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Cognitive models of Social anxiety disorder (SAD) routinely discuss the cognitive biases (e.g., attentional, interpretation, memory) that contribute to thinking about oneself negatively before, during, and after social or performance situations. However, these models do not mention other impacts of negative self-evaluations - including negative evaluations of others - even though cognitive case formulations often include beliefs about oneself, others, the future, and the world. Importantly, CBT for SAD does not always lead to optimal subclinical symptoms at the end of treatment; suggesting that our most evidence-based treatments require modifications. Few studies have experimentally examined the presence of negative evaluations of others within social anxiety, which has led to inconsistent understanding about whether people with social anxiety demonstrate negative evaluations of others. These conflicting findings are even more complicated by no study examining if the negative self-evaluations that are commonly reported by people with SAD cause negative other-evaluations, and vice-versa. I outline two studies in this dissertation where I aimed to understand the relationship (or lack thereof) between negative self-evaluations and negative other-evaluations and its cognitive, behavioural, and emotional consequences. In Study 1, I randomly assigned an unselected sample (N = 152) to provide no-, medium-, or high-evaluations of a videotaped anxious person. Participants also took part in a 10- minute conversation task with a confederate posing as another participant. I measured social anxiety symptoms, state anxiety and electrodermal activity across four-time points, and several measures related to self- and other-evaluations. Overall, my manipulation was effective as participants responded to the subsequent other-evaluations in the way I anticipated. Despite this, I found no differences between conditions on most of my primary self-evaluation outcomes. However, I observed that participants in the high-evaluation condition demonstrated poorer memory recall. In Study 2, I randomly assigned an unselected sample (N = 169) to receive positive, ambiguous, or negative false-feedback following a conversation task with a confederate. My manipulation was effective, and again, I found no differences between conditions on my primary other-evaluation outcomes. Participants in the negative-feedback condition reported greater state anger following the negative evaluation for the remainder of the study, compared to participants in the other conditions. Ultimately, evaluations of others were less problematic than I initially expected. Because I did observe cognitive and emotional consequences of this self-other process, these findings could have important implications for further refinement of SAD models and treatments using Cognitive Behavioural Therapy.

Although several efficacious treatments exist for social anxiety disorder (SAD), less research has been devoted to identifying specific mechanisms involved in the etiology of SAD using high-risk, longitudinal designs. Given the high prevalence and personal and societal burden associated with a diagnosis of SAD, research is needed to elucidate causal factors at play in the development of SAD to inform innovative prevention programs for at-risk individuals. Theoretical models and empirical research suggest that biased attention toward threat-relevant information is an important factor in the maintenance of SAD. However, relatively little is known about the role of attention bias to threat in the development of SAD, and evidence is inconclusive with regard to whether attention biases lead to increases in anxiety over time. Also, only one study has examined attentional control as a potential factor moderating this relationship despite long-held assertions that "control over cognitive processes" may be an important individual difference factor determining the strength of the relationship between attention bias and development of excessive anxiety. Finally, a few studies have shown that attention bias to threat predicts stress reactivity, but these studies have only been conducted in unselected samples rather than with individuals at risk for developing SAD. Thus, the aims of this study were to examine the moderating effects of risk for SAD and attentional control on the relationships between attention bias to threat and (1) psychological and biological social stress reactivity and (2) development of SAD. The primary aim of the study was to examine the aforementioned relationships using attention bias to threat as assessed using the modified probe detection task (MPDT). In an exploratory analysis, the relationships were examined using an index of attention disengagement bias assessed with the Posner spatial cueing task (PSCT). Attentional control was represented by four indices, analyzed in separate regression analyses given their weak bivariate associations (i.e., Antisaccade task reaction time and accuracy rate, Attention Network Test executive control score, and total score on the Attentional Control Scale). First-year college students at low or high risk for developing SAD completed assessments of attention bias, attentional control, and anxiety during their first month of college. Approximately