Kristen M. Bailey, Amanda S. Morrison, R. Nicholas Carleton & Richard G. Heimberg

Michelle Teale

Canadian Institutes of Health Research

Saskatchewan Health Research Foundation (SHRF)

National Institutes of Health (NIH)

Kristen Bailey – None

Amanda Morrison – None

Nicholas Carleton – None

Richard Heimberg - None

Perceived Audience

Preferential Allocation

of Attentional

Resources

Mental Representation

of Self as Seen by

Audience

External Indicators of

Evaluation

Perceived Internal

Cues

Comparison of Mental Representation of Self

as Seen by Audience with Appraisal of

Audience’s Expected Standard

Judgement of Probability and Consequence of

Evaluation from Audience

Behavioral

Symptoms of

Anxiety

Cognitive

Symptoms of

Anxiety

Physical

Symptoms of

Anxiety

Cognitive Behavioral Model of Social Anxiety

Observation/ image of self

and audience behavior

Fear of anxiety-related bodily sensations (e.g., fears of palpitations, dizziness, concentration difficulties), due to belief that these sensations have harmful somatic, psychological, or social consequences (Reiss,

1991; Reiss & McNally, 1985).

Individuals with social anxiety tend to score highest on the social concerns subscale items (e.g., “other people notice when I feel shaky”) (Hazen et al., 1995; Rector et al.,

2007).

painful emotion related to perceptions that one has personal attributes, personality characteristics, or has engaged in behaviours that others will find unattractive and result in rejection (Gilbert, 2000).

• Positive associations between shame and social anxiety symptoms (Fergus et al., 2010; Gilbert et al., 2000)

Both involve a focus on the self and likely contribute to a negative mental representation of the self

Shame associated with social anxiety symptoms while controlling for AS in non-clinical sample (Bailey, Carleton

& Asmundson, 2011)

Relationship between AS and shame in context of social anxiety disorder unknown.

Examine the relationship between AS, shame and social anxiety symptoms in a clinical sample

1. AS and shame will both be positively associated with social anxiety symptoms

2. AS-social concerns will be most strongly related to social anxiety symptoms

3. Shame will mediate the relationship between AS and social anxiety symptoms

PARTICIPANTS N = 55

M Age = 26.9 (20)

51% Women

60% Caucasian; 22%

African American

76% Single (never married)

MEASURES

Social Anxiety – Social Interaction Phobia Scale (Carleton et al., 2009)

Shame – Internalized Shame Scale (Cook, 1994; 2000)

AS – Anxiety Sensitivity Index (Reiss et al., 1996)

Correlations

M (S.D.) Scale α

1. 2. 3.

1. ASI 23.1

(11.4)

.88 - .34* .46**

2. ISS-modified 69.3

(21.2)

.96 - .50**

3. SIPS 32.3

(12.8)

.94 -

Anxiety Sensitivity

(ASI)

Social Anxiety

Symptoms (SIPS)

Anxiety Sensitivity

(ASI)

Shame (ISS)

A

B

c

a b

c’ Social Anxiety

Symptoms (SIPS)

Indirect

Effect

Standard

Error

BCA 95% CI

LL UL

Shame (ISS) .17 .08 .04 .39

Notes: BCA – Bias corrected and accelerated; LL – lower limit; UL – upper limit; 5,000 bootstrap samples

PARTICIPANTS N = 115

M Age = 35.9 (13.1)

58% Women

85% Caucasian; 4% First

Nations

45% Single; 43% married/cohabitating

MEASURES Social Anxiety – Social

Interaction Phobia Scale (Carleton et al., 2009)

Shame – Positive &

Negative Affect Scale – modified guilt subscale (Heaven, Ciarrochi & Leeson, 2009)

AS – Anxiety Sensitivity

Index-3 (Taylor et al., 2007)

Correlations

M

(SD)

Scale

α

1. 2. 3. 4. 5. 6.

1. ASI-3 34.0

(13.1)

.88 - .77** .82** .67** .24* .48**

2. ASI-physical 8.7

(5.7)

.84 - .48** .26** .04 .26**

3. ASI-cognitive 9.3

(6.3)

.88 - .33** .35** .48**

4. ASI-social 16.0

(5.2)

.81 - .13 .35**

5. PANAS-shame 12.9

(5.4)

.90 - .40**

6. SIPS 36.1

(10.0)

.87 -

Anxiety Sensitivity

(ASI-3)

Social Anxiety

Symptoms (SIPS)

Anxiety Sensitivity

(ASI-3)

Shame

(PANAS-shame)

A

B

c

a b

c’ Social Anxiety

Symptoms (SIPS)

Notes: BCA – Bias corrected and accelerated; LL – lower limit; UL – upper limit; 5,000 bootstrap samples

Indirect

Effect

Standard

Error

BCA 95% CI

STUDY 1 LL UL

Shame (ISS) .17 .08 .04 .39

STUDY 2a

Shame

(PANAS-shame)

.05 .03 .01 .12

Anxiety Sensitivity-

cognitive

Social Anxiety

Symptoms (SIPS)

Anxiety Sensitivity-

cognitive

Shame

(PANAS-shame)

A

B

c

a b

c’ Social Anxiety

Symptoms (SIPS)

Notes: BCA – Bias corrected and accelerated; LL – lower limit; UL – upper limit; 5,000 bootstrap samples

Indirect

Effect

Standard

Error

BCA 95% CI

STUDY 1 LL UL

Shame (ISS) .17 .08 .04 .39

STUDY 2a

Shame

(PANAS-shame)

.05 .03 .01 .12

STUDY 2b

Shame

(PANAS-shame)

.15 .06 .05 .31

AS and shame were both positively related to social anxiety symptoms in 2 clinical samples

Shame partially mediated the relationship between AS and social anxiety symptoms in 2 clinical samples

Shame partially mediated the relationship between AS-cognitive concerns and social anxiety symptoms in the 2nd clinical sample

Shame may be important to consider alongside AS when assessing and treating SAD

Incorporate elements of compassion and acceptance into current treatments for SAD Reframe cognitive distortions/maladaptive thoughts as

safety behaviours in order to cultivate self-empathy (Gilbert & Proctor, 2006)

Self-report measures

Generalizability to other clinical SAD samples?

PANAS-shame scale

Other variables as confounds (e.g., depression, substance misuse)