Cognitive Factors in Social Anxiety

Abstract

Social Anxiety Disorder (SAD) is characterised by a marked and persistent fear of social or performance situations. Cognitive models suggest that cognitive factors of SAD, including threat appraisals and dysfunctional thinking styles, play a crucial role in generating and maintaining social anxiety (Clark & Wells, 1995; Rapee & Heimberg, 1997; Hofmann, 2007). Self-report measures are commonly used to assess cognitive factors of SAD in research and clinical settings. However, the psychometric properties of such measures require evaluation in order to select the most methodologically appropriate measure for specific clinical and research purposes. The aim of Study 1 (Chapter 2) was to systematically review studies that report on the psychometric properties of trait cognitive self-report measures of social anxiety. The methodological quality of the measures was assessed using an appraisal of adequacy tool developed by Terwee et al. (2007). Fifty studies were included representing 21 measures. Several measures had some adequate psychometric properties, however, no measure had strong enough positive evidence as yet to allow for recommendations to be made regarding use in clinical and research settings. The best measure to date was the SISST, which received the greatest number of positive ratings, being six out of nine. The aim of Study 2 (Chapter 3) was to describe the development and preliminary psychometric evaluation of the Event Probability and Cost Questionnaire (EPCQ) for adults with social anxiety. In support of cognitive models, the final factor analysis revealed a two-factor solution explaining 52.5% of the variance. The first factor included beliefs relating to the cost or consequence of a negative social outcome occurring, as well as four probably items relating to the potential occurrence of negative evaluation of observable physical symptoms (e.g., blushing). The second factor included beliefs relating to the probability or likelihood that a social situation would occur. Both factors were elevated for SAD patients relative to non-clinical controls. The measure demonstrated good internal consistency, test-retest reliability, and convergent and divergent validity. In addition, the EPCQ demonstrated good sensitivity, specificity, positive and negative predictive values and it was able to effectively discriminate between individuals with SAD and non-clinical controls. The 5 final measure comprised 26 questions, 13 questions relating to probability and cost respectively. Results indicate that the EPCQ is a promising measure with several important applications in both research and clinical settings. Finally, the aim of Chapter 4 was to present a general discussion of the previous chapters, discuss strengths and limitations, and potential clinical implications of the findings from the thesis.