Environmental influences to anxiety

Question 1

Why should we study anxiety?

Answer 1

1 in 14 people worldwide = @ any age has an anxiety disorder

The median global prevalence of all anxiety disorders for 3-17 years olds = ~6% (Baxter et al., 2012)

Mean age of onset of ~11years (Kessler et al., 2005)

Chronic, debilitating course:
1. Lifelong impact on wellbeing and daily functioning
2. Raise risk for other psychological disorders
3. Large societal cost

Question 2

What is the relationship between abnormal fears and anxiety?

Answer 2

Significant proportion of childhood fears + anxiety = clinical anxiety disorders, especially phobias (Muris et al., (2000)

Childhood phobias + anxiety diagnoses = reflect
radicalisations of normal fear and anxiety

genetic + environmental vulnerability factors = risk for development of childhood anxiety disorders

Question 3

What is social anxiety order?

Answer 3

A. Persistent fear of social/ performance situations. A fear that he/she will act in a way (or show anxiety symptoms) = embarrassing + humiliating.
B. Exposure to the feared situation almost invariably provokes anxiety,
C. The person recognises fear = unreasonable/ excessive.
D. The feared situations = avoided/ endured with intense anxiety and distress.
E. Avoidance/ anxious
F. The fear, anxiety, or avoidance is persistent, typically lasting 6+ months
G. Not due to physiological effects of a substance, general medical condition or another
mental disorder.

12 month prevalence estimates for social anxiety vary widely between 0.32% - 7% (Ford et al., 2003; Kessler et al., 2005b; Wittchen et al., 1999)

Question 4

What genetic factors are in social anxiety?

Answer 4

Runs in families
Eley et al. (2007) = ~30% heritable but estimates vary on population
Meier et al. (2019) = beginning to identify actual genetic variants using genome-wide association scans

Question 5

What does polygenic mean?

Answer 5

many genes cause the overall effect

Question 6

What environmental factors are in social anxiety?

Answer 6

genes + environment to etiology of anxiety = poorly understood

Support for direct environmental transmission of anxiety via e.g. verbal information, vicarious learning (Eley et al., 2015)

Non-shared environment factors = a larger role than genetic factors (Scaini, Belotti & Ogliari, 2014)

Question 7

What does non-shared environment factors mean?

Answer 7

Defined as the environmental influences that make children growing up in the same family different

Question 8

According to Spence and Rapee (2016) what environmental factors are identified place children at greater risk of experiencing social anxiety?

Answer 8

parent influences
peer influences
aversive social outcomes
neg. life events
culture

Question 9

What is the social anxiety disorder model (Spence and Rapee, 2016)?

Answer 9

levels of anxiety = emerge across early development. interacting risk factors = influences whether a child will have higher anxiety

diagnosis = if you experience anxiety at the higher end of the continuum. The symps = need to also interfere w/ indvdl’s life.

Where a person sits on the social anxiety continuum = depends on their culture, age and gender.

Influences are:
genetic
temperment
cognitive
behavioural factors: maladaptive bhvrs such as not making eye contact)

Question 10

What are the assumptions of the Etiological Model of Social Anxiety Disorder - Spence & Rapee (2016)?

Answer 10

Risk factors interact

Equifinality = different pathways + combinations of factors = SAD - lots of indvdl differences.

Multifinality = any one risk factor = multiple outcomes, not just SAD

Reciprocal risk factors – social anxiety in young person influences probability a risk factor, + increase young person’s risk for SAD - vicious cycle

e.g. fearful temperament at age 2 = overprotective parenting = predicts social withdrawal 3 years later (Kiel & Buss, 2011)
* e.g. social anxiety symptoms increase risk for peer victimisation = predicts further aversive social outcomes

Question 11

How do aversive social outcomes linked SAD?

Answer 11

Aversive social learning experiences = development and maintenance of SAD (Blote et al., 2015)

A risk factor for future SAD, not just a consequence of social anxiety (Spence & Rapee, 2015)

Question 12

Name some examples of aversive social outcomes

Answer 12

Bullying
Rejection
Humiliation
Exclusion by significant others

Question 13

What are the consequences of aversive social outcomes?

Answer 13

Socially anxious children:
* Have more negative peer interactions
* Are more likely to be rejected, neglected and victimised
* Rated as less socially skilled

Question 14

What is the cycle of adverse social outcomes?

