A Comparison of Attentional Biases and Memory Biases in Women With Social Phobia and Major Depression.

Cognitive processes play an important role in the etiology and maintenance of anxiety and depression. Current theories differ, however, in their predictions regarding the occurrence of attentional biases and memory biases in depression and anxiety. To allow for a systematic comparison of disorders and cognitive processes, 117 women (35 with generalized social phobia, 27 with major depression, and 55 healthy controls) participated in a test of visual attention (visual search), an explicit memory test (free recall), and an implicit memory test (anagram solving). Both clinical groups exhibited attentional biases for disorder-related words, whereas only depressed participants showed clear evidence of explicit and implicit memory biases. The implications of these results for competing theories are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attentional Biases to Internal and External Sources of Potential Threat in Social Anxiety.

D. M. Clark and A. Wells (1995) proposed that a shift of attention inward toward interoceptive information is a central feature of social phobia. However, few studies have examined attentional biases toward internal physiological cues in social phobia. The current experiment assessed whether socially anxious individuals exhibit an attentional bias (a) toward cues for an internal source of potential threat (heart-rate information), (b) toward cues for an external source of potential threat (threatening faces) or (c) both. Ninety-one participants who were selected to form extreme groups based on a social anxiety screening measure performed a dot-probe task to assess location of attention. Results showed that socially anxious participants exhibited an attentional bias toward cues of internal, but not external, sources of potential threat. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive Mediation of Treatment Change in Social Phobia.

Ninety individuals with social phobia (social anxiety disorder) participated in a randomized controlled trial and completed cognitive-behavioral group therapy, exposure group therapy without explicit cognitive interventions, or a wait-list control condition. Both treatments were superior to the wait-list group in reducing social anxiety but did not differ from one another at posttest. Changes in estimated social cost mediated treatment changes in both treatment conditions from pre- to posttest. However, only participants who received cognitive-behavioral therapy showed continued improvement from posttest to 6-month follow-up, which was associated with a reduction of estimated social cost from pretest to posttest. These results suggest that cognitive intervention leads to better maintenance of treatment gains, which is mediated through changes in estimated social cost. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Information-Processing Biases in Young Adults From Bereaved and Divorced Families.

Parental loss or divorce is associated with increased risk for affective disorders, potentially because of dysfunctional information processing. This study evaluated attentional biases to threat or loss-related cues in young adults from divorced, parental-loss, or intact families. Participants from intact families showed avoidance of supraliminal threat and loss cues, whereas those from divorced families showed vigilance toward loss cues. Those from bereaved families showed no pattern of bias. Abuse and poor family relationships were associated independently with vigilance toward negative cues. After controlling for abuse, group differences in threat bias were no longer apparent. Results suggest that parental death or divorce may increase risk of affective disorder owing to the loss of a "protective bias" away from negative stimuli. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Is this happiness I see? Biases in the identification of emotional facial expressions in depression and social phobia.

The present study was designed to examine the operation of depression-specific biases in the identification or labeling of facial expression of emotions. Participants diagnosed with major depression and social phobia and control participants were presented with faces that expressed increasing degrees of emotional intensity, slowly changing from a neutral to a full-intensity happy, sad, or angry expression. The authors assessed individual differences in the intensity of facial expression of emotion that was required for the participants to accurately identify the emotion being expressed. The depressed participants required significantly greater intensity of emotion than did the social phobic and the control participants to correctly identify happy expressions and less intensity to identify sad than angry expressions. In contrast, social phobic participants needed less intensity to correctly identify the angry expressions than did the depressed and control participants and less intensity to identify angry than sad expressions. Implications of these results for interpersonal functioning in depression and social phobia are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Post-Event Rumination and Negative Self-Appraisal in Social Phobia Before and After Treatment.

This study investigated the relationship between self-appraisals of performance, symptom severity and post-event rumination in social phobia, and evaluated the effect of treatment on these variables. A socially phobic group and a nonanxious control group performed an impromptu speech and were told that their performance would be evaluated. Participants appraised their performance immediately after the speech and 1 week later, and the frequency of post-event rumination during the week following the speech was assessed. The socially phobic group maintained the negative appraisals of their speech over the week, whereas the nonclinical group showed increased positivity about their performance The socially phobic group also engaged in more negative rumination than controls. Treatment improved perceptions of performance and reduced negative rumination. These results are discussed in the light of cognitive models of social phobia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive Therapy Versus Fluoxetine in Generalized Social Phobia: A Randomized Placebo-Controlled Trial.