four months later, they completed a social stressor task and the same self-report measures of social anxiety. At the end of their first year in college, they completed the self-report measures of social anxiety once more, as well as a diagnostic interview for SAD. Correlational analyses indicated that attention bias to threat on the MPDT was associated with concurrent self-reported social anxiety but did not prospectively predict psychological or biological social stress reactivity, self-reported social anxiety, or SAD diagnostic status at the end of the first year in college. Hierarchical regression analyses supported the hypothesized double moderation for concurrent social anxiety, such that high levels of attentional control weakened the association between attention bias toward threat and social anxiety, only among the individuals at high risk for SAD. However, analyses did not support this relationship in predicting prospective outcomes, and several unexpected patterns emerged in which interactions between attention bias and attentional control were observed to predict prospective outcomes, but only among individuals at low risk for developing SAD. Likewise, exploratory analyses using the PSCT index of attention bias revealed unexpected interactions between risk group, attention bias, and attentional control. Considered together, results of the current study highlight the importance of considering individual differences in attention bias and attentional control in the maintenance and development of SAD. / Psychology

The overall theme for this European-style dissertation is an examination of how social identities are represented in treatment studies for social anxiety disorder and how fears of confirming stereotypes about one’s social identities affect social anxiety disorder in the form of stereotype confirmation concerns. In the first chapter, I introduce social anxiety disorder (SAD), describe cognitive behavioral therapy for SAD, review recruitment strategies to increase the representation of social minority groups in treatment research, discuss the importance of accurately reporting the social identities represented in samples, describe the particular relevance of stereotypes for social anxiety disorder, and provide a theoretically grounded rationale for the ways in which stereotype confirmation concerns may impact the experience and treatment of social anxiety disorder. For the second chapter, I present a study that examines the extent to which the demographic characteristics of participants (e.g., age, gender) are reported in treatment outcome research for social anxiety disorder. The findings from this study illuminate who participates in clinical trials for social anxiety (and therefore, to whom they may apply), as well as the infrequency with which some social identities are reported. Failure to report demographic characteristics of participants treated for social anxiety disorder makes it impossible to determine the external validity of the empirical literature. It also begs the question of whether we may be failing to identify salient constructs related to the social identities of our participants that affect our understanding of the social anxiety disorder and its treatment. The third and fourth chapters present two papers on the effects of stereotype confirmation concerns on both the experience and the treatment of social anxiety disorder. The final chapter describes how the series of studies presented in this dissertation fits into research on social anxiety disorder, as well as directions for future research.

Ten to 15% of the population is temperamentally shy and have elevated physiological stress responses to novel social situations. Yet, the neural mechanisms underlying this personality trait are not fully understood (Beaton et al., 2009; Schmidt et al., 1997). Efficiently attending to, acting on, and remembering relevant stimuli and filtering out less important information is critical given the sheer volume of sensory and perceptual stimuli the brain is exposed to. Relevant stimuli that garner attention are remembered and consolidated with existing memories. Stimuli that do not warrant extended attention are ignored or habituated to in a process underpinned by cortical and subcortical inhibitory brain networks that reduce processing load on finite attentional resources (Freedman et al., 1991; Adler et al., 1998). Inefficient filtering of irrelevant stimuli could underpin anxiety in those with temperamental shyness and anxiety (Aron, Aron, & Davies, 2005). We measured the P50 auditory event-related potential (ERP) using a paired auditory click paradigm, as well as self-reported social anxiety and shyness, and salivary cortisol in two groups of healthy young adults selected for being very shy or very gregarious. While shy and gregarious groups demonstrated a similar P50 ERP to sound one (S1), the shy group showed elevated P50 amplitudes in response to the second sound (S2) compared to the gregarious group. Participants categorized as being lower or higher on social anxiety displayed a reverse pattern: those higher in social anxiety had a reduced response to S1 compared to those lower in social anxiety, yet a similar response to S2. Further, higher salivary cortisol predicted smaller differences and larger ratios in the P50 ERP from S1 to S2.

