This PhD investigated the theoretical and clinical applications of a meta-cognitive model of psychological disorders in social anxiety. The main objective was to identify potential associations between meta-cognitive knowledge (i.e. meta-cognitive beliefs) and social anxiety. These associations could be direct or indirect via information-processing mechanisms, such as anticipatory processing (AP), focus of attention, and post-mortem processing (PM). The current thesis reports six studies (N = 686).Study 1 explored cross-sectionally the potential contribution of meta-cognitive beliefs about general worry to social anxiety. The results showed that positive and uncontrollability beliefs along with AP were individual positive predictors of social anxiety. Furthermore, these beliefs had an indirect effect on social anxiety through anticipatory processing and the post-mortem. These results prompted further exploration of the nature of meta-cognitive beliefs in social anxiety. Study 2 employed semi-structured interviews to elicit meta-cognitive beliefs that could be specific to social anxiety. High and low socially anxious individuals reported beliefs about anticipatory processing, focusing on an observer perspective (OP) self-image, and the post-mortem. The high socially anxious group reported greater engagement in both AP and focusing on the OP, and spending greater time trying to control AP, OP, and the post-mortem. Moreover, the two groups differed in beliefs about these mechanisms, in coping strategies, and in stop signals. The beliefs elicited informed two new questionnaires that were investigated in Study 3. Each questionnaire revealed three subscales of positive and negative beliefs about AP and about the OP self-image, respectively. The subscales showed good reliability and stability. In addition, the new beliefs revealed further associations with social anxiety. Study 4 investigated whether meta-cognitive beliefs could affect attentional bias in social anxiety. High and low socially anxious individuals completed a dot-probe task with emotional, social and physical words matched with neutral words. The results indicated a potential moderation effect of social anxiety and positive meta-cognitive beliefs on attentional bias. Moreover, meta-cognitive beliefs predicted attentional bias in both social anxiety groups. The above results implicated meta-cognitive beliefs in the maintenance of social anxiety. Study 5 explored whether these beliefs could affect state anxiety in high socially anxious individuals that engaged in either AP or a distraction task prior to giving a speech. The results replicated previous findings that AP was associated with more anxiety compared with distraction. Additionally, uncontrollability beliefs were associated with increased state anxiety before the speech, while positive beliefs interfered with distraction and were associated with the maintenance of anxiety after the speech was over. Finally, Study 6 explored whether a meta-cognitive intervention could be effective in the treatment of social anxiety. In a cross-over design, high socially anxious individuals practiced detached mindfulness and thought challenging prior to giving a speech. The results showed that detached mindfulness was associated with greater reductions in negative beliefs, worry, and the OP. In conclusion, the results of a series of studies support the application of the meta-cognitive model to social anxiety.

Two studies were conducted in which we examined the relation between shyness and facial expression processing in children. In Study 1, facial expression recognition was examined by asking 97 children ages 12 to 14 years to identify six different expressions displayed at 50% and 100% intensity, as well as a neutral expression. In Study 2, the focus shifted from the recognition of emotions to the interpretation of emotions. In this study, 123 children aged 12 to 14 years were asked a series of questions regarding how they would perceive different facial expressions. Findings from Study 1 showed that, in the case of shy boys, higher levels of shyness were related to lower recognition accuracy for sad faces displayed at 50% intensity. However, in most cases, shyness was not related to facial expression recognition. The results from Study 2 suggested broader implications for shy children. The findings of Study 2 demonstrated that shyness is predictive of biased facial expression interpretation and that rejection sensitivity mediates this relation. Overall the results of these two studies add to the research on facial expression processing in shy children and suggest that cognitive biases in the way facial expressions are interpreted may be related to shy children’s discomfort in social situations.

This study examined how social anxiety, gender, and mode of presentation influenced miscommunication and perception of negativity in children’s interpretation of computer-mediated messages. The initial phase of the research involved developing and validating the stimuli for emotion recognition via presentation of various emotionally toned messages. Following preparation of the stimuli, the 98 participants (aged 8-12 years) in the main study were randomly assigned to one of three conditions: audio-visual, audio-only, and text message. The same emotionally toned messages were presented in each of these three conditions. Participants were instructed to select from a list of six emotions (happy, sad, disgusted, angry, surprised, scared) which emotion each message conveyed. Participants then rated how positively or negatively they perceived each sentence, using a 5-point Likert scale that ranged from very negative to very positive. Following the emotion recognition and Likert rating task, participants completed questionnaires that gathered information about social anxiety and attribution bias. Findings revealed that additional nonverbal and paralinguistic, as in the audio-visual or audio-only condition, allowed participants to more accurately identify the emotion being conveyed in the message, compared to the text message condition. This advantage was found for all emotions with the exception of happiness. For happy messages, participants were able to identify the intended emotion at above-chance levels regardless of mode of presentation. When making interpretations about angry messages, a significant three-way interaction was observed between sex, condition and social anxiety. Likert rating analyses revealed that condition, sex, and social anxiety played important roles in the interpretation of both ambiguous and unambiguous emotions, such as surprise and happiness.

