Social anxiety : the possibility of judgment biasis

Social Anxiety: The Possibility of Judgment

Biases

Written by: Chantal Peijs Student no. 10362088 Email address: cspeijs@gmail.com

Bachelor Project

Education program: Bsc Psychology University of Amsterdam Supervisor and Examiner: Jamie Elsey

2nd Examiner:

ABSTRACT

Socially anxious people often feel negatively judged by others. In this study we investigated whether socially anxious people might themselves have biases for judging other people. Two groups of participants were asked to either watch videos or read examples of social scenarios and judge the people in them. Social anxiety was measured using the Social Phobia Inventory and the Negative Self Portrayal Scale. The primary hypothesis was that individuals with higher levels of social anxiety judge others more negatively in a negative social situation than those with lower levels of social anxiety. A secondary hypothesis was that individuals with higher levels of social anxiety judge others more positively in a positive situation than

individuals with a lower level of social anxiety. The results provided preliminary evidence for the first hypothesis, but not for the second one: individuals with high social anxiety seem to judge others more negatively in a negative social scenario, but not more positively in a positive social scenario, than those with lower social anxiety. Implications are discussed and suggestions for further research are made.

Table of contents 1. Introduction 1 2. Method 2.1 Design 5 2.2 Participants 5 2.3 Materials 6 2.4 Procedure 9 3. Results 3.1 Descriptive analysis 10 3.2 Results Group 1 10 3.3 Exploratory analysis 11 3.4 Results Group 2 12 4. Discussion 13 5. References 18

1

1. Introduction

Individuals with social anxiety (also known as social phobia) fear negative evaluation and potential scrutiny by others. They are afraid of embarrassing or humiliating themselves in social situations. (Clark, 2005). These social situations can be anything from public speaking, to social group encounters or talking to strangers. social anxiety has a prevalence of almost 13%, with onset in early adolescence (Kessler et al., 1994). Given this relatively high

prevalence, trying to gain deeper understanding of social anxiety could possibly help alleviate the suffering of a large number of people.

Social anxiety is a disorder which is hard to detect, given the fact that up to 40% of the general population describes themselves as shy (Rapee & Heimberg, 1997). Furthermore, only about half of the people who are suffering from social anxiety seek treatment, and even if they do, it takes them about 15 to 20 years after their first symptoms started to do so (Stein, 2008). Individuals who suffer from this sort of anxiety, often have work-related performance problems, and may also so find it difficult to maintain interpersonal relationships. Besides these impairments, people with this disorder are more at risk for developing depression, substance use disorders, and are known to have a higher suicide risk than less anxious people (Hirsch et al., 2004).

One important difference between social anxiety disorder and other anxiety disorders is that individuals with social anxiety can’t always avoid fearful situations. Social interactions are for most people a part of their daily routine, which are hard to avoid. Even though these feared social interactions are faced instead of avoided, and people with social anxiety actually rarely get negative evaluation from others, the anxiety persists (Hirsch et al., 2004). One possible explanation for maintaining social anxiety could be a cognitive bias called

2

judgmental processing. Some examples of judgmental processing biases are that people with social anxiety usually exaggerate mildly negative social events, if these social events were even negative at all in the first place. They also show an increase in self-focused attention, completely shutting the external social environment out. When they do so, they don’t receive the external feedback that might correct their biases. Finally, individuals with social anxiety are better at detecting negative social cues instead of positive social cues. Their attention is biased towards the negative side of things (Clark & McManus, 2002).

These cognitive biases are the main focus of concern in social anxiety. All patients have a degree of anxiousness regarding exposure to public scrutiny. However, not all people who are diagnosed with social anxiety show the exact same signs of anxiety. There seem to be several different types of self-attributes that are the primary focus of concern. Searching for an explanation for this phenomenon, Moscovitch (2009) argued a new conceptualization of the core features of social anxiety. Moscovitch (2009) suggests that the fears of socially anxious people are related to areas in which they perceive themselves to be particularly flawed. According to Moscovitch, the first area points out perceived flaws in social skills and behaviours. Individuals with social anxiety worry about their social competence, and are afraid of lacking certain social skills. They are particularly afraid of stuttering, having blackouts, or that they might do something stupid or inappropriate (Moscovitch, 2009). The second area of concern brings out perceived flaws in controlling and concealing internal feelings of anxiety. This basically means that individuals with social anxiety are nervous about showing observable signs of anxiety, like blushing, sweating, or shaking. They are scared for other people to notice these signs of anxiety, and that they will interpret these symptoms in a negative manner (Moscovitch, 2009). Third and last area of concern is the perceived flaws in physical appearance. Individuals with social anxiety may be highly focussed on how they look like and how they come across. Their anxiety is based on the fear

