Understanding Psychopathology summary literature week 5
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Course
Understanding Psychopathology (PSB3EKP02)
Institution
Rijksuniversiteit Groningen (RuG)
This document contains the summaries of the articles from Understanding Psychopathology Week 5 . The articles summarized are:
Interpersonal processes in social phobia - Lynn E. Alden, and Charles T. Taylor
Interpersonal Subtypes in Social Phobia: Diagnostic and Treatment Implications - Nicole M....
Literature week 5
FOCUS ON SOCIAL PHOBIA
Interpersonal processes in social phobia – Lynn E. Alden, and Charles T. Taylor
https://www-sciencedirect-com.proxy-ub.rug.nl/science/article/pii/S0272735804000996
Abstract
Social phobia is a condition in which anxiety impairs the person’s ability to relate to others. Here, we
draw on concepts from interpersonal theory to examine the literature on the role of interpersonal
processes in creating and maintaining this disorder. Studies that examine interpersonal interactions
with significant others and strangers are reviewed. We next consider topics of particular relevance to
relationship impairment, such as the effect of anxiety on cognitive processing of social information,
and the social developmental pathways to social phobia. The impact of interpersonal factors on the
process and outcome of cognitive-behavioral treatment is also discussed. Finally, we identify
emerging themes in the research literature and consider directions for future work. Throughout the
paper we highlight topics central to the interpersonal perspective, such as the self-perpetuating
interpersonal cycle, interpersonal variability in social phobia, and the relational nature of self-related
information.
Social Phobia (Social Anxiety Disorder) involves more than anxiety-related symptoms. It is also an
interpersonal disorder, a condition in which anxiety disrupts the individual’s relationships with other
people.
Research on interpersonal factors and social anxiety is distributed across a variety of research areas,
including developmental, personality, social, and clinical psychology. To integrate the various
literatures, we draw on concepts from interpersonal theory.
It is important to note that social anxiety is conceptualized and measured in somewhat different
ways across the various domains. Developmental researchers study the temperaments of behavioral
inhibition and social timidity; personality and social psychologists study shyness and social anxiety,
both as situational-induced states and personality traits; clinical researchers study the diagnostic
categories of social phobia and avoidant personality disorder. These various concepts are related but
not interchangeable.
To reduce overlap with other papers in this volume, this part of the review focuses on topics that
arise from interpersonal theory, such as how other people respond to socially anxious people and the
way in which social relationships shape one’s sense of self and interpretation of social events.
1. Interpersonal perspective
Interpersonal models of psychopathology have emerged in a variety of contexts, each with its own
domain of interest, theoretical viewpoints, and research methods. Despite some differences, these
models share the common assumption that good social relationships are intimately tied to an
individual’s psychological well-being and conversely that poor social relationships contribute to
psychopathology. A central feature of the interpersonal perspective is the concept of the self-
perpetuating interpersonal cycle. We tend to expect people in the present to treat us in the same
way that people have in the past, and we tend to repeat the behavioral strategies we learned to
,handle those earlier events. Furthermore, our behavior exerts a bpullQ on other people that tends to
evoke responses that maintain our social assumptions, expectations, and behavioral patterns. Thus,
people who expect others to respond positively to them engage in social behaviors that tend to elicit
favorable responses, whereas people who anticipate negative responses adopt self-protective
strategies that increase the likelihood of negative responses from previously neutral people.
Interpersonal models also posit that dysfunctional interpersonal patterns are the result of an ongoing
interaction between the individual and the social environment, a social developmental process that
begins early and continues throughout the lifespan. Our relationships shape not only our habitual
social behavior, but also our sense of self and others.
2. Social anxiety disorder and social relationships
There is little doubt that people with social phobia have fewer social relationships than other people.
They have been shown to have fewer friends, fewer dating and sexual relationships, and to be less
likely to marry than people in the general population or even patients with other anxiety disorders.
That being said, we know relatively little about how socially anxious people function in the close
relationships they do develop. To address that issue, Heinrichs (2003) examined marital relationships
(intimate partnerships) in patients with social phobia and found that patients with partners reported
greater life satisfaction than those without partners. While more satisfied than non-partnered
patients, however, they reported more marital distress than a comparison group of people with
panic disorder. Social phobic patients reported lower levels of emotional and social intimacy and
were more likely to display fearful or preoccupied adult attachment styles. They were also more
likely to attribute the cause of negative relationship events to some stable characteristic of their
spouse, which suggested they were more negative and blaming toward their partners.
Davila and Beck (2002) used structured interviews to assess university students’ relationships with
friends, acquaintances, family, and romantic partners. Social anxiety was associated with a variety of
dysfunctional strategies in those relationships, including the expected strategies of nonassertiveness
and avoidance of emotional expression and conflict. One interesting finding to emerge was that
socially anxious people also reported over-reliance on others, a result the authors suggested reflects
their dependence on the few relationships they have. Even when people with social anxiety develop
relationships, they view those relationships as less intimate, functional, and satisfying than do people
without social anxiety.
2.1. Summary
In light of the importance of close relationships to psychological well-being and quality of life,
surprisingly few studies have examined those relationships in any detail. It would be useful for future
research to determine whether the marital discord and low intimacy described by people with social
phobia are also reported by their partners. If so, it would be valuable to determine what behaviors
lead to partner dissatisfaction so they can be addressed in treatment. Another question is whether
relationship impairment is found in all people with social phobia. In short, extant findings suggest
that more work is needed to understand what goes wrong for people with social phobia in
developing close relationships and how they might improve the relationships they are able to
establish.