Sixty patients meeting Diagnostic and Statistical Manual of Mental Disorders (4th ed.: American Psychiatric Association, 1994) criteria for generalized social phobia were assigned to cognitive therapy (CT), fluoxetine plus self-exposure (FLU + SE), or placebo plus self-exposure (PLA + SE). At posttreatment (16 weeks), the medication blind was broken. CT and FLU + SE patients then entered a 3-month booster phase. Assessments were at pretreatment, midtreatment, posttreatment, end of booster phase, and 12-month follow-up. Significant improvements were observed on most measures in all 3 treatments. On measures of social phobia, CT was superior to FLU + SE and PLA + SE at midtreatment and at posttreatment. FLU + SE and PLA + SE did not differ. CT remained superior to FLU + SE at the end of the booster period and at 12-month follow-up. On general mood measures, there were few differences between the treatments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social Information-Processing Skills Training to Promote Social Competence and Prevent Aggressive Behavior in the Third Grades.

This article describes a school-based study designed to promote social competence and reduce aggressive behavior by strengthening children's skills in processing social information and regulating emotions. Three successive cohorts of 3rd graders (N = 548) from 2 schools participated. In 2000-2001, children received a routine health curriculum; in 2001-2002, students received the Making Choices: Social Problem Solving Skills for Children (MC) program; and in 2002-2003, children received MC supplemented with teacher and parent activities. Compared with children in the routine condition, children in both MC conditions were rated lower on posttest social and overt aggression and higher on social competence. Moreover, they scored significantly higher on an information-processing skills posttest. The findings suggest that prevention programs can strengthen social- emotional skills and produce changes in aggressive behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Resolving Ambiguity: The Effect of Experience on Interpretation of Ambiguous Events in Generalized Social Phobia.

The authors examined the effect of learning on multiple encounters with sources of social ambiguity in individuals with generalized social phobia (GSP). The authors modified G. B. Simpson and H. Kang's (1994) paradigm and presented prime-target word pairs to individuals with GSP and nonanxious controls (NACs) to prime threat and nonthreat meanings of homographs and examine the effect of this priming on later encounters with that homograph. Consistent with previous research, NACs showed faster response latencies naming a target primed by a homograph with the same meaning activated in two successive trials than naming the same target primed by an unrelated word. Furthermore, NACs showed slower response latencies naming a target when a different meaning of the homograph prime was activated in successive trials than naming a target primed by an unrelated word. GSP participants did not show this pattern in learning a nonthreat meaning of a homograph. These results support the hypothesis that a faulty learning mechanism may be involved in social anxiety. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changes in Self-Perception During Treatment of Social Phobia.

Ninety individuals with social phobia were randomly assigned to a waitlist control group, a cognitive-behavioral therapy group, or an exposure therapy group without explicit cognitive intervention. Two independent raters classified more than 2,000 thoughts that were reported by participants while anticipating socially stressful situations at pretest and posttest. Each thought was classified on the basis of its valence (positive, negative, or neutral) and attentional focus (self or other). The 2 treatments demonstrated a greater reduction in the frequency of negative self-focused thoughts than the control group. Changes in negative self-focused thoughts and changes in social anxiety were significantly correlated only in the cognitive-behavioral therapy group. The implications of these findings for the cognitive model of social phobia are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Social Thoughts and Beliefs Scale: A New Inventory for Assessing Cognitions in Social Phobia.

Development and initial psychometric features of a new inventory to assess cognitions associated with social phobia are described. The Social Thoughts and Beliefs Scale (STABS) is designed to assess cognitions in individuals with social phobia. In the 1st study, an initial pool of 45 items was reduced to 21. In the 2nd study, psychometric features of the scale were examined in a sample of individuals with social phobia, other anxiety disorders, and no psychiatric disorder. Total scores and two factor scores significantly differentiated individuals with social phobia from those in the other groups and were found to have adequate test-retest reliability and internal consistency. Potential usefulness of the STABS for assessing cognitions associated with social phobia is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Biases in interpretation and memory in generalized social phobia.

Two experiments examined the link between interpretation and memory in individuals diagnosed with Generalized Social Phobia (GSP). In Experiment 1, GSP and control participants generated continuations for nonsocial and ambiguous social scenarios. GSP participants produced more socially anxious and negative continuations for the social scenarios than did the controls. On the subsequent test of recalling the social scenarios, intrusion errors that shared meaning with the original continuations were made more frequently by the GSP group, producing false recall with emotionally negative features. To examine whether nonanxious individuals would also produce such errors if given emotional interpretations, in Experiment 2 the authors asked university students to read the scenarios plus endings produced by GSP participants in Experiment 1. The students either constructed vivid mental images of themselves as the main characters or thought about whether the endings provided closure. Low-anxious students in the closure condition produced fewer ending-based intrusions in recalling the social scenarios than did students in the other 3 conditions. Results illustrate the importance of examining the nature of source-monitoring errors in investigations of memory biases in social anxiety. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Selective Attention to Angry Faces in Clinical Social Phobia.