3

of being dressed inappropriately, being ugly or being uncared for in general. Research shows that in comparison to non-socially-anxious individuals, people with social anxiety have a more distorted body image and judge themselves to be less physically attractive (e.g. Izgic, Akyiz, Dogan & Kugu, 2004; Montgomery, Haemmerlie & Edwards, 1991).

These three different dimensions might be helpful to understand to a higher level how social anxiety can be characterized. Note that these dimensions are not mutually exclusive, but that they are highly correlated. Individuals with social anxiety can experience several anxiety symptoms from different dimensions in different intensities (Moscovitch, 2009).

Somewhat striking is that by individuals with social anxiety these assumptions based on social skills, visible signs of anxiety and physical appearance are seen as evident. People with social anxiety are for some reason unable to see that these assumptions are faulty, even when the feared social situation does not occur. This could possibly be explained with the concept of safety behaviours. Safety behaviours are intended to prevent the fears that people with social anxiety have from coming true. For example, if someone with social anxiety is afraid of stumbling over his words while speaking, a safety behaviour related manner could be to memorize every word, to reduce the chance of stumbling (McManus et al., 2008). Individuals with social anxiety see safety behaviours as the reason why some negative social event did not happen (Taylor & Alden, 2010). Performing safety behaviours, like memorizing every word you are going to say, takes up a lot of concentration and attention. When someone is really busy with focussing on the self, they can come across as distant or uninterested in others (McManus et al., 2008). This focussing on the self is known as self-preoccupation. One other consequence of self-preoccupation, is the impaired ability to comprehend mental states of others (Hezel & McNally, 2014). The cognitive ability to perform this skill is called Theory of Mind. Having a less developed Theory of Mind means that these people could have difficulties empathizing with others, and that they may find it hard to reason about

4

others’ beliefs, emotions and intentions. It is suggested that individuals with social anxiety might indeed have impairments in Theory of Mind (Hezel & McNally, 2014).

To sum, there seem to be several factors that could possibly be maintaining social anxiety disorder. There is evidence found for safety behaviours, self-pre-occupation and Theory of Mind deficit as the reason why the disorder persists (e.g. Clark & McManus, 2002; Taylor & Alden, 2010; Hezel & McNally, 2014). However, comparably little research has considered how socially anxious individuals judge others in social situations. This research is conducted to find out if not only people with social anxiety are more sensitive to judgment from others, but also might be more judgmental themselves. This would not mean that they are always judgmental, but in case someone makes some kind of social mistake, their judgments start to differ from less anxious people. For example, individuals with social anxiety might be more judgmental as a result of safety behaviours they developed over time. In other words, people with social anxiety being more judgmental could be a defence against feeling judged by others. Secondly, it is questioned whether individuals with social anxiety might judge people more positively who are good in social situations. This could be because they feel these people possess something they lack e.g. good social skills. From these

assumptions, two hypotheses were considered. The first and main hypothesis suggests that individuals with higher levels of social anxiety judge others more negatively in a negative social situation than individuals with a lower level of social anxiety. A secondary hypothesis suggests that individuals with higher levels of social anxiety judge others more positively in a positive social situation than individuals with a lower level of social anxiety.

These questions should be explored, as this could be an important factor in treatment efficacy. Therapists might be ignoring a potentially important cognitive bias that could be maintaining the disorder. Acknowledging this component in treatment, could possibly improve treatments plans.

5

This study was designed to do an extensive research on the question whether or not individuals with social anxiety turn out to have judgmental biases.

2. Method

2.1 Design

In this study a correlational design was used. The study had two separate experiments. The first experiment consisted out of a social judgment task where volunteers participating in this research were shown several video clips regarding social situations. Finally, they were asked to complete multiple questionnaires to assess their level of anxiety. The second experiment consisted out of a social judgment task where participants were given vignettes for social scenarios and were asked to judge people on these. The participants in this experiment were asked to complete the same questionnaires as the participants in the first experiment.