Os processos mnemônicos são responsáveis por manter a qualidade e estabilidade de vida de todos os seres humanos, porém pesquisas vêm mostrando ao longo do tempo, que tais processos podem apresentar erros e distorções que podem mudar o curso de nossa vida. As falsas memórias são as recordações de situações, eventos que na realidade não ocorreram exatamente como nos recordamos. Inicialmente acreditava-se que eventos vividos e que possuíssem carga emocional associada, não eram passíveis de distorção, porém já se sabe que tais premissas não são necessariamente verdadeiras. Além disso, o nível de desajustamento e instabilidade emocional interfere para um maior número de falsas memórias. A ansiedade é uma resposta adaptativa, normal e passa a ser patológica quando é desproporcional diante da situação desencadeante. Quando a ansiedade é muito intensa, tende a gerar prejuízos em todas as esferas da vida, esta ansiedade adquire um significado clínico. Dentro os transtornos de ansiedade há um diagnóstico bastante prevalente chamado de Transtorno de Ansiedade Social (TAS). O presente trabalho visou comparar participantes adultos portadores de TAS e participantes adultos sem estes sintomas, investigando o efeito da emoção na performance da memória, para um evento testemunhado. Para o desenvolvimento do trabalho foi utilizada uma sequência de onze slides, acompanhados por duas versões narrativas, sendo uma sem impacto e outra carregada emocionalmente, além de uma Escala Subjetiva de Emoção e um teste de Memória autoaplicativo. O estudo contou com 137 participantes, que foram divididos em quatro grupos: indivíduos sem transtorno de ansiedade e narrativa sem impacto emocional, indivíduos sem transtorno de ansiedade e narrativa com impacto emocional, indivíduos com transtorno de ansiedade e narrativa sem impacto emocional e indivíduos com transtorno de ansiedade e narrativa com impacto emocional. Foram realizadas análises paramétricas utilizando as análises de Variância (ANOVA). Todos os tratamentos estatísticos utilizaram um < 0,05 para o teste de hipóteses e testes post hoc com correção para Bonferroni para identificar as possíveis diferenças encontradas. Os resultados sugerem que os participantes portadores de TAS, os quais foram submetidos à versão sem impacto emocional, obtiveram índices maiores de memória verdadeira, porém apresentaram também índices superiores de falsas memórias, em função do viés atencional característico desta população, sugerindo que a ansiedade social tem uma ação significativa sobre a performance de memória. / Mnemonic processes are responsible for keeping all human beings life quality and stability. However, research has shown that such processes can present mistakes and distortions which can change the course of life. False memories are memories of situations and events that did not happen exactly as remembered. At first, it was believed that events which happened and had an associated emotional load could not be distorted; however it is now known that such premise is not necessarily true. Moreover, it is known that the level of disadjustment and emotional instability interfere for a greater number of false memories. Anxiety is a normal adaptive response but it becomes pathologic when it is not proportional to the triggering situation. When anxiety is too intense, it tends to harm all spheres of life, and it acquires a clinical meaning. Amongst the anxiety disorders, there is a prevalent diagnosis called Social Anxiety Disorder (SAD). This study aims to compare adult participants who suffer from this problem with adult participants who do not have these symptoms, investigating the effect of emotion in memory performance for an event witnessed. To develop this study, a sequence of eleven slides was used, followed by two narrative versions, one with emotional impact and the other without, besides the Subjective Scale of Emotion, a self-test for memory. The study had 137 participants, who were divided into four groups: individuals who do not suffer from the disorder and emotionally loaded narrative, individuals who do not suffer from the disorder and narrative without emotional load, individuals who suffer from the disorder and emotionally loaded narrative, individuals who suffer from the disorder and narrative without emotional load. Parametrical analysis was carried out using the Variance analysis (ANOVA). All the statistical treatments used an < 0,05 for the hypothesis test and post hoc tests with correction for Bonferroni to identify the possible differences found. The results suggest that participants with SAD who were submitted to a version without emotional impact had higher rates of real memories, according to attentional bias characteristic of this population. Besides, the participants who suffer from Social Anxiety Disorder (SAD) had higher rates of false memories who were submitted to a version without emotional impact, suggesting that emotion acted as a protection and suggesting that the social anxiety has a significant action over memory performance.

