was found to be an important factor in the emotional benefits of socially anxious people, i.e., the benefits of positive events were greater the more intense these events were rated (Doorley et al.,
2020). Taken together, most of these empirical findings suggest that emotional reactivity to everyday events seems to be altered in socially anxious individuals, i.e., they appear to have greater emotional benefits. However, there are also conflicting results and the studies cited used different methods, either testing effects against a continuum of social anxiety or testing people with SAD against healthy controls. Although it is likely that the results would be similar, as people without a diagnosis may also have subthreshold social anxiety, it is important to bear this difference in methodology in mind when interpreting the studies. In addition, most studies used convenience or student samples, which may limit generalizability to other parts of the population, especially since EMA studies are inherently subject to selection bias due to their high demands (Stone et al.,
2023), concluding that further research is needed.
In fact, the findings described above partly parallel the mood brightening effect seen in depressive disorders, where people with depression seem to be more responsive to positive events than healthy controls (Khazanov et al.,
2019). This means, that higher levels of depression were associated with greater reductions in depressed mood or negative affect after positive events in daily life, especially after positive interpersonal events (Nelson et al.,
2020; Panaite et al.,
2019; Starr & Hershenberg,
2017). This pattern is explained by the idea that depressed people have fewer positive events in their everyday life, or rate fewer events as positive, resulting in an overall worse mood. A positive event would therefore provide greater contrast and lead to greater reductions in negative affect, also because there is more room for mood improvement (Nelson et al.,
2020; Panaite et al.,
2018). Comparing these findings to those of social anxiety disorder, it appears that both groups derive greater benefit, i.e. greater mood brightening, from positive (interpersonal) events in daily life than healthy controls, (Hur et al.,
2019; Panaite et al.,
2018), although this has not been found consistently (Goodman et al.,
2021). This potential similarity between SAD and depression may be important given the high comorbidity (Beesdo et al.,
2007), as interpersonal difficulties and specific processing of social situations may contribute to secondary depression in SAD.
Against this background, the current study aims to describe the social interaction behavior in the daily life of adolescents and young adults with SAD and to analyze the effect of positive interactions on depression, anxiety, and mental state in terms of a brightening effect. The present study focuses on young people from the general population who meet the criteria for SAD, which seems relevant given the high prevalence of the disorder and its frequent comorbidity, especially with depressive disorders (Beesdo et al.,
2007; Epkins & Heckler,
2011; Fehm et al.,
2005). The following hypotheses were tested: At first, as socially anxious people tend to avoid social contacts (Mufson et al.,
2015) and are characterized by impairments in positive and negative affect (Goodman et al.,
2021), it was expected that participants with SAD report fewer interactions, poorer well-being and higher depression and anxiety levels on average in daily life than healthy controls. Second, participants with SAD were expected to derive greater benefits of positive meaningful social interactions concerning mental state and depression than healthy controls (Doorley et al.,
2020). Third, these effects might be moderated by the type of interaction partner, with greater benefits following positive interactions with close individuals (Hur et al.,
2019; Morgan et al.,
2017). That is, it is assumed that a positive effect of social interaction, i.e., the benefit of interaction, should be more pronounced after positive interactions with close people than after interactions with distant/mixed people.
Discussion
The aim of the current general population study was, first, to describe social interaction behavior in daily life of adolescents and young adults with a social anxiety disorder, second, to analyze the effect of positive interactions on depression, anxiety, and mental state in terms of a brightening effect (Khazanov et al.,
2019), and third, to investigate the impact of the type of interaction partner in this regard. The main findings were that the interactional behavior of young people with SAD was not significantly different from that of healthy controls, and that those with SAD had higher levels of anxiety and depression and poorer mental state in daily life. The assumption of a brightening effect after interactions, especially with close interaction partners, could not be supported. Yet, a negative effect of interactions with distant interaction partners on depressive mood was found in individuals with SAD, even though the interactions themselves were positively rated.
Adolescents and young adults with a 12-month diagnosis of SAD showed overall quite similar communication behavior in daily life as healthy control peers without a 12-months diagnosis of a mental disorder, at least concerning the length of communication and number of interaction partners online. However, they reported a fewer number of interaction partners in real-life. The social network size might be important in this regard. It has been found that socially anxious youths identify fewer people as their friends or confidants (Hur et al.,
2019; Van Zalk et al.,
2011) and are perceived by others as unattractive interaction partners (Creed & Funder,
1998). Therefore, it might be expected that they have fewer people with whom they could easily interact, albeit this does not affect the number of interactions. This means, they would distribute the same number of interactions among a smaller number of people. However, this assumption needs to be tested elsewhere and, in contrast, social anxiety was also found to be associated with social withdrawal and less time with friends (Biggs et al.,
2012; Goodman et al.,
2021; Hur et al.,
2019).
For the most meaningful interactions, the frequencies of the different interaction partners did not differ between those with SAD and healthy controls, indicating some similarity in interaction patterns. The evaluation of these interactions was mostly positive for all, yet socially anxious people were more likely to rate interactions negatively. This finding is consistent with the theory of post-event processing in social anxiety, according to which socially anxious people are more likely to ruminate negatively after social interactions (Dannahy & Stopa,
2007), which could more often lead to devaluation.
