Sub-types of safety behaviours and their effects on social anxiety disorder

Autoři: Emily Gray aff001;  Esther T. Beierl aff001;  David M. Clark aff001
Působiště autorů: Oxford Centre for Anxiety Disorders and Trauma, University of Oxford, Oxford, United Kingdom aff001;  Oxford Health NHS Foundation Trust, Oxford, United Kingdom aff002
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article


Cognitive models suggest that social anxiety disorder (SAD) is maintained through the use of safety behaviours. Previous reports propose that these safety behaviours can be subdivided into two main categories: avoidance and impression management. Study 1 investigates whether certain safety behaviours are specific to SAD. The social behaviour questionnaire was administered to individuals with SAD (N = 106), post-traumatic stress disorder (N = 28) and non-patient controls (N = 59). A factor analysis (N = 164) replicated the previously reported avoidance and impression management subtypes. Scores for both subtypes were significantly higher in individuals with SAD than in individuals with post-traumatic stress disorder or non-patient controls. Study 2 investigated the causal role of such safety behaviours using an experimental design in a non-clinical population (N = 96). Pairs of participants each engaged in two conversations. In one of the conversations, a randomly selected participant performed either avoidance or impression management safety behaviours. In the other conversation, neither participant was instructed to use safety behaviours. Each participant rated their own anxiety and performance as well as rating the other person. Videos of the conversations were also rated. Both types of safety behaviour increased anxiety in the person performing the safety behaviour. The avoidance subtype also had broader effects on the other person that were largely absent from the impression management subtype. Taken together the studies provide support for the distinction between safety behaviour subtypes and have implications for the treatment of SAD.

Klíčová slova:

Anxiety disorders – Behavior – Collective human behavior – Factor analysis – Post-traumatic stress disorder – Questionnaires – Social anxiety disorder – Behavioral disorders


1. NICE. Social Anxiety Disorders. In: Social Anxiety Disorder: Recognition, assessment and treatment. London: The British Psychological Society and The Royal College of Psychiatrists; 2013.

2. Stopa L, Clark DM. Cognitive processes in social phobia. Behav Res Ther. 1993;31:255–67. doi: 10.1016/0005-7967(93)90024-o 8476400

3. Hirsch CR, Meynen T, Clark DM. Negative self-imagery in social anxiety contaminates social interactions. Memory. 2004;12(4):496–506. doi: 10.1080/09658210444000106 15487545

4. Wells A, Clark DM, Salkovskis P, Ludgate J, Hackmann A, Gelder M. Social phobia: The role of in-situation safety behaviors in maintaining anxiety and negative beliefs. Behav Ther. 1995;26:153–61.

5. Salkovskis PM. The importance of behaviour in the maintenance of anxiety and panic: A cognitive account. Behav Psychother. 1991;19(1):6.

6. Ehlers A, David Clark M. A cognitive model of posttraumatic stress disorder. Behav Res Ther. 2000;38:319–45. doi: 10.1016/s0005-7967(99)00123-0 10761279

7. Salkovskis PM. Understanding and treating obsessive-compulsive disorder. Behav Res Ther. 1999;37(SUPPL. 1):29–52.

8. Salkovskis PM, Clark DM. Cognitive Therapy for Panic Attacks. J Cogn Psychother. 1991;5(3):215–26.

9. Clark DM, Wells A. A cognitive model of social phobia. In: Liebowitz M, Hope DA, Schneier F, Heimberg RG, editors. Social phobia: Diagnosis, assessment and treatment. New York: Guilford Press.; 1995. p. 69–93.

10. Mortberg E., Clark D.M, Sundin O. and Arberg-Wistedt A. (2007). Intensive group cognitive treatment and individual cognitive therapy vs. treatment as usual in social phobia: a randomized controlled trial. Acta Psychiatrica Scandinavica, 115, 142–154. doi: 10.1111/j.1600-0447.2006.00839.x 17244178

11. Clark DM. Three Questionnaires for Measuring Central Constructs in the Cognitive Model of Social Phobia: Preliminary Analysis. Oxford; 2005.

12. Cuming S, Rapee RM, Kemp N, Abbott MJ, Peters L and Gaston JE (2009) A self report measure of subtle avoidance and safety behaviors relevant to social anxiety: Development and psychometric properties Journal of Anxiety Disorders Vol. 23, Issue 7, p.879–883 doi: 10.1016/j.janxdis.2009.05.002 19556098

13. Pinto-Gouveia J., Cunha M. I., & do Céo Salvador M. (2003). Assessment of social phobia by self-report questionnaires: The Social Interaction and Performance Anxiety and Avoidance Scale and the Social Phobia Safety Behaviours Scale. Behavioural and Cognitive Psychotherapy, 31(3), 291–311.