2.2 Participants

Participants were selected from the undergraduate population at the University of Amsterdam. Participants who were given the vignettes were first year psychology students only. Participants who gave their opinions on the video clips were both first-, second and bachelor psychology students. Demographic information (reported age and gender) for the participants in Experiment 1 and 2 are presented in Table 1.

6

Table 1. Demographic Characteristics of Participants

2.3 Materials

All participants completed the Social Phobia Inventory (SPIN), the Negative Self Portrayal Scale (NSPS) and the Brief Fear of Negative Evaluation Scale (BFNE) to assess the level of social anxiety. For the purposes of this study, the SPIN and the NSPS were selected for analyses, and are described in further detail below.

The SPIN, (Connor et al., 2000), is a Dutch 17 item questionnaire used to measure the level of Social Anxiety. The questionnaire consists out of questions which evaluate fear (e.g. of being criticised, of being embarrassed), avoidance (e.g. of talking to strangers, of being criticised) and psychological comfort (e.g. blushing or sweating in front of other people). Each of the 17 items is rated on a scale from 0 “not at all” to 4 “extremely.” The full-scale score ranges from 0 to 68, with a higher score indicating a higher level of social anxiety. The internal consistency for the SPIN is high (Cronbach’s alpha = 0.87 to 0.94)

The NSPS, (Moscovitch & Huyder, 2011), is a 27 item questionnaire used to measure the insecurities commonly associated with social anxiety. The questionnaire was translated in Dutch as the participants were all from the Netherlands. Participants were asked to rate the degree to which they are concerned about certain aspects of themselves when in anxiety-provoking social situations. The already discussed core fears theory from Moscovitch was

Experiment 1 (N = 91) Experiment 2 (N = 42)

Age 19.94 years (SD = 1.67) 20.90 years (SD = 2.68)

7

used to cover the different areas of social anxiety. The core fears are: signs of anxiety (e.g. blushing, sweating), social competence (e.g. stuttering) and physical appearance (e.g. clear skin) All items were rated on a scale from 1 “not at all” to 5 “extremely.” The full-scale score ranges from 27 to 135, with a higher score indicating a higher level of insecurities commonly associated with social anxiety. The internal consistency is high (Cronbach’s alpha = .96).

Social Judgment Task.

Experiment 1.

The social judgment task consisted out of two separate experiments. In the first experiment, participants were given social vignettes. These vignettes were social scenarios written down on paper. The vignettes were based on the three core fears discussed by Moscovitch. Vignettes were evenly divided over the three core fears, so that each core fear would be evenly represented. In total there were 24 vignettes. From these vignettes, 12 of them were positive, and 12 of them were negative. Participants read 6 positive social scenarios, and 6 negative. There was made sure participants did not read the same

positive/negative version of the same vignette. The order of the vignettes was randomized so that all the positive or negative vignettes did not all come in a row. Example of a positive scenario is as follows: “You are at a friend’s birthday party. One of the other guests is asked to make a toast. When the guest delivers the speech, you notice that her voice is even and controlled for its whole duration.” An example of a negative scenario is as follows: “You are at a friend’s birthday party. One of the other guests is asked to make a toast. When the guest delivers the speech, you notice that her voice is trembling for its whole duration.” Participants were asked to judge whether they thought the person in the video clip was a socially

competent person, an anxious person, and a physically attractive person. All items were rated on a scale from 1 “strongly disagree” to 7 “strongly agree.” The full-scale score ranges from

8

12 to 84, which created a judgment score. A lower score would mean that the participant had a more negative perception of the person in the vignette. Finally, participants were asked how they think other people will judge this person. These items were rated on a scale from 1 “very negatively” to 7 “very positively.” For the purposes of this study, these last items were not used in the analyses of this study.

Experiment 2.

