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Cognitive Therapy and Research

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01.04.2015 | Original Article

What If I Appear Boring, Anxious, or Unattractive? Validation and Treatment Sensitivity of the Negative Self Portrayal Scale in Clinical Samples

verfasst von: David A. Moscovitch, Karen Rowa, Jeffrey R. Paulitzki, Martin M. Antony, Randi E. McCabe

Erschienen in: Cognitive Therapy and Research | Ausgabe 2/2015

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Abstract

A recently developed self-report questionnaire, the Negative Self Portrayal Scale (NSPS; Moscovitch and Huyder in Behav Ther 42:183–196. doi:10.1016/j.beth.2010.04.007, 2011) assesses concerns about appearing socially incompetent, physically unattractive, and/or visibly anxious to evaluative others. Initial validation studies of the NSPS yielded promising results but were conducted exclusively on samples of undergraduate students. Here, we aimed to replicate and extend those initial studies by examining the factor structure, construct validity, and treatment sensitivity of the NSPS in samples of community-based participants with a principal diagnosis of social anxiety disorder (SAD), a principal anxiety disorder diagnosis other than SAD, or no history of psychological problems. Results provided support for the construct validity of the NSPS within clinical samples and suggested that the types of concerns assessed by the NSPS and its subscales may be useful for predicting individual differences in emotional and behavioral symptoms of social anxiety (SA) and for conceptualizing change processes during cognitive behavioral therapy for SAD. Confirmatory factor analyses indicated that while the hypothesized three-factor model fit significantly better than an alternative one-factor model, the fit indices associated with the three-factor model were below satisfactory cutoffs, thus tempering conclusions that the best fitting structure was found and highlighting the need for additional research. Implications of these findings are discussed vis-à-vis Moscovitch’s (Cogn Behav Pract 16:123–134. doi:10.1016/j.cbpra.2008.04.002, 2009) theoretical model of SA and the potential utility of the NSPS for both clinical research and practice.

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The disorder-specific treatment manuals used for the present study consisted of evidence-based CBT interventions adapted from several published CBT manuals and the scientific literature. More information about the specific treatment manuals is available upon request from the second author.

For the purposes of examining the factor structure of the NSPS, sample size constraints prohibited us from conducting a multiple group CFA. Prior to conducting the CFA on the pooled data, preliminary tests revealed that NSPS scores were not significantly associated with any of the demographic variables which may have differed across the subgroups. For example, the zero-order correlation between participant age and NSPS total scores was nonsignificant, r = .10, p = .19. Univariate ANOVAs further demonstrated that neither marital status, F(5,163) = .97, p = .44, nor ethnicity, F(5,167) = 1.0, p = .42, were predictive of NSPS total scores.

Equivalent results were found when the two CFA models were compared using only clinical participants (i.e., excluding the healthy controls).

Given that CBT for SA is geared toward addressing the types of concerns most typical of SA (and that this is not the focus of treatment for CBT for other AC conditions), it is reasonable to expect the Time × Treatment Focus interaction to be in only one direction (and not the opposite direction). Therefore, a one-tailed test of significance was used.

Examining each of the NSPS subscales separately in 2 (Time) × 2 (Treatment Focus) mixed ANOVAs revealed, interestingly, that there was a significant interaction for signs of anxiety, F(1,89) = 6.0, p = .01, η _p ² = .07 (SA group: Pretreatment Mean = 22.5; SD = 7.8; Posttreatment Mean = 17.2; SD = 7.4; AC group: Pretreatment Mean = 15.9; SD = 6.0; Posttreatment Mean = 13.5; SD = 5.6), but not for social competence [F(1,89) = 1.7, p = .19, η _p ² = .02], or for physical appearance [F(1,89) = 1.6, p = .20, η _p ² = .02]. However, the pattern of differences between group means over time for each of these subscales was consistent with expectations, such that patients who received CBT for SAD reported greater changes in NSPS concerns about social competence (SA group: Pretreatment Mean = 35.5; SD = 11.1; Posttreatment Mean = 29.9; SD = 12.8; AC group: Pretreatment Mean = 22.3; SD = 9.6; Posttreatment Mean = 19.1; SD = 9.6) and physical appearance (SA group: Pretreatment Mean = 25.0; SD = 8.8; Posttreatment Mean = 21.8; SD = 8.9; AC group: Pretreatment Mean = 16.1; SD = 7.5; Posttreatment Mean = 14.4; SD = 7.7) from pre- to post-treatment than those who received CBT for other anxiety disorders.

