Document28

Emotion beliefs in social anxiety disorder: Associations withstress, anxiety, and well-being

Krista De Castella,1,2 Philippe Goldin,2 Hooria Jazaieri,2 Michal Ziv,2 Richard G. Heimberg,3 and James J. Gross2

1Research School of Psychology, Australian National University, Canberra, Australian Capital Territory, Australia,2Clinically Applied Affective Neuroscience Laboratory (CAAN), Department of Psychology, Stanford University,Stanford, California, and 3Adult Anxiety Clinic of Temple (AACT), Department of Psychology, Temple University,Philadelphia, Pennsylvania, USA

Abstract

Dysfunctional beliefs play an important role in the aetiology and maintenance of social anxiety disorder (SAD). Despite this—and theheightened salience of emotion in SAD—little is known about SAD patients’ beliefs about whether emotions can be influenced orchanged. The current study examined these emotion beliefs in patients with SAD and in non-clinical participants. Overall, patientswere more likely to hold entity beliefs (i.e., viewing emotions as things that cannot be changed). However, this group difference inemotion beliefs varied by emotion domain. Specifically, SAD patients more readily held entity beliefs about their own emotions andanxiety than about emotions in general. By contrast, non-clinical participants more readily held entity beliefs about emotions ingeneral than about their own. Results also indicated that even when controlling for social anxiety severity, patients with SAD differedin their beliefs about their emotions, and these beliefs explained unique variance in perceived stress, trait anxiety, negative affect, andself-esteem.

Key words: anxiety, beliefs, emotions, implicit theories, motivation, well-being

Social anxiety disorder (SAD) is a chronic and debilitating

condition. It is the fourth most common psychiatric disor-

der after major depression, substance use disorders, and

specific phobias (Kessler et al., 2005). Patients with SAD

experience marked fear or anxiety in social situations

(American Psychiatric Association, 2013). As a result, they

frequently demonstrate significant impairments at work

(Bruch, Fallon, & Heimberg, 2003), school (Kashdan

& Herbert, 2001; Schneier et al., 1994), and in friend-

ships and intimate relationships (Montesi et al., 2012;

Rodebaugh, 2009). Social anxiety is also associated with

low self-esteem (Schreiber, Bohn, Aderka, Stangier, & Steil,

2012) and poor overall quality of life (Simon et al.,

2002).

Maladaptive beliefs in SAD

Cognitive models of SAD (Clark & Wells, 1995; Heimberg,

Brozovich, & Rapee, 2010; Hofmann, 2007) have largely

emphasised the role of maladaptive beliefs in the disorder’s

aetiology and treatment—particularly maladaptive beliefs

about the probability and costs of performing poorly in

social situations (Smits, Julian, Rosenfield, & Powers,

2012). For example, patients with SAD often believe they

lack the necessary social skills to interact normally with

others (Gaudiano & Herbert, 2003) and that behaving

ineptly has disastrous consequences (Hofmann, 2004).

They also hold excessively high standards for their social

performance and believe their self-worth is contingent on

being positively evaluated (Clark & Wells, 1995; Wong &

Moulds, 2011). In addition to research on probability and

cost biases, researchers have also examined the role of

more general dysfunctional beliefs in SAD. This includes

maladaptive beliefs about one’s appearance (Rapee,

Gaston, & Abbott, 2009), and negative core beliefs about

the self (e.g., I am unlovable; I don’t fit in) (Boden et al.,

2012; Schulz, Alpers, & Hofmann, 2008), as well as the

role of negative imagery (Moscovitch, Gavric, Merrifield,

Bielak, & Moscovitch, 2011). These maladaptive beliefs are

believed to play an important role in SAD as they are

Correspondence: Krista De Castella, Ph.B (Bachelor of Philosophy,Honors (Psychology)), BA in Communications, Department of Psy-chology, Jordan Hall, Bldg. 420, Stanford, CA 94305-2130, USA.Email: [email protected]

The authors of this manuscript do not have any direct or indirectconflicts of interest, financial, or personal relationships or affiliationsto disclose.

Received 21 May 2013. Accepted for publication 23 January2014.© 2014 The Australian Psychological Society

Australian Journal of Psychology 2014; 66: 139–148doi: 10.1111/ajpy.12053

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thought to lead to—and perpetuate—exaggerated emo-

tional reactivity and emotion dysregulation, including

safety and avoidance behaviours, which all play a key role

in the disorder (Clark, 2001; Clark & Wells, 1995;

Hofmann, 2007).