The late positive potential (LPP) is an event-related potential (ERP) component associated with increased affective processing which seems to strongly respond to threats and to be sensitive to emotional faces. Some studies indicate that the LPP is modulated by anxiety symptoms, while others fail to find support for these observations. The facial width-to-height ratio (FWHR) is a facial-masculinity metric that refers to cheekbone width, divided by upper facial height (top of the lip to between the brows). Consequently, FWHR has by some researchers been proposed to serve as a cue of threat. For example, high FWHR and diverse emotional faces (e.g., angry faces) are perceived as more threatening than low FWHR faces. Individuals with social anxiety are thought to be biased towards the threat. The literature has indicated that high FWHR faces in combination with angry facial expression can elicit larger LPPs compared to low FWHR and neutral faces. The current experiment investigated subjective ratings in addition to the LPP in response to high and low FWHR faces in combination with an angry and neutral expression, to examine how different facial morphology and affective cues influence the perception of threat to individuals with high social anxiety. This data, in combination, suggests that high FWHR is a salient threat-related social stimulus that might have a firm influence on the perception of other peoples’ faces. Initial results do not support a significant relationship between increased LPP modulation in individuals with high social anxiety compared to individuals with low social anxiety. However, it opens up for discussion regarding how social anxiety should be approached in future LPP research.

Adolescents with body image dissatisfaction experience more anxiety than their peers who are more satisfied with their body. This is problematic given that adolescents who experience these concerns have a greater likelihood of later developing other mental health disorders and have more disordered eating cognitions and behaviour. For this reason, I investigated how body image dissatisfaction, social anxiety, and fear of negative evaluation were related to one another. Participants included 527 adolescents (301 girls; aged 15 to 19 years; 83.1% White) who were accessed annually over 4 years (Grade 10 to one-year post high school) using the Multidimensional Anxiety Scale for Children, the Brief Fear of Negative Evaluation scale-II, and validated questions to assess body image dissatisfaction. A developmental cascade model was used to examine direct and indirect effects between the study variables. Results indicated two significant indirect paths; body image dissatisfaction to social anxiety via fear of negative evaluation and body image dissatisfaction to fear of negative evaluation via social anxiety. Direct effects included a reciprocal positive association between body image dissatisfaction and social anxiety in mid-adolescence and a reciprocal positive association between social anxiety and fear of negative evaluation across adolescence. Lastly, there was a positive association from body image dissatisfaction to fear of negative evaluation across adolescence. These results suggest that adolescents with low body image dissatisfaction are likely to experience greater fear and anxiety regarding social interaction. This study emphasizes the need to target adolescents with body image intervention programs to reduce the experience of psychopathology.

Social anxiety disorder (SAD) is characterized by fear and avoidance of social interactions and situations in which an individual is being the focus of attention. This current thesis aims to examine the efficacy of pharmacological treatment, particularly selective serotonin reuptake inhibitors (SSRIs) in individuals with a generalized social anxiety disorder (gSAD) in comparison with placebo (no active medication). In this systematic review, Scopus and Web of Science were searched for relevant research regarding the efficacy of the SSRI medication (paroxetine, sertraline, fluvoxamine and escitalopram) in comparison with placebo. Sixteen articles were included in this analysis. Results demonstrated that SSRI medication has greater efficacy in comparison with placebo both in short- and long-term time, prevent relapse in the long-term treatment of SAD and had a beneficial effect on different areas of individuals life's such as work, performance, romantic relationships etc.

Social anxiety disorder (SAD) interferes with everyday life. It can, for instance, hinder careers, relationships, and leisure time. It is a common anxiety disorder that was neglected for decades. SAD individuals crave and fear social interactions simultaneously, leading to isolation in our highly social world. Therefore, research surrounding these kinds of disorders is essential. This systematic review has focused on the neural aspects and differences between SAD and healthy controls surrounding amygdala activation and connectivity. Functional magnetic resonance imaging (fMRI) studies conducted using social and emotional tasks were included. Findings include increased amygdala activation to fearful faces and words and a positive correlation between amygdala activation and symptom severity. Further, deficits in emotion regulation and a finding of gradual habituation have been found in SAD compared to healthy controls. Some limitations to this research are the small sample sizes used in the included articles and the use of both SAD and individuals with generalized SAD. The study is essential to assess future questions and directions regarding diagnosis, treatment, and understanding of SAD.

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