Interpersonal processes in social phobia - summary of an article by Alden & Taylor (2004)

Interpersonal processes in social phobia
Alden, L. E., & Taylor, C. T. (2004)
Clinical Psychology Review, 24(7), 857-882

Introduction

Social phobia involves anxiety-related symptoms and is an interpersonal disorder. It is a condition in which anxiety disrupts the individual’s relationships with other people.

Social anxiety is conceptualized and measured in somewhat different ways across various domains.

Interpersonal perspective

Interpersonal models share the assumption that good social relationships contribute to psychopathology. The self-perpetuating interpersonal cycle means that 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 behavioural strategies we learned to handle those earlier events. Our behaviour exerts a pull on other people that tends to evoke responses that maintain our social assumptions, expectations, and behavioural patterns.

Dysfunctional patterns are the result of an ongoing interaction between the individual and the social environment. This is a social developmental process that begins early and continues throughout the lifespan. Our relationships shape our sense of self and others.

Social anxiety disorder and social relationships

People with social anxiety disorder have fewer social relationships than other people.

Social anxiety is associated with a variety of dysfunctional strategies in relationships, including strategies of non-assertiveness and avoidance of emotional expression and conflict. Socially anxious people also reported over-reliance on others.

Even when people with social anxiety develop relationships, they view those relationships as less intimate, functional and satisfying than do people without social anxiety.

Self-perpetuating interpersonal cycles

Socially anxious people behave in ways that lead to negative social outcomes. People with social phobia may establish negative interpersonal cycles between themselves and others in which they adopt behavioural strategies that evoke negative reactions.

Behavioural patterns

The behaviours most commonly associated with social anxiety are: low social skill, non-assertiveness, visible anxiousness and some studies also found differences between socially anxious and non-anxious people on specific anxiety-related micro behaviours

Socially anxious individuals can appear less skilful and more anxious than other people.

Other researchers report evidence of critical or angry behaviour in socially anxious samples.

Others’ reactions

People with psychological problems often elicit negative responses from other people. There may be a presence of a global negative halo in others’ judgments of anxious people. With longer exposure, others may become more positive about them.

Social behaviour of anxious people led their partners to disengage form relationship development. This may be due to failing to reciprocate others’ self-disclosures. This strategy led others to perceive targets as dissimilar to themselves and disinterested in them.

Social skill deficit or self-protective strategy

The traditional explanation for the dysfunctional behaviour described above is that socially anxious individuals have socially skill deficits. They failed to learn effective social behaviour and their anxiety is in part a reaction to those deficits and the resulting negative responses. But research paints a more complex picture. Socially anxious people do not always display avoidant or maladaptive social behaviour. Maladaptive behaviour relies on the social context.

Dysfunctional behaviour might be the result of cognitive and emotional processes that are activated by social cues. Dysfunctional behaviour reflects anxiety-related behavioural inhibition or is a cue activated self-protective strategy adopted to prevent feared outcomes. When social conditions are right, people with social phobia appear to be capable of behaviour that elicits a positive interpersonal response.

Cognitive processing of social information

Social cues set in motion a cognitive process that ultimately triggers social anxiety and dysfunctional social behaviour. They activate negative beliefs and assumptions about self and others (negative social schema), which leads to selective processing of threat-related information and biased interpretation of social events. Selective attention and biased interpretation heighten anxiety and lead to the use of self-protective behavioural strategies to prevent negative outcomes.

Social schema and the self

Researchers in social cognition posit that social anxiety arises from the activation of relational schema, knowledge based on experiences with significant others. Relational information forms a key part of our sense of self, or self-structure. Therefore, the activation of information about others affects out subjective experience of ourselves.

Social anxiety might arise when the person becomes aware of a discrepancy between knowledge structures representing the actual-self and the ought-self, or the self one believes others think one ought to be. Because socially anxious individuals have extensive experience disapproving others, they develop elaborated negative schema about self in relation to others, which are readily activated by social cues. Once activated, those schema result in negative expectations for social events and hence social anxiety.

Information about others is intertwined in memory with information about self. Activating one type of information automatically affects the other.

Selective attention to social cues

Socially anxious people selectively process threat-related information. Threat information can be internal or external.

Interpretation of social cues

Selective processing of threat cues leads to biased interpretation of social events. The strongest evidence of interpretation bias is found in self-related judgments pertaining to subjects’ own behaviour and others’ responses to them.

Social pathogenesis

There are heritable, biological processes that increase vulnerability to social anxiety. Even within their first year, some children display automatic hypersensitivity to environmental change that operates to inhibit behaviour. Behavioural inhibition is moderated by social factors.

Self-perpetuating cycles

An inhibited temperament can elicit less effective parenting styles. Not only does parenting affect the child’s social anxiety, the child’s social anxiety evokes distinct parental behaviour.

Variability in social learning experiences

At least three dimensions characterize early social experiences in socially anxious individuals. These are: parental over-protection and control, parental hostility and abuse and lack of family socializing. These three dimensions are largely independent. Different early social environments may create different developmental trajectories to social phobia.

Contemporary patterns arise out of past learning experiences.

Social development continues beyond the family of origin. It is associated with a variety of adverse peer social experiences in school situations. Shyness interferes with friendship formation, but does not evoke rejection. Rejection can exacerbate the cognitive aspects of shyness.

Interpersonal processes in treatment

Interpersonal differences affect treatment response. To be effective, treatment must be tailored to the specific interpersonal problems and safety behaviours displayed in the patient.

Individual and group therapy may place different demands on patients. Individual therapy may involve more intense interpersonal contact and hence evoke greater reliance on interpersonal safety behaviours. If not addressed, those behaviours may impair the working alliance and treatment outcome.