Fear of negative and positive evaluation and reactivity to social-evaluative videos in social anxiety disorder

• Published in: Behaviour research and therapy 2019-05, Vol.116, p.140-148
• Main Authors: Reichenberger, Julia, Wiggert, Nicole, Wilhelm, Frank H., Liedlgruber, Michael, Voderholzer, Ulrich, Hillert, Andreas, Timmer, Barbara, Blechert, Jens
• Format: Article
• Language: English
• Subjects: Adult; Affective neuroscience; Anxiety disorders; Appreciation; Arousal; Avoidance behavior; Case-Control Studies; EKG; Electrocardiography; Electromyography; Emotion; Face - physiology; Fear; Fear & phobias; Fear - physiology; Fear - psychology; Fear of positive and negative evaluation; Feedback; Female; Humans; Male; Membership; Phobia, Social - physiopathology; Phobia, Social - psychology; Power; Psychological distress; Psychophysiology; Questionnaires; Reactivity; Shyness; Social anxiety; Social anxiety disorder; Social Perception; Surveys and Questionnaires; Treatment methods; Young Adult
• ISSN: 0005-7967; 1873-622X
• DOI: 10.1016/j.brat.2019.03.009

Social anxiety disorder (SAD) is marked by persistent fear of being scrutinized by others. This and most diagnostic symptoms relate to some form of fear of negative evaluation (FNE). More recent accounts of SAD, such as the Bivalent Fear of Evaluation Model, however, complement FNE with fear of positive evaluation (FPE), described as distress and avoidance of positive feedback. An explicit test of the incremental validity of FPE in discriminating SAD patients from controls – over and on top of the explanatory power of FPE – is currently missing and generally, well controlled laboratory experiments with positive and negative social stimuli in this patient group are rare. To fill this gap, we exposed 35 patients with SAD and healthy controls (HCs) to short social-evaluative video clips with actors expressing negative and positive as well as neutral statements while recording reactivity on experiential measures (valence, arousal, and approval ratings) as well as on facial electromyography and electrocardiography. In addition, participants completed questionnaire measures of FNE and FPE. Results revealed that FPE questionnaire scores as well as experiential (valence and appreciation) and electromyographical reactivity measures to positive videos improved prediction of group membership beyond the predictive power of FNE questionnaires scores and reactivity to negative videos. Results document the importance of FPE to more fully characterize and understand social anxiety and SAD. Implications include amendments to future diagnostic criteria, theoretical models, and treatment approaches for SAD. •Fear of positive evaluation is a novel component of social anxiety disorder (SAD).•Its incremental validity has not been tested experimentally in patients thus far.•Questionnaire scores differentiated between patients and healthy controls.•Experiential and electromyographical reactivity measures improved SAD prediction.•Results underpin the important role of fear of positive evaluation for SAD.