Although there has been a good deal of work on probabil-

ity and cost biases and on maladaptive self-beliefs, one cat-

egory of beliefs that has to date received very little attention

in research on SAD concerns patients’ beliefs about how

much they can change or control their emotions. This is

surprising as emotion beliefs have been presented as a key

mechanism of change in cognitive models of the disorder

(Hofmann, 2000, 2007), and many have called for research

on their role in treatment (Hofmann, 2000, 2007; Manser,

Cooper, & Trefusis, 2011; Tamir & Mauss, 2011). In the

following sections, we present the research on emotion

beliefs in non-selected populations and their relevance for

patients with SAD.

Beliefs about emotions in non-selected populations

Research in non-clinical samples has found that people differ

in their beliefs about the fixed or malleable nature of emo-

tions (De Castella et al., 2013; Tamir, John, Srivastava, &

Gross, 2007). People holding entity beliefs believe emotions

cannot really be changed or controlled. People holding incre-

mental beliefs, on the other hand, view emotions as malle-

able and believe that people can learn to change the

emotions they experience. Because these beliefs are often

not consciously held, they have also been referred to as

implicit beliefs or implicit theories (Dweck, 1999; Tamir

et al., 2007).

Research with undergraduate students indicates that these

beliefs have important associations with emotional health,

social functioning, and well-being. Entity beliefs about one’s

shyness (e.g., ‘my shyness is something about me that I can’t

change very much’) have been linked with greater avoid-

ance behaviour in social situations, whereas people holding

incremental beliefs exhibit more approach-orientated

behaviour despite their fears and are rated as more socially

skilled, likeable, and talkative in conversation tasks by inde-

pendent observers (Beer, 2002). In the context of beliefs

about emotions, students holding entity beliefs report more

emotion regulation difficulties, more negative and less posi-

tive emotional experiences, and reduced social support from

their friends (Tamir et al., 2007). Recently, entity beliefs

have also been linked in non-clinical samples to stress and

depression, as well as to lower levels of self-esteem and

poorer overall satisfaction with life (De Castella et al., 2013).

Interestingly, people’s beliefs about their ability to control

their own emotions are a stronger predictor of these out-

comes than their beliefs about the controllability of emotions

in general (De Castella et al., 2013).

Beliefs about emotions in SAD

SAD is a particularly interesting clinical context for examin-

ing patients’ beliefs about their emotions. Patients with SAD

struggle with attending to, describing, expressing, and regu-

lating their emotional experiences (Mennin, McLaughlin, &

Flanagan, 2009; Werner, Goldin, Ball, Heimberg, & Gross,

2011) and frequently underestimate their control over

external events (Leung & Heimberg, 1996). Barlow (2000)

argues that, for patients with SAD, repeated experience with

uncontrollable events and aversive emotional reactions may

also reinforce a belief that their emotions, in particular, are

outside of their control. In a destructive cycle, this in turn

perpetuates fear and avoidance of social situations. In

support of this model, Hofmann (2005) has found that

among patients with SAD, a perceived lack of control over

physical symptoms of anxiety and external threats partially

mediates the link between catastrophic thinking and social

anxiety. These findings point to the important role emotion

beliefs may play in SAD. However, to date, researchers have

not yet examined how patients with SAD differ from non-

clinical participants in their beliefs about their emotions and

whether patients’ emotion beliefs differ from more specific

beliefs about their own emotions and their social anxiety.

The current study

The goal of the current study was to examine whether

patients with SAD and non-clinical participants differ in

their beliefs about their emotions. We measured (1) general

and (2) personal beliefs about emotions, as has been done in

the non-clinical literature (De Castella & Byrne, unpublished

data; Tamir et al., 2007). We also assessed (3) more speci-

fic beliefs about social anxiety, which may be particularly

important for patients with SAD. By assessing emotion

beliefs in several different domains, we sought to examine

whether people’s beliefs about the controllability of emo-

tions in general differed from their beliefs about the control-

lability of their own emotions and, more specifically, the extent

to which they could change or control their social anxiety.

We predicted that patients with SAD would hold stronger

entity beliefs about emotions than non-clinical participants,

and that this group difference would be maximal in the

domain of one’s own emotions and anxiety (Hypothesis 1).

Furthermore, focusing on patients with SAD, we expected

that, entity beliefs about emotions would be associated with

higher levels of social anxiety, perceived stress, and trait

anxiety (Hypothesis 2). We also predicted an entity theory of

emotions would be associated with lower levels of well-

being (positive and negative affect, self-esteem, and satisfac-

tion with life) (Hypothesis 3). In these analyses, we also

conducted hierarchical linear regressions to examine the

extent to which patients’ emotion beliefs explained unique

140 K. De Castella et al.

© 2014 The Australian Psychological Society

variance in the dependent variables above and beyond what

might already be explained by their existing level of social

anxiety.