,3. Self-perpetuating interpersonal cycles
Writers from many theoretical perspectives have observed that socially anxious people behave in
ways that lead to negative social outcomes. Such observations suggest that people with social phobia
may establish negative interpersonal cycles between themselves and others in which they adopt
behavioral strategies that evoke negative reactions.
3.1. Behavioural patterns
The behaviors most commonly associated with social anxiety in the empirical literature are low social
skill, nonassertiveness, and visible anxiousness, as measured through observer ratings and Q-sort
techniques. Some studies also found differences between socially anxious and nonanxious people on
specific anxiety-related micro behaviors, such as poor eye contact, short speech duration,
conversational pauses, low self-disclosure, trembling, blushing, and other anxious mannerisms. The
extant literature suggests that socially anxious individuals can appear less skillful and more anxious
than other people.
Several studies found that patients with social phobia and avoidant personality disorder report a
variety of focal interpersonal problems. There are individual differences in how socially anxious
patients experience their interpersonal problems.
Other researchers report evidence of critical or angry behavior in socially anxious samples. Jones et
al. found that shy people reported feeling critical and non-affectionate toward their friends and
others. Erwin, Heimberg, Schneier, & Liebowitz (2003) found that relative to nonanxious controls,
patients with social phobia reported more state and trait anger, as well as a tendency to express
anger when criticized or treated unfairly, or even without provocation. Interestingly, avoidant
personality traits predicted not only assault, but also spousal murder.
3.2. Other’s reactions
A central tenet of the interpersonal perspective is that people with psychological problems often
elicit negative responses from other people. Empirical studies support this idea in shy and socially
anxious students. There is a presence of a global negative halo in others’ judgment of these people
(e.g., people also think there less intelligent). Interestingly, spouses and long-term acquaintances
rated shy people more positively than did strangers or recent acquaintances, suggesting that with
longer exposure, others may become more positive about them.
Research on social anxiety paints a similar picture of negative social outcomes. Several studies found
that following a “getting acquainted” discussion, others were less likely to desire future interactions
with socially anxious as opposed to non-anxious students. An attempt was made to identify the exact
behaviors that precipitated disengagement. Failing to reciprocate others’ self-disclosures, a strategy
that led others to perceive targets as dissimilar to themselves and disinterested in them, factors that
weigh heavily in relationship formation.
Friends’ Q-sort ratings indicated that they viewed anxious students as, among other things, sensitive
to demands, having brittle ego defenses, moody, and self-pitying. Partners of socially anxious
individuals were rated by objective observers as trying to dominate and control the interaction,
talking at rather than with them, and displaying irritability. The authors concluded that not only were
socially anxious students rated negatively by their friends, they irritated and alienated strangers very
rapidly.
, Research on other people’s reactions to people with a clinical diagnosis of social phobia is sparse.
One recent study provided evidence for negative social outcomes in children with social phobia.
3.3. Summary
The extant literature suggests that people with social anxiety and with social phobia display
distinctive and less functional social behavior than people without those conditions.
Consistent with the notion of dysfunctional interpersonal cycles, people with social anxiety and social
phobia appear to evoke less positive reactions from other people, even in brief initial encounters.
Socially anxious individuals often worry about displaying anxiety-related symptoms, when in fact the
use of prosocial behaviors (friendly nonverbals and reciprocal self-disclosure) may be more critical to
developing close relationships. In short, it may be okay to be anxious as long as you’re friendly.
Relatively few studies of interpersonal behavior have included psychopathology comparison groups.
An important direction for future research is to determine whether the behavioral patterns and
social responses found in social phobic populations are specific to social phobia or are shared with
other psychological disorders.
4. Social skill deficit or self-protective strategy
If, as the research literature suggests, people with social anxiety and social phobia behave in ways
that disrupt relationship development, the next question is why they do so. The traditional
explanation for the dysfunctional behavior described above is that socially anxious individuals have
social skill deficits; they failed to learn effective social behavior and their anxiety is in part a reaction
to those deficits and the resulting negative responses. Research findings over the last decade paint a
somewhat more complex picture. For one thing, it is increasingly recognized that socially anxious
people do not always display avoidant or maladaptive social behavior. Those findings led cognitive-
behavioral theorists to speculate that dysfunctional behavior is the result of cognitive and emotional
processes that are activated by social cues. One corollary of those theories is that we would expect
dysfunctional social behavior to emerge only when particular contextual cues (i.e., social threat) are
present.
Consistent with situational control explanations, Depaulo et al. (1990) found that socially anxious
students wrote less self-disclosive essays when they were led to expect social evaluation than when
they were not, a pattern not found in nonanxious students. Although the partner behaved the same
in each condition, in the negative appraisal condition, socially anxious participants displayed more
safety behaviors (e.g., low self-disclosure) than nonanxious controls. In the positive appraisal
condition, on the other hand, their behavior was the same as that of the controls. When social
conditions are right, people with social phobia appear to be capable of behavior that elicits a positive
interpersonal response.
4.1. Summary
There appears to be some flexibility in the behavioral strategies used by socially anxious people to
manage social events. In particular, the literature suggests that self-protective behaviors are elicited
by social cues signaling potential criticism and rejection. That flexibility appears inconsistent with the
concept of a social skill deficit, which implies a chronic behavioral deficiency.
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