Emerging research suggests that many adults with Autism Spectrum Disorder (ASD) experience impairing Social Anxiety Disorder (SAD) or social anxiety symptoms (e.g., Joshi et al., 2013; Kleinhans et al., 2010), yet there is little guidance or agreement about how to best assess social anxiety in this population. Direct examination of overt eye gaze patterns may help determine if the attentional biases often reported in people with SAD also operate in those with ASD and co-occurring social anxiety. This study sought to assess the influence of social anxiety on gaze patterns in adults with ASD. An exploratory aim was to better understand the phenomenology of SAD within ASD. Three groups of participants were included: adults with ASD (n = 25), adults with SAD (n = 25), and adults without ASD or SAD (n = 25). As hypothesized, a large subset (n = 11; 44%) of the participants with ASD met diagnostic criteria for SAD. Contrary to study hypotheses related to gaze patterns, however, there was no evidence for gaze vigilance followed by avoidance for socially threatening stimuli in either the ASD or SAD groups, and there was no relationship between fear of negative evaluation and gaze duration toward socially threatening stimuli within the ASD group. Possible reasons for these null findings are considered. Clinical implications and suggestions for future research are also discussed. / Ph. D.

Sexual victimization among college women is a common problem. This two-part study sought to examine social interaction anxiety as a risk factor of sexual victimization and to examine the feasibility, acceptability, and preliminary efficacy of a computer-based risk reduction program. A total of 1095 undergraduate females completed an online survey to assess social anxiety as a risk factor (study part I), a subsample of whom (n = 136, including 51 above the clinical cutoff on a social anxiety measure and 85 below the cutoff) completed the subsequent in-lab study (study part II). During study part II, participants were randomly assigned to either receive a computer-based risk reduction program or an educational program on campus resources (control condition), and their predicted use of resistance techniques was assessed both before and after their assigned program. Participants also responded to an audio recording of a sexual assault vignette to assess risk detection. After controlling for past victimization and depression, social interaction anxiety was not related to predicted use of assertive resistance techniques or to risk detection. However, social anxiety positively predicted use of passive resistance techniques at the lowest level of unwanted sexual advances (i.e., breast fondling) in a series of three escalating sexual advances (i.e., breast fondling, genital fondling, and rape threat). No participants dropped out of the study, and ratings on a questionnaire assessing acceptability of the risk reduction program were positive. Program condition predicted change scores for predicted use of assertive resistance at a low level of unwanted sexual advances (i.e., breast fondling) such that the control group decreased in predicted use of assertive resistance significantly more than the risk reduction program group. Additionally, the risk reduction program group had significantly better risk detection compared to the control group. Therefore, support for the feasibility, acceptability, and preliminary efficacy of the risk reduction program was found. The finding that the control group decreased significantly more than the risk reduction program group in assertive resistance between the two story administrations is important because assertive resistance techniques tend to be the most effective in reducing risk of completed sexual victimization. Therefore, it is important that risk reduction programs encourage women to use assertive resistance. Clinical implications and suggestions for future research are discussed. / Ph. D.

Social Anxiety Disorder is characterized by irrational and persistent fears of potential evaluation and scrutiny by others. For socially anxious youth, the core, maladaptive cognition is fear of negative evaluation (FNE). Whereas Cognitive Behavioral Therapy (CBT) targets remediation of intense and unfounded FNE, Attention Bias Modification Treatment (ABMT) targets attention bias. The degree to which FNE and biased attention are related processes is unknown. This study sought to assess the relationship between FNE and two indices of attention bias (dot probe and eye-tracking). In addition, this study examines differences in attention bias between a clinically confirmed group of youth SAD and healthy controls. A significant group difference in average latency to fixate on angry faces was found [F(1,65) = 31.94, p < .001, ηp2 = .33]. However, the pattern was not consistent across the other attention bias metrics (i.e., dot probe bias scores and first fixation direction percentage towards angry faces). In addition, associations between FNE and the attention bias metrics were not statistically significant in either group. Future directions and implications of these findings within the context of refinements to existing interventions are discussed. / Master of Science / Social Anxiety Disorder (SAD) is characterized by irrational and persistent fears of potential evaluation and scrutiny by others. For socially anxious youth, a main feature of the disorder is fear of negative evaluation (FNE). Whereas Cognitive Behavioral Therapy (CBT) targets FNE, Attention Bias Modification Treatment (ABMT) targets attention bias. However, the degree to which FNE and biased attention are related processes has not been studied. This study examined the relationship between FNE and two indices of attention bias (dot probe and eye-tracking). This study also examines differences in attention bias between a youth with SAD and healthy youth (no psychological diagnoses). Group differences were found for only one attention bias measure (i.e., youth with SAD were quicker to look at anger faces relative to non-anxious youth). In addition, associations between FNE and the attention bias metrics were not statistically significant in either group. Future directions of these findings are discussed.