O Transtorno de Ansiedade Social (TAS) é caracterizado pelo medo acentuado ou persistente de situações nas quais o individuo poderia sentir vergonha, levando ao comportamento de esquiva fóbica. Contudo, ainda é pouco diagnosticado, devido às dificuldades em perceber suas características como sintomas. Desse modo, a validação de instrumentos para rastreamento do TAS são de grande importância para auxiliar no diagnóstico e conduta. Dentre os instrumentos disponíveis na literatura, a Escala de Ansiedade Social de Liebowitz (LSAS) tem sido a mais utilizada mundialmente, seja em situações clínicas ou de pesquisa, porém para uso no contexto brasileiro, este instrumento não foi consistentemente validado. Assim, o objetivo deste estudo é aferir as qualidades psicométricas de validade (concorrente, divergente e discriminativa) e fidedignidade da LSAS-SR, traduzida para o português do Brasil, em sua versão auto-aplicada, em uma amostra de universitários da população geral (N=413) e em uma amostra clínica de TAS (N=252). Para tanto, foram coletados dados com universitários de duas instituições do interior do estado de São Paulo. Foram utilizados instrumentos para avaliação específica do TAS e de seus subtipos e outros para avaliação de constructos correlacionados ao TAS, tais como, ansiedade geral, prejuízos funcionais, depressão e abuso de álcool, além da LSAS-SR e um questionário de identificação. A LSAS-SR apresentou excelente consistência interna (=0,90-0,96). A validade convergente com escalas específicas para avaliação do TAS apresentou correlações que variam de 0,33 a 0,84. Com a escala que avalia aspectos específicos do TAS (falar em púbico) as correlações foram fracas e pouco significativas, sendo que com a escala de ansiedade geral esses valores foram de 0,21 a 0,57, classificada como fraca a moderada. Apresentou correlações moderadas, na maioria dos casos, com construtos correlacionados, tais quais depressão (0,36-0,52) e prejuízo funcional (0,30-0,72). Foi observada também adequada capacidade de discriminação da escala no que tange a diferenciação casos e não-casos (S=0,96, E=0,80). Na análise fatorial exploratória apontou inicialmente uma solução de 12 fatores. Testaram-se também soluções de três, quatro e cinco fatores, sendo que os mesmos foram compostos por agrupamentos de itens diferentes dos estudos prévios. A análise fatorial confirmatória também não replicou os achados prévios, sinalizando, tal como encontrado na literatura, a dificuldade em conseguir-se uma estrutura fatorial de consenso, comum às diversas culturas nas quais o instrumento foi estudado. Para avaliação da fidedignidade teste-reteste, foi calculado o Coeficiente de Correlação Intraclasse (0,81) e de Pearson (0,82) os quais mostram-se satisfatórios. Os presentes achados vão ao encontro de estudos internacionais que certificam às excelentes qualidades psicométricas da LSAS-SR. / Social Anxiety Disorder (SAD) is characterized by the sharp or persistent fear of situations in which the individual could feel shame, leading to a behavior of phobic avoidance. However, it is still little diagnosed, due to the difficulty in recognizing its characteristics as symptoms. Therefore, the validation of instruments to screening SAD is highly important to help in the diagnosis and treatment. Among the instruments available in the literature, Liebowitz Social Anxiety Scale (LSAS) has been the most used worldwide, being in clinical or of research situations. However, in the Brazilian context the use of this instrument has not been consistently validated. Thus, the objective of this study is to verify the psychometric qualities of validity (convergent, divergent and discriminant) and reliability of LSAS-SR, translated into Portuguese, in its self-reported version, in a sample of university students from the general population (N = 413) and in a clinical sample of SAD (N = 252). For this purpose, data from university students of two institutions of the interior of the state of São Paulo were collected. They used instruments for specific evaluation of SAD and of their subtypes and others for evaluation of constructs correlated to SAD, such as general anxiety, functional impairment, depression and alcohol abuse in addition to LSAR-SR and an identification questionnaire. LSAS-SR showed excellent internal consistency (=0.90-0.96). The convergent validity with specific scales for the SAD assessment presented correlations that ranged from 0.33 to 0.84. With the scale that evaluates specific aspects of the SAD (to speak in public) the correlations were weak and insignificant and with the general scale of anxiety these values ranged from 0.21 to 0.57, being classified as weak to moderate. It presented moderate correlations, in most cases, with correlated constructs, such as depression (0.36 0.52) and functional impairment (0.30 0.72). It was also observed adequate capacity of discrimination of the scale concerning the differentiation between cases and non-cases (S=0.96, E=0.80). Initially, the exploratory factorial analysis pointed the solution of 12 factors. The models with three, four and five factors were tested too, howsoever they were composed of clusters of different items compared with the original studies. The confirmatory factorial analysis did not replicate previous findings, signaling, as found in the literature, the difficulty in getting a factorial structure of consensus, common to several cultures where the instrument was studied. For the evaluation of test-retest reliability the Interclass Correlation (0.81) and the Pearson (0.82) Coefficients were calculated. Both demonstrated to be satisfactory. The present findings are aligned with international studies that certify the excellent psychometric qualities of LSAS-SR.