In the second experiment, participants were shown 8 video clips. These video clips included 4 negative and 4 positive ones. These video clips were chosen to reflect different levels of social competence, signs of anxiety, and physical attractiveness in social situations. All video clips were presented in a randomised order. The video clips were short clips from different movies or TV shows, and would take about 2 minutes each. An example of a positive video clip is someone in a social situation who speaks fluently, does not stutter and comes across as self-confident. An example of a negative video clip is someone in a social situation who cannot find the right words, stutters, and seems awkward. Participants were asked to judge whether they thought the person in the video clip was a socially competent person, an anxious person, and a physically attractive person. All items were rated on a scale from 1 “strongly disagree” to 7 “strongly agree.” The full-scale score ranges from 8 to 56, which again created a judgment score. A lower score would mean that the participant had a more negative perception of the person in the vignette. Finally, participants were asked how they think other people will judge this person. These items were rated on a scale from 1 “very negatively” to 7 “very positively.” For the purposes of this study, these last items were not used in the analyses of this study.

9

2.3 Procedure

Experiment 1.

In the first experiment, participants were given the social vignettes in the test week, which is a mandatory week of testing where first year psychology students have to participate in. Participants gave their permission in the form of an informed consent, and then filled out several questionnaires to assess the level of Social Anxiety. These were the SPIN and NSPS. This took them about 15 minutes. These questionnaires were given before the social judgment task took place, to not possibly reveal the purpose of the experiment. When finished,

participants required to read the social vignettes, and judge how anxious, socially competent, and physically attractive the described person was. This took them about 10 minutes. The procedure lasted approximately 25 minutes in total.

Experiment 2.

In the second experiment, participants were first asked to read the information sheet and sign the informed consent. Then, participants filled out several questionnaires to assess the level of Social Anxiety. These were the SPIN and NSPS. This took them about 15 minutes. These questionnaires were given before the social judgment task took place, to not possibly reveal the purpose of the experiment. When finished, participants were required to watch each video clip and judge how anxious, socially competent, and physically attractive the main character was. This took them about 25 minutes. Finally, the participants were given a debriefing, where they were asked if they had any remaining questions. The procedure lasted approximately 40 minutes in total.

10

3. Results

3.1 Descriptive Analyses

Mean scores and standard deviations for the SPIN and NSPS are presented in Table 2. Experiment 1 consisted out of participants who were shown the video clips. Experiment 2 consisted out of participants that were given the social vignettes.

Table 2. Means and (Standard Deviations) of Study Measures Measure

Experiment 1 Experiment 2 Mean (SD)1 Mean (SD)1

NSPS 47.93 (2.37) 50.70 (1.90)

SPIN 13.10 (1.42) 12.41 (1.13)

Note. NSPS = Negative Self-Portrayal Scale; SPIN = Social Phobia Inventory

3.2 Results Experiment 1

As a manipulation check, a paired samples t-test was conducted to compare

participant’s judgments of characters in positive social vignettes relative to negative social vignettes. There was a significant difference in the scores for positive judgments (M = 97.20, SD = 8.84) and negative judgments (M= 65.96, SD = 6.51), t (90) = 26.77, p <.001. This suggests that the experimental manipulation was successful: social vignettes selected to represent poor performance in social situations were judged more negatively than videos selected to represent good performance in social situations.

11

Hypothesis 1.

To assess whether participants with higher levels of social anxiety responded more negatively to individuals in the negative social vignettes than those with lower social anxiety, bivariate correlations were conducted between the social anxiety measures and their judgment scores. In line with the hypothesis, an association was found between the SPIN and the

negative judgments people made, r = -.27, BCa CI [-.427, .084], p < .05. Furthermore, an association was found between the NSPS and the negative judgments people made, r = .243, BCa CI [-.396, -.074], p < .05.

Hypothesis 2.

To assess whether participants with higher levels of social anxiety responded more positively to individuals in the positive social vignettes than those with lower social anxiety, bivariate correlations were conducted between the social anxiety measures and their judgment scores. Contrary to the hypothesis, no association was found between the SPIN and the

positive judgments people made, r = -.091, BCa CI [-.284, .118], p = .389. Furthermore, no association was found between the NSPS and the positive judgments people made, r = .006, BCa CI [-.209, .229], p = .951.