For this reason, the items that comprise the physical appearance subscale of the NSPS were worded specifically to capture these more general SAD-relevant physical appearance concerns rather than the more focused concerns about particular physical body parts, attributes, or weight and shape, which might be more applicable to BDD and the eating disorders.

Alden, L. E., & Bieling, P. (1998). Interpersonal consequences of the pursuit of safety. Behaviour Research and Therapy, 36, 53–64. doi:10.1016/S0005-7967(97)00072-7.CrossRefPubMed

Alden, L. E., & Taylor, C. T. (2004). Interpersonal processes in social phobia. Clinical Psychology Review, 24, 857–882. doi:10.1016/j.cpr.2004.07.006.CrossRefPubMed

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: Author.

Antony, M. M., Coons, M. J., McCabe, R. E., Ashbaugh, A., & Swinson, R. P. (2006). Psychometric properties of the Social Phobia Inventory: Further evaluation. Behaviour Research and Therapy, 44, 1177–1185. doi:10.1016/j.brat.2005.08.013.CrossRefPubMed

Antony, M. M., & Swinson, R. P. (2008). Shyness and social anxiety workbook: Proven, step-by-step techniques for overcoming your fear (2nd ed.). Oakland, CA: New Harbinger Publications.

Arbuckle, J. L. (2008). AMOS 20 user’s guide. Chicago, IL: SPSS Inc.

Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the Beck Depression Inventory—II. San Antonio, TX: Pearson Assessment.

Buhlmann, U., Reese, H. E., Renaud, S., & Wilhelm, S. (2008). Clinical considerations for the treatment of body dysmorphic disorder with cognitive-behavioral therapy. Body Image, 5, 39–49. doi:10.1016/j.bodyim.2007.12.002.CrossRefPubMed

Carelton, R. N., Mulvoque, M. K., Thibodeau, M. A., McCabe, R. E., Antony, M. M., & Asmundson, G. J. (2012). Increasingly certain about uncertainty: Intolerance of uncertainty across anxiety and depression. Journal of Anxiety Disorders, 26, 268–479. doi:10.1016/j.janxdis.2012.01.011.

Carleton, R. N., Norton, M. A., & Asmundson, G. J. G. (2007a). Fearing the unknown: A short version of the Intolerance of Uncertainty Scale. Journal of Anxiety Disorders, 21, 105–117. doi:10.1016/j.janxdis.2006.03.014.CrossRefPubMed

Carleton, R. N., Sharpe, D., & Asmundson, G. J. G. (2007b). Anxiety sensitivity and intolerance of uncertainty: Requisites of the fundamental fears? Behaviour Research and Therapy, 45, 2307–2316. doi:10.1016/j.brat.2007.04.006.CrossRefPubMed

Chiupka, C. A., Moscovitch, D. A., & Bielak, T. (2012). In-vivo activation of anticipatory vs. post-event autobiographical images and memories in social anxiety. Journal of Social and Clinical Psychology, 31, 783–809.CrossRef

Clark, D. M., & Wells, A. (1995). A cognitive model of social phobia. In R. Heimberg, M. Liebowitz, D. A. Hope, & F. R. Schneier (Eds.), Social phobia: Diagnosis, assessment and treatment (pp. 69–93). New York, NY: Guilford Press.

