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Social Anxiety, Fear of Negative Evaluation, and Distress in a Virtual Reality Environment

Published online by Cambridge University Press:  24 February 2021

Rannveig Sigurvinsdottir ,
Karen Soring ,
Karen Kristinsdottir ,
Sveinn Gunnar Halfdanarson ,
Kamilla R. Johannsdottir ,
Hannes H. Vilhjalmsson Open the ORCID record for Hannes H. Vilhjalmsson [Opens in a new window]  and
Heiddis B. Valdimarsdottir
Rannveig Sigurvinsdottir*
Affiliation:
Department of Psychology, Reykjavik University, Reykjavik, Iceland
Karen Soring
Affiliation:
Department of Psychology, Reykjavik University, Reykjavik, Iceland
Karen Kristinsdottir
Affiliation:
Department of Psychology, Reykjavik University, Reykjavik, Iceland
Sveinn Gunnar Halfdanarson
Affiliation:
Department of Psychology, Reykjavik University, Reykjavik, Iceland
Kamilla R. Johannsdottir
Affiliation:
Department of Psychology, Reykjavik University, Reykjavik, Iceland
Hannes H. Vilhjalmsson
Affiliation:
Department of Computer Science, Reykjavik University, Reykjavik, Iceland
Heiddis B. Valdimarsdottir
Affiliation:
Department of Psychology, Reykjavik University, Reykjavik, Iceland Department of Population Health Science and Policy, Center for Behavioral Oncology, Icahn School of Medicine at Mount Sinai, New York, USA
*
*Corresponding author: Rannveig Sigurvinsdottir, Reykjavik University, Reykjavik, Iceland. Email: rannveigssig@gmail.com
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Abstract

According to cognitive theories of social anxiety, fear of negative evaluation (FNE) may be the mechanism whereby social anxiety induces distress. However, studying this can be challenging, as individuals with social anxiety may be reluctant to enter anxiety-provoking social situations, such as speaking in front of others. The present study used virtual reality (VR) to examine if giving a presentation in front of a virtual audience induced distress among undergraduate students and to test the hypothesis that FNE would mediate the relationship between social anxiety and distress. University students (N = 58, 70% female) entered a VR environment where they stood in front of a virtual audience and gave a short, impromptu presentation about their university. Participants also completed self-report measures of social anxiety, FNE, and distress (estimated before, during, and after VR). Distress and FNE had positive relationships with social anxiety and FNE fully mediated the relationship between social anxiety and distress. As far as we are aware, this is the first VR study to show this effect. The findings indicate that FNE could be a useful treatment target to reduce distress when presenting in front of an audience, either in VR or in person.

Keywords

social anxietyfear of negative evaluationdistressvirtual reality
Type
Standard Paper
Information
Behaviour Change , Volume 38 , Issue 2 , June 2021 , pp. 109 - 118
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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References

American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (7th ed.). Washington, DC: American Psychiatric Publishing.Google Scholar
Anderson, PL, Price, M, Edwards, SM, Obasaju, MA, Schmertz, SK, Zimand, E and Calamaras, MR (2013). Virtual reality exposure therapy for social anxiety disorder: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 81, 751.CrossRefGoogle ScholarPubMed
Asmundson, GJ and Stein, MB (1994). Selective processing of social threat in patients with generalized social phobia: Evaluation using a dot-probe paradigm. Journal of Anxiety Disorders, 8, 107–117.CrossRefGoogle Scholar