3.3 Exploratory Analysis

A negative correlation was observed in line with the first hypothesis in the vignette study, but from the global judgment scores it is not clear on which facets (e.g. signs of anxiety, social competence or physical appearance) those with higher levels of anxiety were more critical of. To further assess this, further correlations were conducted to see if the SPIN and NSPS scores correlated with participants' ratings of these specific items, rather than just the global score. The SPIN was not positively correlated with the item signs of anxiety, r =

-12

.084, BCa CI [-.260, .127], p = .427. Similarly, the SPIN was not negatively correlated with the item signs of anxiety, r = -.188, BCa CI [-.380, .051], p = .074. Furthermore, the SPIN was not positively correlated with the item social competence, r = -.099, BCa CI [-.314, .102], p = .353. Similarly, the SPIN was not negatively correlated with the item social competence, r = -.129, BCa CI [-.345, .108], p = .221. Next, the SPIN was not positively correlated with the item physical appearance, r = -.057, BCa CI [-.282, .169], p = .590. However, The SPIN was negatively correlated with the item physical appearance, r = -273, BCa CI [-.423, -.116], p < .01. Looking at the NSPS, there was no positive correlation with the item signs of anxiety, r= .010, BCa CI [-.180, .213], p = .925. However, The NSPS was negatively correlated with the item signs of anxiety, r = -3.16, BCa CI [-.468, -.142], p <.01. Furthermore, the NSPS was not positively correlated with the item social competence, r = .013, BCa CI [-.233, .235], p = .902. Similarly, the NSPS was not negatively correlated with the item social competence, r = -.121, BCA CI [-.287, .075], p = .254. Finally, the NSPS was not positively correlated with the item physical appearance, r = -.005, BCa CI [-.210, .199], p = .963. Similarly, the NSPS was not negatively correlated with the item physical appearance, r = -.102, BCa CI [-.271, .084], p = .335.

3.4 Results Experiment 2

As a manipulation check, a paired samples t-test was conducted to compare

participants’ judgments of characters in positive videos relative to negative videos. There was a significant difference in the scores for positive judgments (M = 70.45, SD = 4.74) and negative judgments (M = 38.45, SD = 5.0), t (41) = 28.95, p <.001. This suggests that the experimental manipulation was successful: videos selected to represent poor performance in social situations were judged more negatively than videos selected to represent good

13

Hypothesis 1.

To assess whether participants with higher levels of social anxiety responded more negatively to individuals in the negative video clips than those with lower social anxiety, bivariate correlations were conducted between the social anxiety measures and their judgment scores. Contrary to the hypothesis, no association was found between the SPIN and the

negative judgments people made, r = .029, BCa CI [-.313, .263], p = .853. Secondly, no association was found between the NSPS and the negative judgments people made, r = .024, BCa CI [-.346, .355], p = .878.

Hypothesis 2.

To assess whether participants with higher levels of social anxiety responded more positively to individuals in the positive video clips than those with lower social anxiety, bivariate correlations were conducted between the social anxiety measures and their judgment scores. Contrary to the hypothesis, no association was found between the SPIN and the

positive judgments people made, r = -.003, BCa CI [-.336, .319], p = .984. Secondly, no association was found between the NSPS and the negative judgments people made, r = .15, BCa CI [-.164, .451]. p = .345.

4. Discussion

This study carried out an extensive research on the question whether or not individuals with social anxiety turn out to have judgmental biases. Two hypotheses were set up. The first and main hypothesis suggests that individuals with higher levels of social anxiety judge others more negatively in a negative social situation than individuals with a lower level of social

14

anxiety. A secondary hypothesis suggests that individuals with higher levels of social anxiety judge others more positively in a positive social situation than individuals with a lower level of social anxiety. These hypotheses were researched with two separate experiments. In these experiments, social scenarios were shown, and participants were asked to judge the main characters in the social situations. In the first experiment, participants were given social vignettes, and in the second experiment, participants were shown video clips of social

situations. Participants judged these people on three areas, based on the core fears theory from Moscovitch. These core fears were: signs of anxiety (e.g. blushing, sweating etc.), social competence (e.g. stuttering etc.) and physical appearance (e.g. clear skin etc.) Then bivariate correlations were conducted between two social anxiety measures and their judgment scores. These social anxiety measures were two questionnaires, the Social Phobia Inventory (SPIN) and Negative Self Portrayal Scale (NSPS), who were used to assess the level of social anxiety. The judgment score was the sum of all items. A lower score would mean that the participant had a more negative perception of the person in the vignette.