Cohen, J., Cohen, P., West, S. G., & Aiken, L. S. (2003). Applied multiple regression/correlation analysis for the behavioral sciences (3rd ed.). Mahwah, NJ: Lawrence Erlbaum Associates.

Conner, K. M., Davidson, J. R. T., Churchhill, E., Sherwood, A., Foa, E., & Weisler, R. H. (2000). Psychometric properties of the Social Phobia Inventory (SPIN). British Journal of Psychiatry, 176, 379–386. doi:10.1192/bjp.176.4.379.CrossRef

Cuming, S., Rapee, R. M., Kemp, N., Abbott, M. J., Peters, L., & Gaston, J. E. (2009). A self-report measure of subtle avoidance and safety behaviors relevant to social anxiety: Development and psychometric properties. Journal of Anxiety Disorders, 23, 879–883. doi:10.1016/j.janxdis.2009.05.002.CrossRefPubMed

Dugas, M. J., & Robichaud, M. (2007). Cognitive-behavioral treatment for generalized anxiety disorder: From science to practice. New York, NY: Routledge.

English, T., & John, O. P. (2013). Understanding the social effects of emotion regulation: The mediating role of authenticity for individual differences in suppression. Emotion, 13, 314–329. doi:10.1037/a0029847.CrossRefPubMed

Fang, A., & Hofmann, S. G. (2010). Relationship between social anxiety disorder and body dysmorphic disorder. Clinical Psychology Review, 30, 1040–1048. doi:10.1016/j.cpr.2010.08.001.CrossRefPubMedCentralPubMed

Fang, A., Sawyer, A. T., Aderka, I. M., & Hofmann, S. G. (2013). Psychological treatment of social anxiety disorder improves body dysmorphic concerns. Journal of Anxiety Disorders, 27, 684–691. doi:10.1016/j.janxdis.2013.07.005.CrossRefPubMed

First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (2002). Structured clinical interview for DSM-IV-TR axis I disorders, research version, patient edition (SCID-I/P). New York, NY: Biometrics Research, New York State Psychiatric Institute.

Freeston, M., Rhéaume, J., Letarte, H., Dugas, M. J., & Ladouceur, R. (1994). Why do people worry? Personality and Individual Differences, 17, 791–802. doi:10.1016/0191-8869(94)90048-5.

Hofmann, S. G. (2007). Cognitive factors that maintain social anxiety disorder: A comprehensive model and its treatment implications. Cognitive Behaviour Therapy, 36, 193–209. doi:10.1080/16506070701421313.CrossRefPubMedCentralPubMed

Hofmann, S. G., Heinrichs, N., & Moscovitch, D. A. (2004). The nature and expression of social phobia: Toward a new classification. Clinical Psychology Review, 24, 769–797. doi:10.1016/j.cpr.2004.07.004.CrossRefPubMed

Hu, L., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6, 1–55.CrossRef

Kashdan, T. B., Weeks, J. W., & Savostyanova, A. A. (2011). Whether, how, and when social anxiety shapes positive experiences and events: A self-regulatory framework and treatment implications. Clinical Psychology Review, 31, 786–799. doi:10.1016/j.cpr.2011.03.012.CrossRefPubMed

Khawaja, N. G., & Yu, L. N. H. (2010). A comparison of the 27-item and 12-item intolerance of uncertainty scales. Clinical Psychologist, 14, 97–106. doi:10.1080/13284207.2010.502542.