Sexual victimization is a significant problem on college and university campuses, and it is important to evaluate risk factors for sexual victimization in order to attempt to reduce women's risk of victimization. This study investigated social interaction anxiety as a risk factor for sexual victimization. It was hypothesized that social interaction anxiety may increase risk of sexual victimization by decreasing sexual assertiveness and increasing alcohol-related problems. College women (n = 690) completed an online survey that assessed social interaction anxiety, sexual assertiveness, alcohol-related problems, and a variety of types of sexual victimization, in addition to other measures. When total effects were examined, social interaction anxiety only significantly predicted victimization by coercion. However, when indirect effects of sexual assertiveness were examined, social interaction anxiety had a significant effect on all types of sexual victimization (i.e., unwanted sexual contact, attempted coercion, coercion, attempted rape, and rape). Alcohol-related problems did not significantly account for the relationship between social interaction anxiety and sexual victimization. It is recommended that interventions designed to reduce women's risk of victimization include interventions designed to address both social interaction anxiety and sexual refusal assertiveness. / Master of Science

Social anxiety is widely thought to be positively associated with alcohol use. However, these studies rely primarily on self-report of drinking behavior. This research aimed to further explore this research by assessing blood alcohol concentration (BAC), a physiological measure of alcohol intoxication, as the dependent measure in naturalistic settings (i.e., fraternity parties). Results from Study 1 suggest a weak relationship between self-reported anxiety levels and BAC. Study 2 was based on Burke and Stephen's (1999) proposed social cognitive model in which alcohol expectancies and drink-refusal self-efficacy act as moderators of the relationship between dispositional social anxiety and alcohol consumption. Analyses (n=86) did not support a relationship between social anxiety and alcohol use, nor the moderating effects of alcohol expectancies and drink-refusal self-efficacy. Implications for this type of research and possible future directions are discussed. / Master of Science

Individuals with Social Anxiety Disorder (SAD) are typically perceived by others as shy, submissive, or risk-averse. However, recent work has identified an understudied subtype within SAD characterized by high levels of anger and high-risk or novelty-seeking impulsive behaviors. Interestingly, this subtype bears conceptual similarities with prior accounts of vulnerable narcissism. For example, both are associated with concerns regarding self-presentation and how they are perceived by others. The angry-impulsive subtype and vulnerable narcissism may further share similar etiologic origins and similar associations with self-reported anger, impulsivity, and anxiety-related characteristics. However, despite these key similarities no prior work has systematically evaluated the common and potentially distinguishing factors within and between these conceptually similar but diagnostically distinct groups. For example, cognitive features such as fear of negative evaluation and interpersonal rivalry could be distinguishing features of SAD and vulnerable narcissism, although the utility of these distinguishing features to clarify the differential diagnosis remains unknown. Accordingly, the purpose of this study was to utilize a person-centered analytic approach (latent profile analysis; LPA) to empirically establish whether vulnerable narcissistic traits exist within high anger, risk-prone individuals who are also socially anxious, or alternatively whether specific features of each disorder can be used to disambiguate them empirically. Results of this work supported the existence of the angry impulsive socially anxious subtype and supported a relationship between that group and vulnerable narcissistic traits. These findings have implications for treatment selection among affected individuals and may further clarify why prior work evaluating interventions for adults with SAD and angry impulsive features has been met with only limited success. / M.S. / Individuals with Social Anxiety Disorder (SAD) are typically perceived by others as shy, submissive, or risk-averse. However, recent work has identified an understudied subtype within SAD characterized by high levels of anger and high-risk or novelty-seeking impulsive behaviors. Interestingly, this subtype has conceptual similarities with descriptions of vulnerable narcissism. For example, both are associated with concerns regarding self-presentation and how they are perceived by others. The angry-impulsive subtype and vulnerable narcissism may further share similar origins and similar associations with self-reported anger, impulsivity, and anxiety-related characteristics. However, despite these key similarities no prior work has evaluated the common and potentially distinctive factors within and between these distinct groups. For example, features such as fear of negative evaluation and interpersonal rivalry could be distinguishing features of SAD and vulnerable narcissism, although the utility of these differentiating features to clarify the differential diagnosis is unknown. Accordingly, the purpose of this study was to utilize a person-centered analytic approach (latent profile analysis; LPA) to establish whether vulnerable narcissistic traits exist within high anger, risk-prone individuals who are also socially anxious, or whether specific features of each disorder can be used to differentiate them. Results of this work supported the existence of the angry impulsive socially anxious subtype and supported a relationship between that group and vulnerable narcissistic traits. These findings have implications for treatment selection among affected individuals and may further clarify why prior work evaluating interventions for adults with SAD and angry impulsive features has been met with only limited success.