METHODS

Participants and procedure

Participants were 75 patients (40 men, 35 women) who met

the Diagnostic and Statistical Manual of Mental Disorders

(DSM-IV, American Psychiatric Association, 1994) criteria

for a principal diagnosis of generalised SAD, and 42 non-

clinical participants (20 men, 22 women) with no history of

current or past DSM-IV psychiatric disorders. All participants

were between 21 and 53 years of age (M = 33 years, standard

deviation (SD) = 9 years) and were ethnically heterogeneous

(55% Caucasian; 29% Asian; 7% Latino; 2% Filipino; 1%

African American; 6% Other). There were no significant

age, gender, ethnicity, or educational differences between

patients and non-clinical participants (all p values >.75).

Non-clinical participants and patients with SAD both

underwent extensive diagnostic screening prior to selection

including survey and telephone screening as well as an

in-person diagnostic interview—the Anxiety Disorders

Interview Schedule Lifetime Version for the DSM-IV

(Brown, DiNardo, & Barlow, 1994). Clinical psychologists

conducted the interviews, which assessed current (and past)

episodes of anxiety, mood, somatoform, and substance use

disorders as well as patients’ medical and psychiatric treat-

ment history. Participants were recruited from 2007 to 2010

as part of a larger study on the neural substrates of emotion

regulation in generalised SAD and its treatment with cogni-

tive behavioural therapy (CBT). Because participants were

part of a larger study using functional magnetic resonance

imaging, they also had to be right handed and pass safety

screening. They were excluded if they reported prior or

current CBT, a history of medical disorders, head trauma,

current pharmacotherapy, or psychotherapy.

Among patients, current Axis-I co-morbidity included 14

with generalised anxiety disorder, 5 with specific phobia, 3

with panic disorder, and 3 with dysthymic disorder. All other

co-morbidities were exclusion criteria. Thirty-six patients

reported past psychotherapy (i.e., ended more than 1 year

ago), and 25 reported a past history of pharmacotherapy.

Informed consent was obtained from all participants. The

overall design of the study and its main outcomes are

reported elsewhere (Goldin et al., 2012).

Measures

Beliefs about emotions

General beliefs about the malleability of emotions were

assessed with the four-item Implicit Theories of Emotion

Scale (Tamir et al., 2007). Two items measured incremental

beliefs, e.g., ‘If they want to, people can change the emo-

tions that they have’, and two measured entity beliefs, e.g.,

‘The truth is, people have very little control over their

emotions’. Participants were asked to rate their agreement

on a 5-point Likert-type scale. For each of the emotion

beliefs scales, incremental theory items were reverse

scored, and all items were then summed so that higher

scores reflected an entity theory and lower scores an incre-

mental theory of emotions. Cronbach’s alphas for all scales

can be found in Table 1.

Personal beliefs about the malleability of emotions were

assessed using the four-item personal scale (De Castella

et al., 2013). Unlike the general scale, each item reflects a

first-person claim about the extent to which one can change

or control one’s own emotions, e.g., ‘If I want to, I can change

the emotions that I have’. Although no research exists on

Table 1 Descriptive statistics, Cronbach’s alphas, means, and standard deviations for patients with social anxiety disorder (SAD, n = 75) andnon-clinical participants (NC, n = 42)

VariablePossiblerange

SAD NC SAD NC

α α M SD M SD

Emotion beliefs1. Entity beliefs about emotions (General) 4–20 .78 .70 9.77 3.42 8.5 3.132. Entity beliefs about emotions (Personal) 4–20 .80 .91 11.40 3.54 7.43 3.173. Entity beliefs about emotions (Anxiety) 4–20 .81 .92 11.77 4.03 6.79 2.78

Stress and anxiety4. Perceived stress (PSS-4) 4–16 .81 .64 10.21 3.15 6.45 1.995. Trait anxiety (STAI-T) 20–80 .89 .87 55.02 9.11 29.19 6.346. Social anxiety (SIAS-S) 0–68 .89 .88 44.63 10.21 13.4 8.67. Social anxiety (LSAS-SR) 0–144 .91 .92 82.78 18.25 15.95 10.24

Well-being8. Self esteem (RSES) 10–40 .88 .79 24.92 5.21 35.19 3.749. Life satisfaction (SWLS) 5–35 .91 .88 16.68 5.99 26.62 5.44

10. Positive affect (PANAS) 10–50 .87 .85 28.10 5.70 34.93 6.6011. Negative affect (PANAS) 10–50 .89 .87 25.64 7.67 14.62 4.89

Emotion beliefs in social anxiety disorder 141


these general and personal beliefs in clinical samples,

research in student samples indicates that the personal scale

is reliable (α = .79) and explains greater variance in well-

being and psychological distress than the general emotion

beliefs scale (De Castella et al., 2013).

