abstract: Intimate relationship functioning and mental well-being are inherently linked; thus, for those with mental illness, such as social anxiety, intimate relationship functioning may be impaired. Research on the intimate relationships of those with social anxiety has often focused on emotion regulation, as emotions play a crucial role in the development and maintenance of interpersonal relationships and are a clear area of deficit among those with social anxiety. The current thesis had three primary aims: 1a) to examine individual emotion expressivity and 1b) interpersonal emotion regulation processes among individuals with varying levels of social anxiety; 2) to examine individual and interpersonal emotion regulation within romantic relationships; and, 3) to examine how individual emotion expressivity and interpersonal emotion regulation influence relationship health and intimacy among those with varying levels of social anxiety. For Aim 1, differences in individual emotion expressivity and interpersonal emotion regulation were analyzed using regression analyses with social anxiety as a continuous predictor. Analyses were also conducted using a dichotomous grouping (i.e., non-socially anxious and socially anxious) and conducting a multivariate analysis of covariance (MANCOVA). For Aim 2, the impact of individual and interpersonal emotion regulation processes on relationship health was examined using a series of regression analyses. Finally, Aim 3 was tested using structural equation modeling (SEM). Results suggest those with social anxiety show specific, but not general, deficits in individual emotion expressivity and interpersonal emotion regulation, and both individual and interpersonal emotion regulation had positive effects on relationship health. Regarding the primary analyses, interpersonal emotion regulation fully mediated the association between individual emotion expressivity and relationship health. Further, although the strength of these paths varied between groups, the valence and general pattern of these findings were similar for both those with social anxiety and those without. The study provided novel insights into the role of interpersonal emotion regulation in relationship health, and extended previous findings on emotion regulation and relationship health among those with social anxiety. / Dissertation/Thesis / Masters Thesis Psychology 2019

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Background: Few studies have focused on the contextual influences that impact negative affect (NA) and risk for mood disorders in young adults. Research using ecological momentary assessment (EMA) methods has shown that neurotypical adults with elevated social anxiety may be more sensitive to their social environment. To date, little is known about how types of social interactions impact autistic adults, who may show varying levels of social anxiety and social motivation. Aim: Our goal was to examine the heterogeneity in daily social experiences for autistic and socially anxious adults. Method: Using EMA surveys, we tracked daily self-reported face-to-face interactions and examined how these interactions influenced daily affect. We likewise examined how social anxiety (using the Liebowitz Social Anxiety Scale) and autism traits (using the Autism Spectrum Quotient) influenced day-to-day social experiences while controlling for potential covariates (age and biological sex). Participants consisted of 88 young adults who participated in a mental health longitudinal study. We used a multilevel model approach (MLM) to examine predictors of NA. Results: MLM analysis showed that a model with face-to-face interactions and social anxiety predictors best explained outcomes in NA. AQ scores, age, and sex covariates did not improve model fit. Social anxiety was a significant negative predictor of NA after controlling for face-to-face interaction. Conclusion: These findings highlight that autism traits do not predict NA after controlling for social anxiety, and that social anxiety interventions may improve overall moods by addressing types of interactions.

Selective mutism (SM) is a diagnosis marked by withdrawal of speech in certain social situations. The treatment of SM is often a difficult and lengthy process and there are many barriers to successful intervention. Behavioral therapy is most effective in the treatment of SM and the addition of therapeutic activities such as games and mobile devices may provide distinct advantages to this treatment (i.e., decreased patient anxiety levels and more active engagement). The current investigation examined the utility of mobile applications during the behavioral treatment of SM as well as the effect of using mobile applications on child-reported and physiological indicators of anxious responding. Results indicated that children made remarkable treatment gains in just two treatment sessions (i.e., spoke to the clinician within 22 minutes of treatment and held five, five-minute conversations with additional adults during a second session) regardless of modality of delivery (using mobile applications, other activities, or reinforcement alone). Children shaped to speak with the inclusion of mobile applications reported less anxiety and exhibited decreased physiological anxious distress during treatment. The utility of mobile applications during the treatment of SM is discussed in addition to areas for future research (e.g., mobile-based treatment dissemination initiatives).

Although social anxiety disorder is most often diagnosed during adolescence, few investigations have examined the clinical presentation of this disorder exclusively in adolescents. Prior studies have demonstrated that some clinical features of SAD in adolescents are unique relative to younger children with the condition. Furthermore, the extant literature on daily functional impairment in this population is limited. In this investigation, multiple areas of functioning were examined in adolescents with SAD (n = 16) and normal control adolescents (n = 14): specific social skills, subjective distress and physiological reactivity during one speech performance task and one social interaction task; alcohol use and expectancies; subjective and objective quality of sleep; and daily distressing social activities. No differences were observed in sleep actigraphy, self-reported sleep difficulties, alcohol use, or alcohol expectancies. Adolescents with SAD reported greater distress during both analogue tasks relative to NC adolescents. During the speech task, adolescents with SAD exhibited significantly greater speech latency (4.42 seconds vs. 1.75 seconds) and spoke significantly less (83.09 seconds vs. 167.75 seconds) than NC adolescents. Additionally, SAD participants manifested greater skin conductance during the speech task. During the social interaction, adolescents with SAD asked significantly fewer questions (2.20 vs. 7.07) and required significantly more confederate prompts (2.33 vs. 1.14) to stimulate interaction. Finally, adolescents with SAD reported more frequent anxiety-provoking situations in their daily lives and greater avoidance of these situations, including answering questions in class, assertive communication, and interacting with a group. iv The findings are discussed with respect to the current understanding of alcohol use, quality of sleep, and social functioning in adolescents with SAD.

Objective: Two significant challenges for the dissemination of social skills training programs are (a) the need to provide sufficient practice opportunities to assure skill consolidation and (b) the need to assure skill generalization (i.e., use of the skills outside the clinic setting). In the case of social anxiety disorder, virtual environments may provide one strategy to address these issues. This investigation describes the development of an interactive skills-oriented virtual school environment and evaluated its utility for the treatment of social anxiety disorder in preadolescent children (Study 1). This environment included both in-clinic and at-home solutions. In addition, a pilot replication/extension study further examined preliminary treatment efficacy between children who received a standard multi-component treatment and children who received the modified treatment with social skills practice in a virtual environment (Study 2). Method: Eleven children with a primary diagnosis of social anxiety disorder between 7 to 12 years old participated in the initial feasibility trial (Study 1). Five additional children participated in the replication/extension study (Study 2). To investigate preliminary treatment efficacy, clinical outcome measures for the Study 2 sample were compared to a comparison sample who received the standard treatment. Results: Overall, the virtual environment program was viewed as acceptable, feasible, and credible treatment components to children, parents, and clinicians alike but modifications would likely improve the current version. Additionally, although preliminary, children who received the modified treatment with virtual environment practice demonstrated significant improvement at post-treatment on clinician ratings but not parent or self-reported measures. Conclusion: Virtual environments are feasible, acceptable, and credible treatment components for clinical use. Future investigations will determine if the addition of this dose-controlled and iv intensive social skills practice results in treatment outcome equivalent to traditional cognitivebehavioral programs.