O Transtorno de Ansiedade Social (TAS) é caracterizado pelo medo acentuado ou persistente de situações nas quais o individuo poderia sentir vergonha, levando ao comportamento de esquiva fóbica. Contudo, ainda é pouco diagnosticado, devido às dificuldades em perceber suas características como sintomas. Desse modo, a validação de instrumentos para rastreamento do TAS são de grande importância para auxiliar no diagnóstico e conduta. Dentre os instrumentos disponíveis na literatura, a Escala de Ansiedade Social de Liebowitz (LSAS) tem sido a mais utilizada mundialmente, seja em situações clínicas ou de pesquisa, porém para uso no contexto brasileiro, este instrumento não foi consistentemente validado. Assim, o objetivo deste estudo é aferir as qualidades psicométricas de validade (concorrente, divergente e discriminativa) e fidedignidade da LSAS-SR, traduzida para o português do Brasil, em sua versão auto-aplicada, em uma amostra de universitários da população geral (N=413) e em uma amostra clínica de TAS (N=252). Para tanto, foram coletados dados com universitários de duas instituições do interior do estado de São Paulo. Foram utilizados instrumentos para avaliação específica do TAS e de seus subtipos e outros para avaliação de constructos correlacionados ao TAS, tais como, ansiedade geral, prejuízos funcionais, depressão e abuso de álcool, além da LSAS-SR e um questionário de identificação. A LSAS-SR apresentou excelente consistência interna (=0,90-0,96). A validade convergente com escalas específicas para avaliação do TAS apresentou correlações que variam de 0,33 a 0,84. Com a escala que avalia aspectos específicos do TAS (falar em púbico) as correlações foram fracas e pouco significativas, sendo que com a escala de ansiedade geral esses valores foram de 0,21 a 0,57, classificada como fraca a moderada. Apresentou correlações moderadas, na maioria dos casos, com construtos correlacionados, tais quais depressão (0,36-0,52) e prejuízo funcional (0,30-0,72). Foi observada também adequada capacidade de discriminação da escala no que tange a diferenciação casos e não-casos (S=0,96, E=0,80). Na análise fatorial exploratória apontou inicialmente uma solução de 12 fatores. Testaram-se também soluções de três, quatro e cinco fatores, sendo que os mesmos foram compostos por agrupamentos de itens diferentes dos estudos prévios. A análise fatorial confirmatória também não replicou os achados prévios, sinalizando, tal como encontrado na literatura, a dificuldade em conseguir-se uma estrutura fatorial de consenso, comum às diversas culturas nas quais o instrumento foi estudado. Para avaliação da fidedignidade teste-reteste, foi calculado o Coeficiente de Correlação Intraclasse (0,81) e de Pearson (0,82) os quais mostram-se satisfatórios. Os presentes achados vão ao encontro de estudos internacionais que certificam às excelentes qualidades psicométricas da LSAS-SR. / Social Anxiety Disorder (SAD) is characterized by the sharp or persistent fear of situations in which the individual could feel shame, leading to a behavior of phobic avoidance. However, it is still little diagnosed, due to the difficulty in recognizing its characteristics as symptoms. Therefore, the validation of instruments to screening SAD is highly important to help in the diagnosis and treatment. Among the instruments available in the literature, Liebowitz Social Anxiety Scale (LSAS) has been the most used worldwide, being in clinical or of research situations. However, in the Brazilian context the use of this instrument has not been consistently validated. Thus, the objective of this study is to verify the psychometric qualities of validity (convergent, divergent and discriminant) and reliability of LSAS-SR, translated into Portuguese, in its self-reported version, in a sample of university students from the general population (N = 413) and in a clinical sample of SAD (N = 252). For this purpose, data from university students of two institutions of the interior of the state of São Paulo were collected. They used instruments for specific evaluation of SAD and of their subtypes and others for evaluation of constructs correlated to SAD, such as general anxiety, functional impairment, depression and alcohol abuse in addition to LSAR-SR and an identification questionnaire. LSAS-SR showed excellent internal consistency (=0.90-0.96). The convergent validity with