Beliefs about the malleability of social anxiety were

assessed using a new variant of the four-item personal scale.

Efforts were made to ensure items stayed closely aligned to

the originals with each reflecting a first-person claim about

one’s ability to change or control one’s social anxiety. Items

were as follows: ‘If I want to, I can change the social anxiety

that I have’, ‘I can learn to control my social anxiety’, ‘The

truth is, I have very little control over my social anxiety’, and

‘No matter how hard I try, I can’t really change the social

anxiety that I have’.

Stress and anxiety

Stress was measured with the four-item Perceived Stress

Scale (PSS-4) (Cohen, Kamarck, & Mermelstein, 1983). The

PSS-4 asks about the extent to which life situations are

appraised as stressful over the past month (e.g., ‘I felt that

difficulties were piling up so high that I could not overcome

them’). Items are scored on a 4-point Likert-type scale

ranging from 1 (rarely or none of the time) to 4 (most or all of the

time). Summed scores range from 4 to 16. In non-SAD clini-

cal samples, the PSS-4 has been shown to be internally

consistent and reliable (Hewitt, Flett, & Mosher, 2012).

Trait anxiety was measured with the trait subscale of

the State Trait Anxiety Inventory (STAI-T) (Spielberger,

Gorsuch, Lushene, Vagg, & Jacobs, 1983). The STAI-T is a

widely used measure of clinical anxiety and assesses how

patients ‘general feel’ e.g., ‘I worry too much over something

that really doesn’t matter’. Responses are scored on a 4-point

Likert-type scale ranging from 0 (almost never) to 3 (almost

always). Summed scores ranged from 20 to 80. Overall, the

STAI-T displays good convergent and discriminant validity,

internal consistency, and retest reliability (Spielberger et al.,

1983).

Social interaction anxiety was measured with the

Social Interaction Anxiety Straightforward Scale (SIAS-S,

Rodebaugh, Woods, & Heimberg, 2007; Rodebaugh, Woods,

Heimberg, Liebowitz, & Schneier, 2006). Based on the origi-

nal 20-item SIAS (Mattick & Clarke, 1998), the revised

SIAS-S excludes three reversed-keyed items, reducing the

scale to 17 straightforward items that measure social anxiety

in social situations, dyads, and groups (e.g., ‘I have difficulty

making eye-contact with others’). Items are rated on a

5-point Likert-type scale ranging from 0 (Not at all character-

istic or true of me) to 4 (Extremely characteristic or true of me).

Summed scores ranged from 0 to 68. The SIAS-S has dem-

onstrated good internal consistency and construct validity,

and research indicates that it is an improved measure of

social interaction anxiety in clinical and non-clinical samples

(Rodebaugh et al., 2006, 2007).

Social anxiety was assessed with the self-report version of

the Liebowitz Social Anxiety Scale (LSAS) (Fresco et al.,

2001). The LSAS is a commonly used clinical measure of

social anxiety, and the clinician administered (Liebowitz,

1987) and self-report versions yield equivalent results

(Fresco et al., 2001). The scale consists of 24 items, which

assess fear and avoidance of social (e.g., meeting strangers)

and performance (e.g., taking a written test) situations

during the past week. Participants rate their fear and avoid-

ance on a 4-point scale from 0 (no fear/avoidance) to 3 (severe

fear or anxiety/usually avoid). Total scores, summing fear and

avoidance ratings, range from 0 to 144. Research indicates

the scale is reliable and displays good convergent and

discriminant validity (Fresco et al., 2001; Ledley, Erwin,

Morrison, & Heimberg, 2013).

Well-being measures

Self-esteem was assessed using the Rosenberg Self-Esteem

Scale (RSES, Rosenberg, 1965). The RSES is a widely used

measure of global self-esteem. It contains 10-items rated on

a 4-point Likert-type scale (summed scores ranging from 10

to 40). The scale demonstrates good convergent validity,

test-retest reliability, and internal consistency in research on

social anxiety (Kuo, Goldin, Werner, Heimberg, & Gross,

2011).

Life satisfaction was measured using the five-item Satis-

faction With Life Scale (SWLS, Diener, Emmons, Larsen, &

Griffin, 1985). The SWLS is a commonly used measure of life

satisfaction (e.g., ‘In most ways my life is close to ideal’). The

SWLS has displayed high internal consistency, test-retest

reliability, as well as convergent and discriminant validity

(Pavot & Diener, 2008). Items are rated on a 7-point Likert-

type scale with total scores ranging from 5 to 35.