As hypothesized and consistent with the literature (Doorley et al.,
2020; Goodman et al.,
2021), socially anxious adolescents and young adults reported higher levels of anxiety and depression in daily life and poorer well-being. Yet, an unexpected finding was that the mood brightening effect found in other studies for depression (Bylsma et al.,
2011; Nelson et al.,
2020; Panaite et al.,
2019) and social anxiety (Doorley et al.,
2020; Hur et al.,
2019; Morgan et al.,
2017) was not supported by the current data in the way that socially anxious youths would benefit more from positive interactions. Meanwhile, Goodman and colleagues (
2021) have not been able to prove this effect in their study either. Apart from the generally poorer well-being and higher levels of depression, and anxiety found in socially anxious young adolescents, positive interactions in daily life instead appear to have overall effects similar to those in non-anxious healthy individuals. However, when the type of interaction partner was considered, interactions with only unfamiliar, distant individuals were found to be associated with higher levels of depression compared to no interaction in socially anxious individuals. Thus, interactions with distant people seem to have a particularly disadvantageous effect. This was most evident for depressive symptoms. But, graphically, a trend also emerged for anxiety. With respect to mental state, no differential effects on the benefit of positive interactions were found, although a tendency for a brightening effect after close or mixed interactions was observed graphically.
There may be several reasons why our study did not find the mood brightening effect, but rather an association of increased depressiveness with social interactions with distant, unfamiliar people. It is important to look at the methodological differences from the studies that found the brightening effect. These studies asked about current or contextual affect (Doorley et al.,
2020; Hur et al.,
2019; Morgan et al.,
2017). For anxiety and depression symptoms, we referred to the time since the last assessment, which was on average more than two hours ago. Given that people with SAD tend to have negative post-event processing (Dannahy & Stopa,
2007), one might assume that positive experiences would be devaluated over time, so that potential brightening effects would only be found during the event. The longer assessment interval left a little more room for retrospective bias, which, combined with the negative post-processing, may have led people with SAD not to report a possible reduction in depression and anxiety symptoms. However, this is contradicted by the study by Goodman and colleagues (
2021), who also did not find the effect, despite examining the current affect and context. The evidence for the mood brightening effect in people with social anxiety is thus very heterogeneous, and further studies are needed to identify possible mediator or moderator variables.
Further, it remains to be discussed why social interactions with unfamiliar, distant people were associated with increased levels of depression in youths with SAD, even though these interactions themselves were not rated as negative. Communicating with unfamiliar people is a very uncomfortable situation for individuals with SAD (Ruscio et al.,
2008) and can lead to negative self-evaluations and increased rumination afterwards (Dannahy & Stopa,
2007; Kocovski et al.,
2005). Referring to Clark and Wells’ (
1995) cognitive model, they focus on the negative feelings and cognitions they experienced in the situation and may infer incompetence, leading to self-devaluation and increased feelings of depression. It is now questionable why the situation was however not rated as negative. As a reminder, in this study an interaction was defined as negative if the mean of the bipolar scales pleasantness, intimacy, and harmony was below the cutoff of 5, which is the midpoint of the response scale. Thus, one might assume that socially anxious people evaluated the interaction in two parallel ways: On the one hand, more objectively, in the sense that there were no overt conflicts, and the interaction was generally friendly. On the other hand, they may strongly devalue their own role in the interaction and attribute negative aspects of the situation to themselves, which increases feelings of incompetence and depressive thoughts. Combined, this could indicate an adverse attributional style, similar to that seen in depression, namely internal, stable, and global attributions for negative events (Fresco et al.,
2006; Sweeney et al.,
1986). This also parallels to the theory of double standard bias in social anxiety, according to which socially anxious individuals tend to make more stringent predictions about themselves than about others (Voncken et al.,
2006). However, the assumption of an attributional style that moderates depressive thoughts following interactions with strangers in socially anxious individuals remains to be tested.
One might further assume that, despite the dichotomization of quality and that in this sense only positive interactions were considered, socially anxious individuals might have rated the quality of distant interactions worse than healthy controls, so that the quality rating might act as a mediator. Although this assumption was not fully tested, a closer look at the descriptive data revealed no remarkable differences in the quality ratings between socially anxious and healthy participants. Thus, it appears that factors other than the perceived quality of the interaction contribute to increased depressive feelings following distant interactions in socially anxious individuals.
The increased depressiveness did not occur when familiar people, like friends or family members, were involved in the interactions. This could be explained by the fact that interaction situations with familiar people may not be anxiety-provoking for socially anxious and, when unfamiliar people are also involved in the situation, familiar people might instead serve as regulatory role (Morgan et al.,
2017).