Kollei, I., Schieber, K., de Zwaan, M., Svitak, M., & Martin, A. (2013). Body dysmorphic disorder and nonweight-related body image concerns in individuals with eating disorders. International Journal of Eating Disorders, 46, 52–59. doi:10.1002/eat.22067.CrossRefPubMed

MacCallum, R. C., Browne, M. W., & Sugawara, H. M. (1996). Power analysis and determination of sample size for covariance structure modeling. Psychological Methods, 1, 130–149.CrossRef

McManus, F., Sacadura, C., & Clark, D. M. (2008). Why social anxiety persists: An experimental investigation of the role of safety behaviours as a maintaining factor. Journal of Behavior Therapy and Experimental Psychiatry, 39, 147–161. doi:10.1016/j.jbtep.2006.12.002.CrossRefPubMed

Meng, X., Rosenthal, R., & Rubin, D. B. (1992). Comparing correlated correlation coefficients. Psychological Bulletin, 111, 172–175. doi:10.1037/0033-2909.111.1.172.CrossRef

Merrifield, C., Balk, D., & Moscovitch, D. A. (2013). Self-portrayal concerns mediate the relationship between recalled teasing and social anxiety in adults with anxiety disorders. Journal of Anxiety Disorders, 27, 456–460. doi:10.1016/j.janxdis.2013.05.007.CrossRefPubMed

Moscovitch, D. A. (2009). What is the core fear in social phobia? A new model to facilitate individualized case conceptualization and treatment. Cognitive and Behavioral Practice, 16, 123–134. doi:10.1016/j.cbpra.2008.04.002.CrossRef

Moscovitch, D. A., Chiupka, C. A., & Gavric, D. L. (2013a). Within the mind’s eye: Negative mental imagery activates different emotion regulation strategies in high versus low socially anxious individuals. Journal of Behavior Therapy and Experimental Psychiatry, 44, 426–432. doi:10.1016/j.jbtep.2013.05.002.CrossRefPubMed

Moscovitch, D. A., Gavric, D. L., Merrifield, C., Bielak, T., & Moscovitch, M. (2011). Retrieval properties of negative vs. positive mental images and autobiographical memories in social anxiety: Outcomes with a new measure. Behaviour Research and Therapy, 49, 505–517. doi:10.1016/j.brat.2011.05.009.CrossRefPubMed

Moscovitch, D. A., & Huyder, V. (2011). The Negative Self-Portrayal Scale: Development, validation, and application to social anxiety. Behavior Therapy, 42, 183–196. doi:10.1016/j.beth.2010.04.007.CrossRefPubMed

Moscovitch, D. A., Orr, E., Rowa, K., Reimer Gehring, S., & Antony, M. M. (2009). In the absence of rose-colored glasses: Ratings of self-attributes and their differential certainty and importance across multiple dimensions in social phobia. Behaviour Research and Therapy, 47, 66–70. doi:10.1016/j.brat.2008.10.007.CrossRefPubMed

Moscovitch, D. A., Rowa, K., Paulitzki, J. R., Ierullo, M. D., Chiang, B., Antony, M. M., et al. (2013b). Self-portrayal concerns and their relation to safety behaviors and negative affect in social anxiety disorder. Behaviour Research and Therapy, 51, 476–486. doi:10.1016/j.brat.2013.05.002.CrossRefPubMed

Moscovitch, D. A., Suvak, M. K., & Hofmann, S. G. (2010). Emotional response patterns during social threat in individuals with generalized social anxiety disorder and non-anxious controls. Journal of Anxiety Disorders, 24, 785–791. doi:10.1016/j.janxdis.2010.05.013.CrossRefPubMed

Muthén, B., & Kaplan, D. (1985). A comparison of some methodologies for the factor analysis of non-normal Likert variables. British Journal of Mathematical and Statistical Psychology, 38, 171–189.CrossRef

Nevitt, J., & Hancock, G. R. (2001). Performance of bootstrapping approaches to model test statistics and parameter standard error estimation in structural equation modeling. Structural Equation Modeling, 8(3), 353–377.CrossRef

Orr, E., & Moscovitch, D. A. (2014). Physical appearance anxiety impedes the therapeutic effects of video feedback in high socially anxious individuals. Behavioural and Cognitive Psychotherapy, 42, 92–104.CrossRefPubMed

Osman, A., Barrios, F. X., Gutierrez, P. M., Williams, J. E., & Bailey, J. (2008). Psychometric properties of the Beck Depression Inventory-II in nonclinical adolescent samples. Journal of Clinical Psychology, 64, 83–102. doi:10.1002/jclp.20433.