Positive and negative affect were assessed using the

20-item Positive and Negative Affect Schedule (Watson,

Clark, & Tellegen, 1988). The scale consists of two 10-item

subscales containing adjectives that assess positive (e.g.,

enthusiasm) and negative affect (e.g., irritable) over the last

week. Responses are scored on a 5-point Likert-type scale

with total scores ranging from 10 to 50. The scale is a widely

used measure of positive and negative affect and displays

excellent psychometric properties (Crawford & Henry, 2004;

Watson et al., 1988).

RESULTS

Means (M), SD, ranges, internal consistencies (α), and cor-

relations among the three emotion belief domains and meas-

ures of clinical symptoms, anxiety, perceived stress, and

well-being are presented in Tables 1 and 2.



Hypothesis 1: Patients with SAD andnon-clinical participants

To examine whether patients with SAD differed from non-

clinical participants (NC) in their beliefs about emotions, we

conducted a 2 group (SAD vs NC) × 3 belief domain (per-

sonal, general, anxiety) repeated-measures analysis of vari-

ance. Consistent with Hypothesis 1, there was a significant

main effect for group (F(1, 115) = 34.06, p < .001, R2 = .23)

and a significant group × belief domain interaction (F(1,

115) = 29.25, p < .001, R2 = .20). Follow-up planned t-tests

showed that, compared with non-clinical participants,

patients with SAD were significantly more likely to hold

fixed entity beliefs about their own emotions (MSAD = 11.4,

SD = 3.54 vs MNC = 7.43, SD = 3.17, t(115) = 6.04, p < .001,

d = 1.18). They also held stronger entity beliefs about emo-

tions in general (MSAD = 9.81, SD = 3.44 vs MNC = 8.5,

SD = 3.13, t(115) = 2.04, p < .05, d = 0.40) and about their

social anxiety (MSAD = 11.73, SD = 4.04 vs MNC = 6.79,

SD = 2.78, t(115) = 7.80, p < .001, d = 1.42). This was a small

to medium effect on the general scale and a large effect on

the personal and anxiety belief scales, according to J.

Cohen’s (1988) conventions (see Fig. 1).

Paired-samples t-tests for each group were also used to

examine whether participants’ personal beliefs about their

own emotions differed significantly from their beliefs about

emotions in general. We also examined whether their

personal beliefs differed from their beliefs about their

social anxiety. Patients with SAD endorsed stronger entity

beliefs on the personal scale than on the general scale

(M(PERSONAL) = 11.4, SD = 3.54 vs M(GENERAL) = 9.81,

SD = 3.44, t(74) = −4.71, p < .001, d = 0.541), indicating a

greater perceived lack of control over their own emotions.

They also held stronger entity beliefs about their social anxiety

than about emotions in general (M(ANXIETY) = 11.73,

SD = 4.04 vs M(GENERAL) = 9.81, SD = 3.44, t(74) = −4.40,

p < .001, d = 0.51). There was no significant difference

however, between patients’ scores on the personal and

Table 2 Correlations between measures for patients with social anxiety disorder (SAD, n = 75)

Variable

Correlations

1 2 3 4 5 6 7 8 9 10 11

Emotion beliefs1. Entity beliefs about emotions (General) 1 .65*** .51*** .43*** .11 .01 −.13 −.13 −.08 −.09 .172. Entity beliefs about emotions (Personal) 1 .79*** .40*** .23* .15 −.02 −.39*** −.15 −.07 .26*3. Entity beliefs about emotion (Anxiety) 1 .36*** .24* .23* .08 −.41*** −.17 −.06 .28**

Stress and anxiety4. Perceived stress (PSS-4) 1 .50*** .29* −.40*** −.40*** −.60*** −.42*** .40**5. Trait anxiety (STAI-T) 1 .36*** .32** −.74*** −.66*** −.35** .57***6. Social anxiety (SIAS-S) 1 .55*** −.38*** −.37*** −.14 .29*7. Social anxiety (LSAS-SR) 1 −.25* −.29** −.14 .34***

Well-being8. Self esteem (RSES) 1 .60*** .34*** −.52***9. Life satisfaction (SWLS) 1 .26* −.42***

10. Positive affect (PANAS) 1 −.1411. Negative affect (PANAS) 1

Note. Correlations for patients with social anxiety disorder (n = 75). PSS-4 = Perceived Stress Scale; STAI-T = State Trait Anxiety Inventory (TraitScale); SIAS-S = Social Interaction Anxiety Straightforward Scale; LSAS-SR = Liebowitz Social Anxiety Scale (Self-Report); RSES = Rosenberg Self-Esteem Scale; SWLS = Satisfaction with Life Scale; PANAS = Positive and Negative Affect Schedule.

