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
© 2014 The Australian Psychological Society
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.
142 K. De Castella et al.
© 2014 The Australian Psychological Society
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.
Emotion beliefs in social anxiety disorder 143
© 2014 The Australian Psychological Society
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
144 K. De Castella et al.
© 2014 The Australian Psychological Society
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.
Emotion beliefs in social anxiety disorder 145
© 2014 The Australian Psychological Society
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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