Bögels, SM and Mansell, W (2004). Attention processes in the maintenance and treatment of social phobia: Hypervigilance, avoidance and self-focused attention. Clinical Psychology Review, 24, 827–856.CrossRefGoogle ScholarPubMed
Bögels, SM, Alberts, M and de Jong, PJ (1996). Self-consciousness, self-focused attention, blushing propensity and fear of blushing. Personality and Individual Differences, 21, 573–581.CrossRefGoogle Scholar
Botella, C, Fernández-Álvarez, J, Guillén, V, García-Palacios, A and Baños, R (2017). Recent progress in virtual reality exposure therapy for phobias: A systematic review. Current Psychiatry Reports, 19, 42.CrossRefGoogle ScholarPubMed
Bouchard, S, Dumoulin, S, Robillard, G, Guitard, T, Klinger, E, Forget, H, … Roucaut, FX (2017). Virtual reality compared with in vivo exposure in the treatment of social anxiety disorder: A three-arm randomised controlled trial. The British Journal of Psychiatry, 210, 276–283.CrossRefGoogle ScholarPubMed
Bremner, JD, Staib, LH, Kaloupek, D, Southwick, SM, Soufer, R and Charney, DS (1999). Neural correlates of exposure to traumatic pictures and sound in Vietnam combat veterans with and without posttraumatic stress disorder: A positron emission tomography study. Biological Psychiatry, 45, 806–816. doi:10.1016/S0006-3223(98)00297-2.CrossRefGoogle ScholarPubMed
Bricken, M and Byrne, CM (1993). Chapter 9 — Summer students in virtual reality: A pilot study on educational applications of virtual reality technology© 1992 Washington Technology Center. Sponsored by the US West Foundation, the Washington Technology Center, and the Pacific Science Center. In A. Wexelblat (Ed.). Virtual Reality, 199–217. doi:10.1016/B978-0-12-745045-2.50019-2.CrossRefGoogle Scholar
Bruce, M and Regenbrecht, H (2009). A Virtual Reality Claustrophobia Therapy System — Implementation and Test. 2009 IEEE Virtual Reality Conference, pp. 179–182.CrossRefGoogle Scholar
Buckner, JD, Maner, JK and Schmidt, NB (2010). Difficulty disengaging attention from social threat in social anxiety. Cognitive Therapy and Research, 34, 99–105.CrossRefGoogle ScholarPubMed
Carlin, AS, Hoffman, HG and Weghorst, S (1997). Virtual reality and tactile augmentation in the treatment of spider phobia: A case report. Behaviour Research and Therapy, 35, 153–158. doi:10.1016/s0005-7967(96)00085-x.CrossRefGoogle ScholarPubMed
Cheng, G, Zhang, D and Ding, F (2015). Self-esteem and fear of negative evaluation as mediators between family socioeconomic status and social anxiety in Chinese emerging adults. International Journal of Social Psychiatry, 61, 569–576.CrossRefGoogle ScholarPubMed
Chesham, RK, Malouff, JM and Schutte, NS (2018). Meta-analysis of the efficacy of virtual reality exposure therapy for social anxiety. Behaviour Change, 35, 152–166.CrossRefGoogle Scholar
Clark, DM and Wells, A (1995). A cognitive model of social phobia. Social Phobia: Diagnosis, Assessment, and Treatment, 41, 69–93.Google Scholar
García-López, LJ, Olivares, J, Hidalgo, MD, Beidel, DC and Turner, SM (2001). Psychometric properties of the social phobia and anxiety inventory, the Social Anxiety Scale for Adolescents, the Fear of Negative Evaluation Scale, and the Social Avoidance and Distress Scale in an adolescent Spanish-speaking sample. Journal of Psychopathology and Behavioral Assessment, 23, 51–59. doi:10.1023/A:1011043607878.CrossRefGoogle Scholar
Hayes, AF (2015). An index and test of linear moderated mediation. Multivariate Behavioral Research, 50, 1–22. doi:10.1080/00273171.2014.962683.CrossRefGoogle ScholarPubMed