14. Plasencia ML, Alden LE, Taylor CT. Differential effects of safety behaviour subtypes in social anxiety disorder. Behav Res Ther. 2011;49(10):665–75. doi: 10.1016/j.brat.2011.07.005 21831356

15. First M. B., & Gibbon M. (2004). The Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) and the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II). In Hilsenroth M. J. & Segal D. L. (Eds.), Comprehensive handbook of psychological assessment, Vol. 2. Personality assessment (pp. 134–143). Hoboken, NJ, US: John Wiley & Sons Inc.

16. Grisham J. R., Brown T. A., & Campbell L. A. (2004). The Anxiety Disorders Interview Schedule for DSM-IV (ADIS-IV). In Hilsenroth M. J. & Segal D. L. (Eds.), Comprehensive handbook of psychological assessment, Vol. 2. Personality assessment(pp. 163–177). Hoboken, NJ, US: John Wiley & Sons Inc.

17. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh JK. An inventory for measuring depression. Arch Gen Psychiatry. 1961;4(6):561.

18. Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: The Beck Anxiety Inventory. J Consult Clin Psychol. 1988;56:893–7. doi: 10.1037//0022-006x.56.6.893 3204199

19. Leary MR. A brief version of the Fear of Negative Evaluation Scale. Personal Soc Psychol Bull. 1983;9:371–6.

20. IBM SPSS Statistics for Windows. Armonk, NY: IBM Corp; 2015.

21. Beck AT, Steer RA, Brown G. Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation; 1996.

22. Fydrich T, Dowdall D, Chambless DL. Reliability and validity of the beck anxiety inventory. J Anxiety Disord. 1992 Jan;6(1):55–61.

23. Fabrigar L, Wegener D, MacCallum R, Strahan E. Evaluating the use of exploratory factor analysis in psychological research. Psychological Methods. 1999;4(3):272–90.

24. Velicer W, Jackson D. Component Analysis versus Common Factor Analysis: Some Issues in Selecting an Appropriate Procedure. Multivar Behav Res. 1990;25(1):1–28.

25. Horn JL. A rationale and test for the number of factors in factor analysis. Psychometrika. 1965;30:179–85. 14306381

26. Courtney MGR. Determining the number of factors to retain in EFA: Using the SPSS R-Menu v2.0 to make more judicious estimations. Pract Assessment, Res Eval. 2013;18(8):1–14.

27. Rapee RM, Craske MG, Barlow DH. Assessment instrument for panic disorder that includes fear of sensation producing activities: The Albany Panic and Phobia Questionnaire. Anxiety. 1994;1(3):114–22. 9160559

28. Rapee RM, Heimberg RG. A cognitive-behavioral model of anxiety in social phobia. Behav Res Ther. 1997;35(8):741–56. doi: 10.1016/s0005-7967(97)00022-3 9256517

29. Stangier U., Heidenreich T., Peitz M., Lauterbach W., Clark D.M. Cognitive therapy for social phobia: individual versus group treatment. Behaviour Research and Therapy. 2003;41(9):991–1007. 12914803

30. Alden L. E., Taylor C. T. Relational treatment strategies increase social approach behaviors in patients with Generalized Social Anxiety Disorder. J Anxiety Disord. 2011;Apr;25(3):309–18. doi: 10.1016/j.janxdis.2010.10.003 21094019

31. Alden LE, Buhr K, Robichaud M, Trew JL, Plasencia ML. Treatment of social approach processes in adults with social anxiety disorder. J Consult Clin Psychol. 2018 Jun;86(6) 505–517. doi: 10.1037/ccp0000306. 29781649.

32. Warnock-Parkes E, Wild J, Stott R, Grey N, Ehlers A, Clark DM. Seeing Is Believing: Using Video Feedback in Cognitive Therapy for Social Anxiety Disorder. Cogn Behav Pract. 2017;24(2):245–55. doi: 10.1016/j.cbpra.2016.03.007 29033532

33. Miller G. A.; Chapman J. P. (2001). "Misunderstanding Analysis of Covariance". Journal of Abnormal Psychology. 110 (1): 40–48. doi: 10.1037//0021-843x.110.1.40 11261398

Článek vyšel v časopise


2019 Číslo 10
Nejčtenější tento týden