Self-Focused Attention in Social Anxiety Disorder: The Role of Ruminative Self-Focus, Negative-Self-Imagery, and Traumatic Experiences

Abstract

Social anxiety disorder (SAD) involves persistent and excessive fear of negative evaluation or judgement in social/performance situations. The current thesis aimed to explore self-focused attention in SAD, which is considered a key maintaining feature in cognitive models of the disorder. This thesis sought to investigate the nature of self-focused attention, and to examine the efficacy of interventions which may reduce the negative impact of this process. The present thesis comprises two main parts. Part 1 of this thesis focused on ruminative self-focus, investigating the impact of different types of self-focus and exploring the efficacy of mindfulness and acceptance-based treatments for SAD. Hence, literature reviews 1 (chapter 2) and 2 (chapter 3) reviewed theoretical models and empirical evidence for self-focused processes in SAD, and empirical evidence for the impact of mindfulness and experiential self-focus on social anxiety. In addition, a systematic literature review of mindfulness and acceptance-based interventions for SAD was conducted (chapter 4), and suggested that such treatments may not be the most effective first-line intervention for the disorder. Empirical study 1 (chapter 5) further explored the impact of experiential compared to analytic self-focus among SAD individuals (n = 40) and non-clinical controls (n = 40). Contrary to expectations, results indicated that analytic self-focus may be adaptive for individuals with SAD, whereas experiential self-focus may be maladaptive. Part 2 involved a shift to focusing on negative self-referential imagery that occurs during self-focused attention in SAD, and is linked to aversive social experiences. Hence, literature review 3 (chapter 6) examined evidence for the role of key environmental factors in the aetiology of SAD, including the impact of aversive social experiences on the development of negative self-imagery. Empirical study 2 (chapter 7) was an interview-based study that extended current aetiological literature in SAD by exploring the relationship of various types of trauma with SAD development and maintenance. Outcomes suggested that early relational trauma may be a key proximal cause of SAD onset, leading to the development of negative beliefs and imagery that subsequently maintain the disorder. Thus, empirical study 3 (chapter 8) investigated the efficacy of imagery rescripting for SAD, an intervention aiming to alter negative meanings associated with memories of distressing experiences.Results provided support for the benefits of imagery rescripting in the treatment of SAD, yielding large reductions in trait social anxiety, equivalent to cognitive restructuring, and greater than a no treatment control. Hence, this thesis provides support for cognitive models of SAD, extends understanding of aetiological and maintaining factors in the disorder, and supports the use of imagery rescripting in the treatment of social anxiety. Empirical findings are comprehensively discussed, including clinical implications, limitations, and avenues for future research.