specific scales for the SAD assessment presented correlations that ranged from 0.33 to 0.84. With the scale that evaluates specific aspects of the SAD (to speak in public) the correlations were weak and insignificant and with the general scale of anxiety these values ranged from 0.21 to 0.57, being classified as weak to moderate. It presented moderate correlations, in most cases, with correlated constructs, such as depression (0.36 0.52) and functional impairment (0.30 0.72). It was also observed adequate capacity of discrimination of the scale concerning the differentiation between cases and non-cases (S=0.96, E=0.80). Initially, the exploratory factorial analysis pointed the solution of 12 factors. The models with three, four and five factors were tested too, howsoever they were composed of clusters of different items compared with the original studies. The confirmatory factorial analysis did not replicate previous findings, signaling, as found in the literature, the difficulty in getting a factorial structure of consensus, common to several cultures where the instrument was studied. For the evaluation of test-retest reliability the Interclass Correlation (0.81) and the Pearson (0.82) Coefficients were calculated. Both demonstrated to be satisfactory. The present findings are aligned with international studies that certify the excellent psychometric qualities of LSAS-SR.

El presente estudio tiene como finalidad adaptar y validar en el contexto peruano la Escala de Ansiedad Social de Liebowitz en una muestra de 42 pacientes de un Hospital de salud mental con edades correspondientes entre los 17 y los 55 años, diagnosticados con trastorno de ansiedad social The purpose of this study is to adapt and validate in the Peruvian context the Liebowitz Social Anxiety Scale in a sample of 42 patients of a mental health hospital aged between 17 and 55 years, diagnosed with social anxiety disorder.

Contemporary research into the health concerns of students is sparse, particularly in New Zealand. Overseas literature indicates that students in tertiary education institutions may be at increased risks for physical health problems, stress-related syndromes and emotional dysfunctions. Of particular concern are anxiety disorders as, in addition to their negative impact on quality of life, they are associated with impaired academic performance and poorer educational outcomes. Skilled, educated individuals are a social asset and it is therefore surprising that so little interest has been paid to the ways in which involvement with the tertiary education impacts on student welfare and anxiety levels. As a first step towards redressing the lack of health data for tertiary populations, this thesis investigates aspects of anxiety among students at a New Zealand university. The primary research aims were to establish an estimate of the levels of anxiety experienced by students and to outline the requirements of tertiary study that students perceive to be the most anxiety-inducing. To achieve the former, students (n = 1,082) were invited by e-mail to participate in an online psychometric survey; to explore the latter, discussion groups were arranged wherein students (n = 18) were asked to talk about their anxiety-related experiences. Anxiety has many forms and can be conceptualised in a number of different ways. In recognition of the diverse nature of tertiary study, it was decided that a broad framework would be needed to thoroughly investigate the ways in which it might manifest in tertiary student populations. Thus, a tripartite conceptualisation was constructed, viewing anxiety in cognitive, physiological and interpersonal terms. Specifically, the study assessed worry, stress and social anxiety among tertiary students and invited participants to comment on personal experiences in each of these areas. Comparing study data to norms for student populations in America revealed that New Zealand tertiary students report greater levels of worry, stress and social anxiety than their American counterparts. Within-group comparisons were made as a function of student gender, age, school of study, ethnicity and birth status. Significant differences on at least one survey measure were noted within each of these categories, with the exception of school of study. The possible implications of and explanations for these findings are discussed.