Answer 14

Adverse social outcomes/less pos. response
from peers
Heightened anxiety/expectations of future neg. outcomes
Avoidance of future social situations
Reduced opportunity to acquire social skills
Poorer performance on social tasks

Question 15

What was Blote et al. (2015) study?

Answer 15

Examined impact of social anxiety and social performance on the way children are judged by their peers

N = 40 (HSA/LSA) 13-17 years old recorded giving a speech to a pre-recorded audience

N = 534 observers rated HSA and LSA speakers on:
Rejection using Desire for Future Interaction Scale
- Would you like to have this speaker sit next to you in class?
- Attractiveness
- Performance
*
Additional adult ratings of social skills performance * e.g. how friendly did the speaker look?

Question 16

What were the results of Blote et al. (2015) show?

Answer 16

HSA adolescents = more rejected by peer, judged + adult observers = lower social skills performance +
rated less physically attractive vs LSA adolescents

Higher rejection of HSA adolescents = partially mediated by them rated as less physically attractive + having poorer social performance

Question 17

What are role of peer influences in SAD?

Answer 17

Cross-sectional studies = SA children more likely to experience peer victimisation (Ranta et al., 2009)

Prospective longitudinal studies suggest victimisation = increasing future risk for social anxiety

Social anxiety = cause victimisation + increase chances of being victimised

Question 18

What is direct/ overt victimisation?

Answer 18

Physical and verbal bullying behaviour aimed at causing harm

Question 19

What is relational victimisation?

Answer 19

Harms social standing and reputation
Withdrawal of friendships and attention, exclusion from activities, spreading of gossip and rumours

Question 20

What happened in Storch et al. (2005) study?

Answer 20

N = 144, 13-15 year olds completed baseline + 1 year assessment

Overt and relational victimisation = Social Experience Questionnaire

Social anxiety symptoms = using Social Phobia and Anxiety Inventory for Children

Results showed = Relational victimisation predicted = social phobia symptoms BUT No significant association with overt victimisation

Question 21

What is the criticism of Storch et al’s study on the quality of the evidence?

Answer 21

Sample = generalisability
- WEIRD
- beta bias = unequal distribution of male vs female (64%)

DESIGN - Self-report measures

More than one types of bullying = e.g. cyberbullying (Fisher et al., 2016)

Lots of other studies, not all showing same pattern of effects (see Ranta et al., 2013)

Question 22

How do trauma and life events relate to SAD?

Answer 22

risk of developing SAD

Rates of social anxiety 2x likely in a trauma exposed vs. non-exposed group in a community sample (Copeland et al., 2007)

Mainly retrospective or cross-sectional research
Why do some children who experience adversity develop SAD whereas others do not?

Question 23

What does Gren-Landell et al., (2011) study show?

Answer 23

N = 3211 Swedish adolescents, nationally representative

Social Phobia Screening Questionnaire for Children = diagnostic assessment of SAD

Juvenile Victimisation Questionnaire – prior year and lifetime
* Conventional crime
* Maltreatment
* Peer or siblings victimisation
* Sexual victimisation
* Witnessing victimisation

Results = 10.6% prevalence rate for SAD overall, higher in those who identified as female (14.9%) than male (6.2%) so analyses split by gender

Question 24

What are the strengths and weaknesses of Gren-Landell et al., (2011) study?

Answer 24

Not generalisable = Focus on adolescence as vulnerable period of development

Unable to determine causality – would need prospective longitudinal design - it is a reprospective report

Captured different types of trauma and victimisation
All self-report data
No assessment of other outcomes of adversity

Question 25

How does culture relate to SAD?

Answer 25

Variations in definitions of social anxiety + diagnosis SAD (Stein & Stein, 2008)

Culture impacts:
* Expression of social anxiety
* Thresholds for clinical diagnosis and prevalence
* Societal reactions + impact of withdrawn/reticent behaviour

Question 26

What are the differences in expressions between cultures in SAD?

Answer 26

UK = SAD - Fear of negative evaluation by others + Individualistic culture

Japan = Taijin Kyofusho (TKS) syndrome - Fear of causing offence or harm to others due to bodily actions/appearance + Collectivist culture

Question 27

What are the differences in prevalence and reaction to SA in different countries?

Answer 27

Very low prevalence in East Asian countries vs higher prevalence in US/Western world (Brockveld et al., 2014)

in collectivist cultures = social reticence appeasement = positively so impact of SAD symptoms is less perceived

SAD symptoms = neg. in Western countries = greater impact on functioning and higher prevalence rates