Social anxiety disorder (SAD) is a debilitating disorder marked by persistent fear of one or more social or performance situations that is associated with poor daily functioning in various areas of life. Most empirically-supported interventions for SAD are based on cognitive behavioral models that focus largely on reducing negative emotions. However, these approaches produce only modest rates of remission, suggesting that core components of SAD may not be sufficiently targeted by current treatments. Recent theoretical models have suggested that diminished sensitivity to reward may be a specific factor related to low positive affect (PA) and by extension social anxiety, yet no research has systematically examined this relationship. Additionally, working memory has been found to activate dopamine synthesis related to reward, however this relation has not been demonstrated in social anxiety. Accordingly, research proposed here sought to characterize PA and working memory, and determine whether reward sensitivity is altered in a self-reported socially anxious sample of 59 young adults. We hypothesized that social anxiety symptomatology would be inversely correlated with the magnitude of reward sensitivity as measured using the Reward Bias Task (RBT). Results within the full sample did not support our hypothesis; however, an unexpected relationship between PA and working memory emerged. Once using conservative data quality procedures, results indicated that the online version of the reward bias task demonstrated promising relationships with depression and working memory. Additionally, after controlling for depression, the restricted sample demonstrated a relationship between reward bias mean and working memory, and SPIN and diminished PA. / M.S. / Social anxiety disorder is related to poor daily functioning in various areas of life, such as school, work, and social functioning, and also increases the risk for depression and substance abuse. Over half of patients with the disorder remain symptomatic after treatment. Low levels of positive emotionality, or positive affect (PA), has been associated with social anxiety. Additionally, individuals with social anxiety are thought to have less reward seeking behaviors, which may be related to their working memory abilities. Our study looked at PA, reward and working memory in a sample of 59 socially anxious young adults. Within our full sample, we found that PA and working memory were related, such that participants with higher levels of PA also had better working memory abilities. Within our restricted sample of 17 socially anxious adults we found that reward seeking behaviors were related to depression and working memory. Additionally, after accounting for depression, reward seeking and working memory were related, and social anxiety symptoms and PA were related.

Social anxiety is a prevalent and harmful experience, predicting negative outcomes even for those not reaching clinical levels. While evidence-based treatments are well-documented for Social Anxiety Disorder, simple and accessible interventions for subclinical samples are a valuable endeavor for research. The current study aimed to test an experimental task for reducing social anxiety through increasing participants’ impression self-efficacy. A secondary goal was to explore the impacts of and responses to positive and neutral feedback. The primary hypothesis was that condition would predict changes in social anxiety indirectly through changes in impression self-efficacy. Participants (n=127) completed a structured interaction with a research confederate. In the experimental condition, participants were exposed to a social obstacle and provided with positive feedback, while a neutral condition and control condition did not encounter an obstacle and received neutral and no feedback, respectively. A mediation analysis indicated that condition significantly predicted changes in impression efficacy and changes in social anxiety, and changes in impression efficacy significantly predicted changes in social anxiety. However, the indirect effect when comparing the experimental condition to the control condition was nonsignificant. Additionally, neutral evaluative feedback predicted lower positive affect and increased rejected feelings compared to other conditions. Exploratory analyses were conducted to investigate nuances of participants’ responses to feedback. Overall, results offer noteworthy information about the use of the experimental manipulation and the impacts of feedback within research contexts and non-laboratory settings.