*p < .05, **p < .05, ***p < .001.

0

2

4

6

8

10

12

14

General Beliefs Personal Beliefs Anxiety Beliefs

Ent

ity T

heor

y

Non-clinical Participantsn = 42

Patients with SAD n = 75

Figure 1 Beliefs about emotion in non-clinical (NC) and socialanxiety disorder (SAD) participants.Note. Patients with SAD held stronger entity beliefs about emotionsthan non-clinical participants (in all belief domains), and strongerentity beliefs on the personal and anxiety scales than on the generalscales. Non-clinical participants, by contrast, held weaker entitybeliefs on the personal and anxiety scales than on the general. Forpatients with SAD and non-clinical participants, there was no sig-nificant difference between emotion beliefs on the personal andanxiety scales.



anxiety belief measures (t(41) = −1.17, p = .25, d = 0.14)

(see Fig. 1).

For non-clinical participants, the reverse pattern emerged.

Consistent with previous research (De Castella & Byrne,

unpublished data; De Castella et al., 2013), non-clinical par-

ticipants endorsed entity beliefs less on the personal measure

than on the general measure, indicating greater perceived

control over their own emotions (M(GENERAL) = 8.5,

SD = 3.13 vs M(PERSONAL) = 7.43, SD = 3.17, t(41) = 2.94,

p < .01, d = 0.45). They also endorsed entity beliefs less on

the anxiety scale than on the general scale (M(GENERAL) =8.5, SD = 3.13 vs M(ANXIETY) = 6.79, SD = 2.78, t(41) =3.84, p < .001, d = 0.60), indicating greater perceived control

over their social anxiety. Once again, there was no signifi-

cant difference between non-clinical participants’ scores on

the personal and anxiety belief measures (t(41) = 1.83,

p = .08).

Hypothesis 2: Emotion beliefs, clinical symptoms,perceived stress, and anxiety in SAD

To examine whether entity beliefs about emotions were

associated with higher levels of clinical symptoms, perceived

stress, and anxiety in patients with SAD, we first examined

Pearson product-moment correlations between patients’

beliefs and their scores on these measures (see Table 1).

Among patients with SAD, personal and social anxiety emotion

beliefs were significantly correlated with perceived stress and

trait anxiety. Social anxiety beliefs were also positively corre-

lated with social interaction anxiety. General emotion beliefs,

by contrast, were only associated with perceived stress. None

of the emotion belief scales were associated with fear and

avoidance of social situations as indicated on the LSAS-SR.

Next, we tested whether patients’ emotion beliefs predicted

stress and trait anxiety above and beyond what might already

be explained by their existing social anxiety symptoms. Using

a series of two-step hierarchical regressions, we controlled for

social anxiety (LSAS-SR and SIAS) in the first step. Emotion

beliefs were then entered in the second step to examine the

unique variance explained on each of the dependent vari-

ables (see Table 3). Results revealed that even when control-

ling for social anxiety, patients’ beliefs about their emotions

(general, personal, and anxiety belief measures) accounted

for 11–23% of unique variance in stress. For trait anxiety,

personal emotion beliefs also contributed 4% of unique vari-

ance. The general and anxiety belief scales, however, did not.

Hypothesis 3: Emotion beliefs and well-being in SAD

To examine whether entity beliefs about emotions were

associated with lower levels of well-being in patients with

SAD, we next examined Pearson product-moment correla-

tions between emotion beliefs and the well-being measures.

Greater personal entity beliefs about emotions were associ-

ated with lower self-esteem and greater negative affect. The

same pattern emerged for patients’ beliefs about their social

anxiety; however, neither measure was associated with posi-

tive affect or life satisfaction. General emotion beliefs, on the

other hand, were not correlated with any of the well-being

measures.

To see whether patients’ emotion beliefs accounted for

unique variance in well-being, we again conducted a series

of hierarchal regressions controlling for social anxiety fol-

lowing the procedures outlined above. Once again, personal

and anxiety emotion beliefs (but not general beliefs)

accounted for unique variance in well-being: explaining an

additional 11–12% of the variance in self-esteem; and 5–6%

of the variance in negative affect. None of the emotion belief

measures, however, were significant predictors of life satis-

faction or positive affect. Overall, these findings indicate that

even when controlling for symptom severity, patients differ

in their beliefs about the controllability of their emotions,

and these beliefs uniquely predict patients’ levels of stress,

trait anxiety, self-esteem, and negative affect.

