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Social anxiety can be defined as nervousness in social situations[1]. Some disorders associated with the social anxiety spectrum include Anxiety disorders, Mood disorders, Autism, Eating disorders, and Substance use disorders [1]. Individuals higher in social anxiety avert their gazes, show fewer facial expressions, and show difficulty with initiating and maintaining conversation[2]. Trait social anxiety, the stable tendency to experience this nervousness, can be distinguished from state anxiety, the momentary response to a particular social stimulus[3]. Nearly 90% of individuals report feeling a form of social anxiety (i.e., shyness) at some point in their lives [4]. Half of the individuals with any social fears meet criteria for social anxiety disorder[5]. The function of social anxiety is to increase arousal and attention to social interactions, inhibit unwanted social behavior, and motivate preparation for social situations such as performance situations[1].

Physiological Symptoms

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Blushing is a physiological response unique to humans and is a hallmark physiological response associated with social anxiety[6]. Blushing is the involuntary reddening of the face, neck, and chest in reaction to evaluation or social attention [7]. Blushing occurs not only in response to feelings of embarrassment but also other socially-oriented emotions such as shame, guilt,shyness, and pride[6]. Individuals high in social anxiety perceive themselves as blushing more than those who are low in social anxiety[6]. Fear of blushing is also associated with social anxiety[8]. Three types of blushing can be measured: self-perceived blushing (how much the individual believes he or she is blushing), physiological blushing (blushing as measured by physiological indices), and observed blushing (blushing observed by others). Social anxiety is strongly associated with self-perceived blushing, weakly associated with blushing as measured by physiological indices such as temperature and blood flow to the cheeks and forehead, and moderately associated with observed blushing. The relationship between physiological blushing and self-perceived blushing is small among those high in social anxiety, indicating that individuals with high social anxiety may overestimate their blushing[6]. That social anxiety is associated most strongly with self-perceived blushing is also important for cognitive models of blushing and social anxiety, indicating that socially anxious individuals use both internal cues and other types of information to draw conclusions about how they are coming across[6].

Genetic and Environmental Contributions

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Both genetic and environmental influences contribute to social anxiety symptoms and social anxiety disorder[9]. Twin studies show that there is a genetic component to social anxiety disorder as well as environmental factors[9]. Familial resemblance for social anxiety is primarily explained by genetic influences[9]. The genetic contribution to social anxiety is particularly strong when examining social anxiety symptoms that do not meet full criteria for the disorder[9]. In adults, the genetic contribution to social anxiety is half of that for youth, indicating that as we age, environmental factors play a greater role in the onset and maintenance of social anxiety symptoms[9].

Personality and Traits

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Anxiety associated with communicating with others is a stable trait in the individual[10]. Individuals who show high levels of communication apprehension tend to show this in a variety of situations[10].

Behavioral inhibition is a biologically based temperament associated with a tendency to withdraw in response to objects, people, and situations that are unfamiliar[11]. Individuals high in social anxiety show increased behavioral inhibition[1]. Childhood behavioral inhibition is also associated with later increases in social anxiety[12].

Cognitive and Emotional Components

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Diminished Positive Experiences

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Research has shown that individuals who are rated higher on social anxiety tend to experience less positive affect independent of mood[13]. In social anxiety, there is an excess of avoidance and therefore a lack of rewarding social experiences, an important source of meaning and happiness[14].

Emotion Knowledge

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Emotion knowledge is the ability to identify the experienced or expressed emotions of oneself and others, assign emotions to their appropriate contexts, and recognize what causes emotions and their consequences[15]. This skill is important for choosing appropriate emotion regulation strategies[16]. Individuals high in social anxiety show worse emotion knowledge such that they interpret other people’s emotional expressions in a way that is negative, distorted, and personalized[16]. They show an intact ability to recognize discrete emotions such as sadness or anger, but show worse emotion knowledge in complex emotional situations that rely on overall social understanding[16]. There are no differences between individuals with social anxiety disorder and individuals who simply score highly in emotion anxiety in emotion knowledge[16].  This association between social anxiety and low emotion knowledge has been shown for both intrapersonal emotion knowledge in which one monitors one’s own emotional state, and interpersonal emotion knowledge in which one monitors the emotions of others[16].