In the first experiment, using social vignettes, support was found for the idea that higher levels of social anxiety are related to more negative judgments of individuals in negative social situations. However, in the second experiment using videos of social encounters this association was not present. Similarly, in both experiments no support was found for the idea that higher levels of social anxiety are related to more positive judgments of individuals in positive social situations. The implications of these findings, and possible explanations for the differences observed in our two experiments, are discussed below.

First of all, some support for the main hypothesis was found. This means that, as hypothesized, individuals with social anxiety seem to have judgment biases. In previous research it was observed that there was an almost exclusive focus on socially anxious individuals and their fear of judgment from others. However, this research suggests that

15

individuals with social anxiety may be more judgmental themselves. If this result is a genuine finding, this could have several implications for clinical practice. Individuals with social anxiety already feel troubled in social contact, but being more judgmental themselves, could even further restrict the positive social contact they have. Furthermore, being more

judgmental could mean that they might shun other people, or act in ways that lead them to be shunned. This characteristic of socially anxious people being more judgmental could have consequences for the clinicians as well. Clinicians may change the way they treat socially anxious individuals. Instead of only trying to make a socially anxious person see that other people are not always judging them, a clinician might also consider focussing on making the socially anxious person less judgmental. This might improve their social contact with other people.

Secondly, a general negative correlation was observed in line with our hypothesis. However, these results were based on a global score. To further asses on which facets from the core fears theory from Moscovitch individuals with higher levels of anxiety were more critical of, further correlations were conducted. From the results, two specific items came forward. These were the items physical appearance and signs of anxiety. The item signs of anxiety is a large factor in social anxiety. Individuals with social anxiety have the fear of being negatively evaluated, or of being humiliated. They are particularly afraid that other people will pick up on certain cues that give away their fear, e.g. sweating or shaking (Clark, 2005). Therefore, the item signs of anxiety was expected to come forward in the analysis. More surprising, was the item physical appearance as a most common facet. Physical appearance is the most arbitrary item from the core fears. What people see as physically attractive differs from person to person. However, the sample of this study

16

psychical appearance plays an important role. This could have been a reason why significant correlations were found with this specific item.

For this research, several study limitations should be noted. First of all, a possible limitation could be that the sample consisted of mostly female participants. Therefore, the study may not generalize to males. However, social anxiety is much more common in women, and so the findings are still relevant for the majority of socially anxious individuals. Secondly, because this study did not use clinical diagnoses, very extreme clinical cases might be

different. However, although no clinical diagnoses were used in this study, a good spread of social anxiety scores came forward. Therefore, the participants used in this research were qualified to test the hypothesis that social anxiety is related to judgments varying levels of social anxiety. There also might be some limitations in how the study was set up. In this study two experiments were conducted: one experiment where the participants were given social vignettes, and one experiment where participants looked at video clips. Support was found for the main hypothesis in the first experiment, but not in the second. There are several

explanations for this finding that should be considered. First, it could have been that the association that was found in the vignettes group was spurious. This study could have stumbled upon this association by accident. However, two different measures of social anxiety, the SPIN and the NSPS, showed this association. This would suggest that the result obtained in this research is not down to chance. Secondly, it could have been possible that there was a difference between the vignettes and the video clip experiment. The vignette experiment was more controlled, and had well balanced versions of the same scenarios in which only specific details are changed. The video clips however, are different from one other. The video clips had different lengths, different main characters and often had music and editing which made the videos diverse. Another possible explanation is that participants might have been familiar with the movies or main characters. This could have coloured their

17

judgments in a way. Furthermore, the video clips were observable, as the vignettes were based on imagination. Socially anxious individuals might have judged the person in the social vignettes more harshly based on their imagination. There might be an association between the social vignettes, who were based on imagination, and possible negative imagery of

individuals with social anxiety. Hirsch, Meynen & Clark (2004) found that people with social anxiety report experiencing negative images of themselves performing poorly when in feared social situations. Based on that research, it could be suggested that people with social anxiety imagine much worse behaviour in their imaginations. Similarly, Hirsch, Clark & Mathews (2006) found that individuals with social anxiety interpret external social information in a less positive way than those without social anxiety. It could have been possible, that because of this negative imagery, the social vignettes evoked more extreme judgmental behaviour than the video clips. This could have resulted in a significant effect in the vignette experiment, but no significant effect in the video clip experiment.