Plasencia, M. L., Alden, L. E., & Taylor, C. T. (2011). Differential effects of safety behaviour subtypes in social anxiety disorder. Behaviour Research and Therapy, 49, 665–675. doi:10.1016/j.brat.2011.07.005.CrossRefPubMed

Rapee, R. M., Gaston, J. E., & Abbott, M. J. (2009). Testing the efficacy of theoretically derived improvements in the treatment of social phobia. Journal of Consulting and Clinical Psychology, 77, 317–327. doi:10.1037/a0014800.CrossRefPubMed

Rapee, R. M., & Heimberg, R. G. (1997). A cognitive-behavioral model of anxiety in social phobia. Behaviour Research and Therapy, 35, 741–756. doi:10.1016/S0005-7967(97)00022-3.CrossRefPubMed

Rodebaugh, T. L. (2009). Hiding the self and social anxiety: The core extrusion schema measure. Cognitive Therapy and Research, 33, 375–389. doi:10.1007/s10608-007-9143-0.CrossRef

Rubin, D. B. (1987). Multiple imputation for nonresponse in surveys. New York: Wiley.CrossRef

Ruscio, A. M. (2010). The latent structure of social anxiety disorder: Consequences of shifting to a dimensional diagnosis. Journal of Abnormal Psychology, 119, 662–671. doi:10.1037/a0019341.CrossRefPubMedCentralPubMed

Schafer, J. L. (1997). Analysis of incomplete multivariate data. London: Chapman & Hall.CrossRef

Sideridis, G. D., Morgan, P. L., Botsas, G., Padeliadu, S., & Fuchs, D. (2006). Predicting LD on the basis of motivation, metacognition, and psychopathology: An ROC analysis. Journal of Learning Disabilities, 39, 215–229.CrossRefPubMed

Taylor, C. T., & Alden, L. E. (2011). To see ourselves as others see us: An experimental integration of the intra and interpersonal consequences of self-protection in social anxiety disorder. Journal of Abnormal Psychology, 120, 129–141. doi:10.1037/a0022127.CrossRefPubMed

Van Ginkel, J. R., & Kroonenberg, P. M. (2014). Analysis of variance of multiply imputed data. Multivariate Behavioral Research, 49, 78–91.CrossRefPubMedCentralPubMed

Weeks, J. W., Rodebaugh, T. L., Heimberg, R. G., Norton, P. J., & Jakatdar, T. A. (2009). “To avoid evaluation, withdraw”: Fears of evaluation and depressive cognitions lead to social anxiety and submissive withdrawal. Cognitive Research and Therapy, 33, 375–389. doi:10.1007/s10608-008-9203-0.CrossRef

Wells, A. (2009). Metacognitive therapy for anxiety and depression. New York, NY: Guilford Press.

West, S. G., Finch, J. F., & Curran, P. J. (1995). Structural equation models with non-normal variables: Problems and remedies. In R. Hoyle (Ed.), Structural equation modeling: Concepts, issues and applications (pp. 56–75). Newbury Park, CA: Sage.

Titel: What If I Appear Boring, Anxious, or Unattractive? Validation and Treatment Sensitivity of the Negative Self Portrayal Scale in Clinical Samples
verfasst von: David A. Moscovitch
Karen Rowa
Jeffrey R. Paulitzki
Martin M. Antony
Randi E. McCabe
Publikationsdatum: 01.04.2015
Verlag: Springer US
Erschienen in: Cognitive Therapy and Research / Ausgabe 2/2015
Print ISSN: 0147-5916
Elektronische ISSN: 1573-2819
DOI: https://doi.org/10.1007/s10608-014-9645-5

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What If I Appear Boring, Anxious, or Unattractive? Validation and Treatment Sensitivity of the Negative Self Portrayal Scale in Clinical Samples

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