Social anxiety is related to various comorbidities, with the most common being elevated alcohol use (Bolton et al., 2006). The symptom profile of this unique subset of cases with social anxiety and comorbid alcohol use is more complex and experiences higher resistance to treatment (Buckner et al., 2008). Both social anxiety and alcohol use emerge during the adolescent developmental period, and yet there remains a gap in the understanding of potential developmental risk factors associated with the onset and maintenance of these co-occurring symptoms. The current study investigated trait impulsivity, cognitive flexibility, and risk-seeking during adolescence and associations with alcohol use and social anxiety in young adulthood. Participants included 167 adolescents (Mage = 14.07 years, SD = 0.54; 52.7% male) followed to young adulthood (Mage = 22.30, SD = 0.69). Growth mixture models indicated that high levels of risk-seeking during adolescence predicted social anxiety in young adulthood. Contrary to hypotheses, high (compared to moderate) risk-seeking participants had lower alcohol use. Longitudinal patterns of high attentional impulsivity during adolescence into young adulthood predicated later social anxiety, whereas non-planning and motor impulsivity did not. Linear regression analyses indicated that lower cognitive flexibility during early adolescence was associated with social anxiety and alcohol use in young adulthood. Finally, moderation models suggested that global trait impulsivity was not a significant moderator of the relation between alcohol use during adolescence and social anxiety in young adulthood. This is the first work to evaluate these developmental risk-factors in relation to comorbid social anxiety and alcohol use, and has important implications for bolstering therapeutic interventions, especially for those with elevated impulsivity. / Doctor of Philosophy / Some socially anxious young adults have more difficulties with alcohol use compared to their peers. The combination of social anxiety and elevated alcohol use can lead to challenges in various aspects of life, such as school, work, and social functioning. Previous literature in the field suggests that both social anxiety and alcohol use emerge during early adolescence (ages 13-14); however, risk-factors during this important developmental period are still being explored. This dissertation evaluated the following possible risk-factors during adolescence that may be associated with the later development of social anxiety and alcohol use: trait impulsivity, cognitive flexibility, and risk-seeking. These risk-factors were explored using a dataset collected in Virginia that followed 167 adolescents over an eight-year period. Results indicated that youth with higher risk-seeking and attentional impulsivity during adolescence (ages 13-21) had significant social anxiety symptoms once they reached young adulthood (ages 22-23). Additionally, lower cognitive flexibility during ages 13-14 was associated with higher social anxiety and alcohol use in young adulthood. This is the first work to evaluate these risk-factors in relation to social anxiety and alcohol use, and has important implications for interventions, especially for those who have increased impulsivity and risk-seeking behaviors.

The objective of this study was to examine attentional bias for threat in relation to social anxiety. It is well known that socially anxious individuals are likely to exhibit this bias, and this phenomenon may be clearly separated into two subsections: facilitation and disengagement. Facilitation, or vigilance, is the initial drawing of attention toward threat, and disengagement is the process of drawing attention away from threat. Past research focuses only on individuals ranked in the lowest and highest percentiles of any particular social anxiety measure, however, and fails to consider those having median scores. The current study included participants representing the full range of socially anxious individuals. In order to do this, the Fear of Negative Evaluations Scale (FNE) was distributed to undergraduate students (N = 230). A portion of these students was then drawn from each of six scoring ranges on the FNE. Participants in this new sample (N = 19) were asked to complete a computerized dot-probe detection task measuring attentional bias. The face stimuli for the current version of the computerized task included disgusted, happy, and neutral faces. Results of the correlational analyses showed a statistically significant positive correlation between FNE score and disengagement bias for disgust faces. There also was a statistically significant negative correlation between FNE score and vigilance bias for disgust faces. There was no suggestion of a statistically significant correlation between FNE score and vigilance or disengagement biases with happy faces.