DISCUSSION

Cognitive models of SAD have emphasised the role of dys-

functional cognitive content in SAD. To date, however, there

has been limited research on patients’ beliefs about their

ability to change or control their emotions. Our results indi-

cate that these beliefs can help to distinguish patients with

SAD from non-clinical participants and that these beliefs are

linked to clinical symptoms, stress, anxiety, and well-being.

For example, SAD patients who believed they could not

change or control their emotions reported higher levels of

perceived stress and anxiety, higher levels of negative affect,

and lower levels of self-esteem. Even when controlling for

social anxiety severity, patients differed in their beliefs about

their emotions, and these beliefs explained unique variance

on these measures. Interestingly, entity beliefs were not sig-

nificantly correlated with positive affect or life satisfaction.

These results are inconsistent with observed links between

emotion beliefs and indices of well-being in larger under-

graduate samples (De Castella et al., 2013; Tamir et al.,

2007). However, it is possible that for patients with SAD,

emotion beliefs have a smaller—or indirect—association

with these indices of positive well-being. The large degree of

variance in the LSAS-SR (see Table 1) may have also

explained the lack of association between emotion beliefs

and this measure of social anxiety.

Our findings regarding the clinical significance of beliefs

about emotion control accord well with existing research.

Hofmann (2000, 2005, 2007) suggests that perceived control

over emotions may also play an important role in promoting

treatment for SAD. Patients with SAD typically struggle with



their symptoms for a prolonged period, often waiting more

than 9 years before finding appropriate specialist care

(Wagner, Silove, Marnane, & Rouen, 2006). If patients with

SAD more readily hold fixed entity beliefs about their

emotions and anxiety—believing them to be stable qualities

or personality traits rather than a treatable psychiatric

disorder—this may help explain why many sufferers fail to

seek treatment (Grant et al., 2005).

Acknowledging discrepancies between people’s broader

beliefs and their beliefs about themselves is also important in

the context of clinical interventions. Treatment credibility

and positive expectations for change in treatment are con-

sidered one of the most potent nonspecific factors in predict-

ing general treatment response (Arnkoff, Glass, & Shapiro,

2002). Such expectations are linked treatment outcomes for

patients with SAD (Safren, Heimberg, & Juster, 1997), and

they predict rate of change in CBT for SAD patients (Price &

Anderson, 2011).

These findings have led to renewed interest in the effects

of motivational enhancement therapy (Miller, Zweben,

DiClemente, & Rychtarik, 1992) and motivational inter-

viewing (Miller & Rollnick, 2002). Research indicates that

these approaches are an effective adjunct to CBT for gener-

alised anxiety (Westra, Arkowitz, & Dozois, 2009), and there

is some support for their efficacy among patients with SAD

(Buckner & Schmidt, 2009). Motivational enhancement

strategies adopt a client-centred approach to counselling

with the aim of helping clients overcome their ambivalence

or lack of resolve for change. They can also be flexibly added

to existing treatments to improve their effectiveness

(Brozovich & Heimberg, 2011). However, neither approach

explicitly addresses patients’ beliefs about their emotions or

Table 3 Results of hierarchical regressions predicting variables from emotion beliefs in patients with SAD (n = 75)

Dependent variable and step

Step 1 Step 2

B SE B β R2 B SE B β R2 Total R2 Change

StressSocial anxiety (LSAS-SR) .05 .02 .36**Social anxiety (SIAS) .02 .04 .05 .15**General emotion beliefs .37 .07 .49** .39** .23**Personal emotion beliefs .31 .07 .41** .28** .16**Anxiety emotion beliefs .22 .07 .34** .26** .11**

Trait anxietySocial anxiety (LSAS-SR) .09 .07 .18Social anxiety (SIAS) .26 .13 .26* 15**General emotion beliefs .38 .29 .14 .17** .02Personal emotion beliefs .53 .28 .21* .19** .04*Anxiety emotion beliefs .41 .25 .18 .18** .03

Self esteemSocial anxiety (LSAS-SR) −.02 .04 −.06Social anxiety (SIAS) −.20 .08 −.34 .14**General emotion beliefs −.18 .17 −.12 .16** .02Personal emotion beliefs −.51 .15 −.35** .26** .12**Anxiety emotion beliefs −.44 .14 −.34** .26** .11**

Life satisfactionSocial anxiety (LSAS-SR) .01 .05 .01Social anxiety (SIAS) −.25 .10 −.32 .10*General emotion beliefs −.13 .23 −.07 .10* .00Personal emotion beliefs −.14 .23 −.07 .11* .01Anxiety emotion beliefs −.09 .20 −.05 .10* .00