This study investigated the time course of attentional responses to emotional facial expressions in a clinical sample with social phobia. With a visual probe task, photographs of angry, happy, and neutral faces were presented at 2 exposure durations: 500 and 1,250 ms. At 500 ms, the social phobia group showed enhanced vigilance for angry faces, relative to happy and neutral faces, in comparison with normal controls. In the 1,250-ms condition, there were no significant attentional biases in the social phobia group. Results are consistent with a bias in initial orienting to threat cues in social anxiety. Findings are discussed in relation to recent cognitive models of anxiety disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive Processing of Emotional Information in Depression, Panic, and Somatoform Disorder.

Emotional Stroop tasks (subliminal/supraliminal exposures), implicit memory tasks (tachistoscopic word identification), and explicit memory tasks (free recall after incidental learning) with 4 word types (physical threat, positive, negative, and neutral words) were administered to patients with major depressive disorder (n = 30), panic disorder (n = 33), somatoform disorder (n = 25), and healthy control participants (n = 33). On the Stroop task, panic patients showed subliminal interferences for physical threat and negative words, depressive patients showed supraliminal interferences for negative words, and somatoform patients showed supraliminal interferences for physical threat words. No patient groups demonstrated implicit memory biases. On the explicit memory task, depressive and panic patients showed memory biases for negative words; somatoform patients showed biases for physical threat words. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social constraints, cognitive processing, and adjustment to breast cancer.

This cross-sectional study of 70 breast cancer survivors examined relationships among social constraints, behavioral and self-report indicators of cognitive processing, depression, and well-being. On the basis of a social-cognitive processing (SCP) model, it was predicted that social constraints would inhibit cognitive processing of the cancer experience, leading to poorer adjustment. Constraints were positively associated with intrusions, avoidance, and linguistic uncertainty in cancer narratives. Greater uncertainty, intrusions, and avoidance, as well as less talking about cancer were associated with greater depression and less well-being. Intrusions partially mediated the positive constraints-depression relationship. Talking about cancer partially mediated the inverse avoidance-well-being relationship. Findings support the SCP model and the importance of using behavioral indicators of cognitive processing to predict positive and negative psychosocial outcomes of cancer. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Specificity of Stroop interference in patients with pain and PTSD.

The authors investigated processing of threat words in motor vehicle accident survivors using a modified Stroop procedure. Three samples were included: 28 participants with comorbid posttraumatic stress disorder (PTSD) and pain, 26 participants with pain without PTSD, and 21 participants without pain or any psychiatric conditions. Four word categories were used: (a) accident words, (b) pain words, (c) positive words, and (d) neutral words. This study examined whether processing biases would occur to accident words only in participants with PTSD or if these biases would also be noted in the No PTSD/Pain sample. Additionally, this study examined whether processing biases would be noted to pain words in the 2 pain samples, irrespective of PTSD. Overall, color naming was significantly slower in the PTSD/Pain group in comparison with the other groups. As well, the PTSD/Pain sample showed significant response delays to both accident and pain-related words, whereas patients with No PTSD/Pain showed delays to pain stimuli only. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attention training in individuals with generalized social phobia: A randomized controlled trial.

The authors conducted a randomized, double-blind placebo-controlled trial to examine the efficacy of an attention training procedure in reducing symptoms of social anxiety in 44 individuals diagnosed with generalized social phobia (GSP). Attention training comprised a probe detection task in which pictures of faces with either a threatening or neutral emotional expression cued different locations on the computer screen. In the attention modification program (AMP), participants responded to a probe that always followed neutral faces when paired with a threatening face, thereby directing attention away from threat. In the attention control condition (ACC), the probe appeared with equal frequency in the position of the threatening and neutral faces. Results revealed that the AMP facilitated attention disengagement from threat from pre- to postassessment and reduced clinician- and self-reported symptoms of social anxiety relative to the ACC. The percentage of participants no longer meeting Diagnostic and Statistical Manual (4th ed.) criteria for GSP at postassessment was 50% in the AMP and 14% in the ACC. Symptom reduction in the AMP group was maintained during 4-month follow-up assessment. These results suggest that computerized attention training procedures may be beneficial for treating social phobia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Testing the efficacy of theoretically derived improvements in the treatment of social phobia.

Recent theoretical models of social phobia suggest that targeting several specific cognitive factors in treatment should enhance treatment efficacy over that of more traditional skills-based treatment programs. In the current study, 195 people with social phobia were randomly allocated to 1 of 3 treatments: standard cognitive restructuring plus in vivo exposure, an “enhanced” treatment that augmented the standard program with several additional treatment techniques (e.g., performance feedback, attention retraining), and a nonspecific (stress management) treatment. The enhanced treatment demonstrated significantly greater effects on diagnoses, diagnostic severity, and anxiety during a speech. The specific treatments failed to differ significantly on self-report measures of social anxiety symptoms and life interference, although they were both significantly better than the nonspecific treatment. The enhanced treatment also showed significantly greater effects than standard treatment on 2 putative process measures: cost of negative evaluation and negative views of one's skills and appearance. Changes on these process variables mediated differences between the treatments on changes in diagnostic severity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)