Attention Bias

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Attention to and Away from Threat

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Individuals with social anxiety turn their attention away from threatening social information and toward themselves, prohibiting them from challenging negative expectations about others and maintaining high levels of social anxiety[17]. A socially anxious individual perceives rejection from a conversational partner, turns his or her attention away, and never learns that the individual is actually welcoming[18]. Individuals who are high in social anxiety tend to show increased initial attention toward negative social cues such as threatening faces followed by attention away from these social cues, indicating a pattern of hypervigilance followed by avoidance[18][19]. Attention in social anxiety has been measured using the dot-probe paradigm, which presents two faces next to one another. One face has an emotional expression and the other has a neutral expression, and when the faces disappear, a probe appears in the location of one of the faces. This creates a congruent condition in which the probe appears in the same location as the emotional face, and an incongruent condition. Participants respond to the probe by pressing a button and differences in reaction times reveal attentional biases. This task has revealed mixed results, with some studies finding no differences between socially anxious individuals and controls, some studies finding avoidance of all faces, and others finding vigilance toward threat faces[18]. There is some evidence that vigilance toward threat faces can be detected during short but not longer exposures to faces, indicating a possible initial hypervigilance followed by avoidance[18]. The Face-in-the-crowd task shows that individuals with social anxiety are faster at detecting an angry face in a predominantly neutral or positive crowd or slower at detecting happy faces than a nonanxious person[18]. Results overall using this task are mixed and this task may not be able to detect hypervigilance toward angry faces in social anxiety[18].

Self-Focused Attention

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Focus on the self has been associated with increased social anxiety and negative affect, however there are two types of self-focus: In public self focus, one shows concern for the impact of one’s own actions on others and their impressions. This type of self-focus predicts greater social anxiety[20]. Other more private forms of self-consciousness (e.g., egocentric goals) are associated with other types of negative affect[20].

Modification

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Basic science research suggests that cognitive biases can be modified. Attention bias modification training has been shown to temporarily impact social anxiety[21].

Culture and Demographics

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Social anxiety is a universal phenomenon but differs across cultures.. Because of differences in social norms across East Asian and Western European countries, a large body of research has compared these two groups on social anxiety. East Asian individuals report higher social anxiety than Western Europeans[22]. Asian heritage individuals show more social introversion[23] and shyness[24] compared to individuals of Western heritage. Some factors that contribute to these differences include Individualistic versus Collectivistic culture, perception of social norms, and gender roles[25]. Cultures that value social obligations and group harmony may foster greater social anxiety than societies that do not emphasize these things[22]. Country of residence is a stronger predictor of social anxiety than is cultural heritage; for example, someone of Asian heritage living in an Asian country may show increased social anxiety compared to an individual of Asian heritage living in a Western country[22]. There are no sex differences in social anxiety[26].

Measures

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Trait social anxiety is most commonly measured by self report[27]. This method possesses limitations, however subjective responses are the most reliable indicator of a subjective state. Other measures of social anxiety include diagnostic interviews, clinician- administered instruments, and behavioral assessments[28]. No single trait social anxiety self-report measure shows all psychometric properties including different kinds of validity (content validity, criterion validity, construct validity,) reliability and internal consistency[27]. These measures include:

  • Clinically Useful Social Anxiety Disorder Outcome Scale (CUSADOS)[29]
  • Fear of Negative Evaluation (hyperlink) (FNE) (Watson & Friend, 1969) and Brief form (BFNE)[30]
  • Fear Questionnaire Social Phobic Subscale (FQSP)[31]
  • Interaction Anxiousness Scale (IAS)[32]
  • Liebowitz Social Anxiety Scale-Self Report (hyperlink) (LSAS-SR)[33]
  • Older Adult Social-Evaluative Situations (OASES)[34]
  • Social Avoidance and Distress (SAD)[35]
  • Self-Consciousness Scale (SCC)[36]
  • Social Phobia Diagnostic Questionnaire (SDPQ)[37]
  • Social Interaction Anxiety Scale (hyperlink) (SIAS)[38]
  • Brief form (SIAS-6A and -6B) (Peters et al., 2012).
  • Social Phobia Scale (SPS)[38]
  • Brief form (SPS 6A and 6B)[39],[40]
  • Social Interaction Phobia Scale (SIPS)[38]
  • Social Phobia Inventory (hyperlink) (SoPhi)[41]
  • Social Phobia and Anxiety Inventory (hyperlink) (SPAI)[35][42]
  • Brief form (SPAI-23)[43]
  • Social Phobia Inventory (hyperlink) (SPIN)[44]
  • Abbreviated Social Phobia Inventory (Mini-SPIN)[45]
  • Revised Mini-SPIN (Mini-SPIN-R)[46]
  • Situational Social Avoidance (SSA)[47]

The SIAS and SPS along with the SIAS-6A and -6B and the SPS 6A and 6B are the highest rated across these psychometric properties[27]. Other highly rated measures included the CQSP, LSAS-SR, SIPS, SPAI, and SPDQ, with the qualifier that their reproducibility is yet to be determined[27].

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