Heimberg, RG (1995). Social phobia: Diagnosis, assessment, and treatment. New York, NY: Guilford Press.Google Scholar
Hirsch, CR and Clark, DM (2004). Information-processing bias in social phobia. Clinical Psychology Review, 24, 799–825.CrossRefGoogle ScholarPubMed
Hofmann, SG and Otto, MW (2017). Cognitive behavioral therapy for social anxiety disorder: Evidence-based and disorder specific treatment techniques. New York, NY: Routledge.CrossRefGoogle Scholar
Iverach, L, Rapee, RM, Wong, QJ and Lowe, R (2017). Maintenance of social anxiety in stuttering: A cognitive-behavioral model. American Journal of Speech-Language Pathology, 26, 540–556.CrossRefGoogle ScholarPubMed
Kahlon, S, Lindner, P and Nordgreen, T (2019). Virtual reality exposure therapy for adolescents with fear of public speaking: A non-randomized feasibility and pilot study. Child and Adolescent Psychiatry and Mental Health, 13, 1–10.CrossRefGoogle ScholarPubMed
Kampmann, IL, Emmelkamp, PM and Morina, N (2016). Meta-analysis of technology-assisted interventions for social anxiety disorder. Journal of Anxiety Disorders, 42, 71–84.CrossRefGoogle ScholarPubMed
Kothgassner, OD, Felnhofer, A, Hlavacs, H, Beutl, L, Palme, R, Kryspin-Exner, I and Glenk, LM (2016). Salivary cortisol and cardiovascular reactivity to a public speaking task in a virtual and real-life environment. Computers in Human Behavior, 62, 124–135.CrossRefGoogle Scholar
Leary, MR (1983). A brief version of the Fear of Negative Evaluation Scale. Personality and Social Psychology Bulletin, 9, 371–375.CrossRefGoogle Scholar
Levinson, CA, Rodebaugh, TL, White, EK, Menatti, AR, Weeks, JW, Iacovino, JM and Warren, CS (2013). Social appearance anxiety, perfectionism, and fear of negative evaluation. Distinct or shared risk factors for social anxiety and eating disorders? Appetite, 67, 125–133.CrossRefGoogle ScholarPubMed
Lin, XB, Lee, TS, Cheung, YB, Ling, J, Poon, SH, Lim, L, … Guan, C (2019). Exposure therapy with personalized real-time arousal detection and feedback to alleviate social anxiety symptoms in an analogue adult sample: Pilot proof-of-concept randomized controlled trial. JMIR Mental Health, 6, e13869.CrossRefGoogle Scholar
Lindner, P, Miloff, A, Fagernäs, S, Andersen, J, Sigeman, M, Andersson, G, … Carlbring, P (2019). Therapist-led and self-led one-session virtual reality exposure therapy for public speaking anxiety with consumer hardware and software: A randomized controlled trial. Journal of Anxiety Disorders, 61, 45–54.CrossRefGoogle ScholarPubMed
Lundh, LG and Sperling, M (2002). Social anxiety and the post-event processing of socially distressing events. Cognitive Behaviour Therapy, 31, 129–134.CrossRefGoogle Scholar
Mansell, W, Ehlers, A, Clark, D and Chen, YP (2002). Attention to positive and negative social-evaluative words: Investigating the effects of social anxiety, trait anxiety and social threat. Anxiety, Stress & Coping, 15, 19–29.CrossRefGoogle Scholar
Mattick, RP and Clarke, JC (1998). Development and validation of measures of social phobia scrutiny fear and social interaction anxiety. Behaviour Research and Therapy, 36, 455–470.CrossRefGoogle ScholarPubMed
Mattick, RP and Clarke, JC (1998). Development and validation of measures of social phobia scrutiny fear and social interaction anxiety. Behaviour Research and Therapy, 36, 455–470. doi:10.1016/S0005-7967(97)10031-6.CrossRefGoogle ScholarPubMed
Menatti, AR, DeBoer, LBH, Weeks, JW and Heimberg, RG (2015). Social anxiety and associations with eating psychopathology: Mediating effects of fears of evaluation. Body Image, 14, 20–28.CrossRefGoogle ScholarPubMed