It is important to note, that anxiety ratings showed a similar pattern to depression, although the effect did not reach significance, probably due to large variances. Social interactions with unfamiliar people are among the most feared situations in social anxiety (Beidel et al.,
2007; Stein et al.,
2010). So, one might have expected that the difference in anxiety between interactions with strangers and no interaction would be more pronounced in people with SAD than in healthy people. This tendency can also be seen visually. A quite similar picture can be found for current mental state, which seems to be higher for both groups after interaction situations and in general lower for the socially anxious. Although the interaction effects were not statistically significant, descriptively, there was a higher dynamic between interaction situations and a tendency toward a brightening effect in socially anxious individuals. Unlike other studies that have examined momentary affect as a function of social interactions (Goodman et al.,
2021; Hur et al.,
2019), we asked about the most meaningful interaction situation since the last assessment, rather than the current social situation. However, the mental status questions referred to the current mental conditions. This is important in that the dynamics of the current affect and differences between individuals with SAD and healthy individuals may be even more pronounced considering the current situation. Furthermore, the exploratory moderation analyses of age suggest that age did not moderate the effect of social interactions on depression and mental state, but partially on anxiety. The results suggest that younger people with SAD seem to feel more anxious after social interactions with mixed groups/other people, which may be related to new social contexts that become particularly relevant in early adolescence (e.g., starting to go out with friends). In conclusion, there is a need for further research on the emotional dynamics of different social situations in in young people with social anxiety disorder.
The exploratory post hoc estimates of the effects of negative interactions showed that negative interactions in daily life were associated with higher levels of depressive and anxiety symptoms and poorer mental state in healthy individuals and individuals with SAD. Interestingly, there may be as well group differences when the type of interaction partner is taken into account. Although not statistically supported due to lack of power, the data graphically suggested that negative interactions with close people had a negative effect for all, whereas negative interactions with distant people seemed to be particularly distressing for the adolescents with SAD. This suggests that healthy individuals may be better able to distance themselves from negative social experiences with unfamiliar people, whereas this does not seem to be the case in adolescents and young adults with SAD. This would support the specific role that interacting with unfamiliar people plays in the daily lives of socially anxious adolescents. Also, findings may likely be explained by cognitive bias and double standards, similar to positive interactions.
There are some limitations to be mentioned. First, the sample size of the SAD group (n = 60) was quite small, and only adolescents and young adults living in the city of Dresden, Germany, participated, which limits the interpretation and generalization of the results to other regions, cultures, or age groups. The results of the moderation analyses by age must be interpreted with caution due to limited power. Moderation analyses by sex were not conducted due to small subsamples, although this would be interesting to consider for further research, as the adjustment appeared to be relevant in some parts of our analyses. We adjusted for age and sex, which allowed the results to be interpreted independently of the expression of these variables. Since this was not a clinical sample and mainly mild forms of social anxiety were included, fear and avoidance behavior were likely to be less pronounced compared to clinical SAD. In addition, the HC group was defined as a very healthy group with no DSM-5 diagnosis in the past 12 months, which may not be considered a typical population reference. However, as social interactions are impaired in various ways in many mental disorders, it would be very difficult to interpret the effect in individuals with SAD against a mixture of all other disorders and healthy people. Thus, our approach allowed us to test the effects for SAD, although no conclusions can be drawn about its specificity or other psychopathologies. Interpretation of the results of the exploratory analyses on negative social interactions is limited due to the small number of meaningful negative interactions reported. Nevertheless, the results can be interpreted as a tendency and provide starting points for further research.
Beside these limitations, there are also strengths to be highlighted. The study examined daily life data from a general population sample of adolescents and young adults, so it can be assumed to have high ecological validity in the context of the groups studied. The diagnostic status was assessed in each participant by means of a fully standardized computer-assisted personal interview and the diagnoses were based on current DSM-5 diagnostic criteria. In light of this, our study provides important information, complementary to previous EMA studies (e.g. Doorley et al.,
2020; Goodman et al.,
2021; Hur et al.,
2019), on social interaction behavior and its emotional impact in young people with mild forms of SAD.
Our study provides directions for future research. In addition to replicating our results, researchers could examine which factors explain the elevated depression scores following contact with unfamiliar people in socially anxious adolescents. Investigating this pattern and potential moderating factors is particularly interesting given the high rates of secondary depression in SAD (Beesdo et al.,
2007). Overall, it seems useful to further investigate emotional variability and stability in everyday life of young people with SAD. As our study included only mild forms of SAD, examination of daily life records of people with clinically relevant SAD with and without comorbid depression could provide further important information.
In summary, adolescents and young adults with mild forms of SAD seem to have a quite similar pattern of interaction in daily life as healthy individuals. However, consistent with other studies (Goodman et al.,
2021; Hur et al.,
2019), our findings suggest that the emotional effects of social interactions are altered. In particular, the type of interaction partner appears to be of greater importance to emotional state in people with SAD than in healthy individuals. That is, we found meaningful interactions with unfamiliar individuals to be associated with increased depression in young people with SAD. Given the high rate of secondary depression in SAD, this is an important indication of potentially problematic cognitive processing of such situations. Accordingly, our results provide an important starting point for further research on the development of depressive symptoms in social anxiety and the potential progression to depressive disorders.