The limitations being mentioned; the present study does provide evidence for the first and main hypothesis. Individuals with a higher level of social anxiety do seem to be more judgmental to others in a negative way, as they feel more negatively evaluated by others. However, further research is required to see if this effect can be generalized to different studies. It could be suggested to replicate the results from the vignette experiment in an actual clinical sample, as this study was based on a student sample. Another suggestion could be that a different study could be set up, were video clips are created that are more controlled. This way, differences between the vignette and video clip experiment are limited. It would be helpful to see if in this situation, other results are found.

18

5. References

Clark, D.M. (2005). A Cognitive Perspective on Social Phobia.

Clark, D. M., & McManus, F. (2002). Information Processing in Social Phobia.

Biological Psychiatry, 51(1), 92-100.

Collins, K. A., Westra, H. A., Dozois, D. J. A., & Steward, S. H. (2005). The

Validity of the Brief Version of the Fear of Negative Evaluation Scale. Journal of

Anxiety Disorders, 19(3), 345-359.

Connor, K. M., Davidson, J. R. T., Churchill, L. E., Sherwood, A., Weisler, R. H., Foa, E. (2000). Psychometric Properties of the Social Phobia Inventory (SPIN). The British

Journal of Psychiatry, 176(4), 379-386.

Hezel, D. M., & McNally, R. J. (2014). Theory of Mind Impairments in Social Anxiety Disorder. Behaviour Therapy, 45(4), 530-540.

Hirsch, C. R., Clark, D. M., & Mathews, A. (2006). Imagery and Interpretations in Social Phobia: Support for the Combined Cognitive Bias Hypothesis. Behavior Therapy,

37(3), 223-236.

Hirsch, C. R., Meynen, T., & Clark, D.M. (2004). Negative Self-Imagery in Social Anxiety Contaminates Social Interactions. Memory, 12(4), 496-506.

Izgic, F., Akyuz, G., Dogan, O., & Kugu., N. (2004). Social Phobia Among University Students and Its Relation to Self-Esteem and Body Image. Canadian Journal of

Psychology, 49(9), 630-634.

Kessler, R. C., McGonagle, K. A., Zhao, S., Nelson, C. B., Hughes, M.,

Eshleman, S., Wittchen, H. U., & Kendler. K. S. (1994). Lifetime and 12-Month Prevalence of DSM-3-R Psychiatric Disorders in the United States. Arch Gen Psych,

19

McManus, F., Sacadura, C., & Clark, D. M. (2008). Why Social Anxiety

Persists: An Experimental Investigation of the role of Safety Behaviors as

Maintaining Factor. Journal of Behavior Therapy and Experimental Psychiatry, 39(2), 147-161.

Montgomery, R. L., Hammerlie, F. M., Edwards, M. (1991). Social, Personal, and Interpersonal Deficits in Socially Anxious People. Journal of Social Behavior and

Personality, 6(4), 859-872.

Moscovitch, D. A. (2009). What is the Core Fear in Social Phobia? A new Model to Facilitate Individualized Case Conceptualization and Treatment. Cognitive and

Behavioral Practice, 16(2), 123-134.

Moscovitch, D. A., & Huyder, V. (2011). The Negative Self-Portrayal Scale: Development, Validation, and Application to Social Anxiety. Behavior Therapy, 42(2), 183-196. Moscovitch, D. A., Rowa, K., Paulitzki, J. R., Ierullo, M. D., Chaing, B., Antony,

M. M., & McCabe, R. E. (2013). Self-portrayal concerns and their relation to Safety Behaviors and Negative Affect in Social Anxiety Disorder. Behaviour Research and

Therapy, 51(8), 476-486.

Rapee, R. M., & Heimberg, R. G. (1997). A Cognitive-Behavioral Model of Anxiety in Social Phobia. Elsevier, 35(8), 741-756.

Stein, M. B., & Stein, D. J. (2008). Social Anxiety Disorder. The Lancet,

371(9618), 1115-1125.

Taylor, C. T., & Alden, L. E. (2010). Safety Behaviors and Judgmental Biases in Social Anxiety. Behavior Research and Therapy, 48(3), 226-237.

20

F. R., & Liebowitz, M. R. (2005). Empirical Validation and Psychometric Evaluation of the Brief Fear of Negative Evaluation Scale in Patients with Social Anxiety