Mogg, K, Philippot, P and Bradley, BP (2004). Selective attention to angry faces in clinical social phobia. Journal of Abnormal Psychology, 113, 160.CrossRefGoogle ScholarPubMed
Ólafsdóttir, HO (2012). An examination of the psychometric properties and discriminatory validity of the Social Interaction Anxiety Scale (SIAS) and the Social Phobia Scale (SPS). Master's thesis in Psychology from the University of Iceland. Retrieved from: https://skemman.is/bitstream/1946/12111/1/LOKAVERK_Halla_11.j%C3%BAn%C3%AD.pdfGoogle Scholar
Owens, ME and Beidel, DC (2015). Can virtual reality effectively elicit distress associated with social anxiety disorder? Journal of Psychopathology and Behavioral Assessment, 37, 296–305.CrossRefGoogle Scholar
Paul, KI and Moser, K (2009). Unemployment impairs mental health: Meta-analyses. Journal of Vocational Behavior, 74, 264–282.CrossRefGoogle Scholar
Rapee, RM and Heimberg, RG (1997). A cognitive-behavioral model of anxiety in social phobia. Behaviour Research and Therapy, 35, 741–756. doi:10.1016/S0005-7967(97)00022-3.CrossRefGoogle ScholarPubMed
Rodebaugh, TL, Holaway, RM and Heimberg, RG (2004). The treatment of social anxiety disorder. Clinical Psychology Review, 24, 883–908. doi:10.1016/j.cpr.2004.07.007.CrossRefGoogle ScholarPubMed
Safren, SA, Turk, CL and Heimberg, RG (1998). Factor structure of the Social Interaction Anxiety Scale and the Social Phobia Scale. Behaviour Research and Therapy, 36, 443–453.CrossRefGoogle ScholarPubMed
Sapach, MJNT, Carleton, RN, Mulvogue, MK, Weeks, JW and Heimberg, RG (2015). Cognitive constructs and social anxiety disorder: Beyond fearing negative evaluation. Cognitive Behaviour Therapy, 44, 63–73. doi:10.1080/16506073.2014.961539.CrossRefGoogle Scholar
Stein, M, Walker, J and Ford, D (1994). Setting diagnostic thresholds for social phobia. American Journal of Psychiatry, 151, 408–412.Google ScholarPubMed
Stein, MB, Walker, JR and Forde, DR (1996). Public-speaking fears in a community sample: Prevalence, impact on functioning, and diagnostic classification. Archives of General Psychiatry, 53, 169–174.CrossRefGoogle Scholar
Steuer, J (1992). Defining virtual reality: Dimensions determining telepresence. Journal of Communication, 42, 73–93. doi:10.1111/j.1460-2466.1992.tb00812.x.CrossRefGoogle Scholar
Van Ameringen, M, Mancini, C and Farvolden, P (2003). The impact of anxiety disorders on educational achievement. Journal of Anxiety Disorders, 17, 561–571.CrossRefGoogle ScholarPubMed
Vassilopoulos, SP (2005). Social anxiety and the vigilance-avoidance pattern of attentional processing. Behavioural and Cognitive Psychotherapy, 33, 13.CrossRefGoogle Scholar
Warner, CM, Fisher, PH, Shrout, PE, Rathor, S and Klein, RG (2007). Treating adolescents with social anxiety disorder in school: An attention control trial. Journal of Child Psychology and Psychiatry, 48, 676–686.CrossRefGoogle Scholar
Winton, EC, Clark, DM and Edelmann, RJ (1995). Social anxiety, fear of negative evaluation and the detection of negative emotion in others. Behaviour Research and Therapy, 33, 193–196. doi:10.1016/0005-7967(94)E0019-F.CrossRefGoogle ScholarPubMed
Wong, QJJ and Rapee, RM (2016). The aetiology and maintenance of social anxiety disorder: A synthesis of complementary theoretical models and formulation of a new integrated model. Journal of Affective Disorders, 203, 84–100. doi:10.1016/j.jad.2016.05.069.CrossRefGoogle Scholar
Wong, J, Gordon, EA and Heimberg, RG (2014). Cognitive-behavioral models of social anxiety disorder. In Weeks, JW (ed.), The Wiley Blackwell Handbook of Social Anxiety Disorder. West Sussex, UK: Wiley-Blackwell, pp. 1–23.Google Scholar