Positive affectSocial anxiety (LSAS-SR) −.03 .04 −.10Social anxiety (SIAS) −.05 .09 −.08 .03General emotion beliefs −.18 .20 −.11 .04 .01Personal emotion beliefs −.11 .19 −.06 .03 .00Anxiety emotion beliefs −.05 .17 −.03 .03 .00

Negative affectSocial anxiety (LSAS-SR) .11 .06 .26Social anxiety (SIAS) .12 .11 .14 .13**General emotion beliefs .46 .25 .20 .17** .04Personal emotion beliefs .54 .24 .25 .19** .06*Anxiety emotion beliefs .44 .21 .23 .18** .05*

Results from hierarchical regression analyses reported above. Significance levels are based on two-tailed significance tests. Increments for variablesentered at R2 Change significance levels are based upon F-tests for that step.

*p < .05, **p < .01.



the effectiveness of treatment in teaching skills for control-

ling or changing their anxiety. If treatment ambivalence is

due in part to patients’ entity beliefs about their emotions,

strategies for explicitly targeting these beliefs may prove

beneficial.

Although the current study makes important contributions

to research on emotion beliefs and SAD, several limitations

should be noted. First, we developed instruments to assess

emotion beliefs at different levels of specificity. We also

included indicators of perceived stress, trait-anxiety, and

well-being, rather than focusing exclusively on clinical symp-

toms and negative functioning. Nonetheless, as with much of

the research on implicit theories (Dweck, 1999), the data

collected in the current study are based on participant self-

reports. It will therefore be important to build on this work

using other measures to further supplement our assessment

of emotion beliefs, stress, anxiety, and well-being. Future

research might benefit from including independent evalua-

tions, implicit association tasks, psychophysiological assess-

ments, and behavioural measures. This would also help

control for potential self-report bias and provide information

on shared method variance.

A second limitation relates to generalizability. Patients in

the current study were carefully screened and only eligible if

they met the criteria for a principal diagnosis of generalised

SAD. Although this carefully defined clinical population is a

key strength of the current study, it is also a limitation. SAD

is highly prevalent and is frequently co-morbid with other

mood and anxiety disorders (Schneier, Johnson, Hornig,

Liebowitz, & Weissman, 1992). Our findings then, while

representative of most patients with SAD, cannot be gener-

alised to all people with social anxiety. It is also important to

note that in clinical studies, patients are typically seeking

treatment for their symptoms and are often required to

undergo multiple assessments as part of the overall research

programme. In this way, clinical samples such as ours typi-

cally reflect a highly motivated population who likely

believe in the utility of therapy and their capacity to change.

Given that many patients fail to seek treatment (especially

patients with SAD), it is possible—and even likely—that

entity beliefs about emotions are even more prevalent

among non-treatment-seekers in the general population. It

will also be important to examine whether links between

emotion beliefs, clinical symptoms, and well-being can be

generalised across multiple mood and anxiety disorders or

alternatively, whether these findings are unique to patients

with SAD. Examining patients’ beliefs about emotions in

other clinical populations will help clarify the role these

beliefs play more broadly in emotion dysregulation and psy-

chological illness.

Third, although the current study documents robust cross-

sectional associations between emotion beliefs, perceived

stress, anxiety, and well-being, we still know little about the

origins and developmental course of emotion beliefs—such

as the potential role that parental messages and parenting

practices may play in this process (see for example Monti,

Rudolph & Abaied, 2013; Rudolph & Zimmer-Gembeck,

2013, this issue). More research is also needed to better

understand the causal links between emotion beliefs, per-

ceived stress, anxiety and well-being, and the implications

these beliefs might have for psychosocial interventions and

long-term recovery. We have suggested that beliefs about

emotions may play an important role in promoting

help seeking, and recovery—particularly in therapeutic

approaches such as CBTs which actively teach patients strat-

egies for changing and controlling their emotions. Causal

links between implicit beliefs and such outcomes are also

consistent with a large body of research on implicit theories

(see Dweck, 1999 for a review) and emotion regulation

(De Castella et al., 2013; Tamir et al., 2007). Nonetheless, it

is also possible that entity beliefs reflect existing deficiencies

in emotion regulation or that alternative variables account

for the relationship between beliefs and symptoms.

Although we controlled for the severity of social anxiety in

our analyses and found that emotion beliefs still predicted

unique variance in outcomes, it will be important that future

work in this area further examines if and how patients’

beliefs about their emotions can be changed and what effect

(if any) this has on their clinical symptoms, response to

treatment, and quality of life.

NOTE

1. Within-subjects estimates of effect size using J. Cohen’s

d have been corrected for dependence between the means

(see equation 8, Morris & DeShon, 2002).

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