Adolescents who experience social anxiety concerns often display symptoms and impairments when interacting with unfamiliar peers. For adolescent clients, reducing symptoms and impairments within ...these interactions comprises a key treatment target within exposure-based therapies for social anxiety. Recent work on mechanisms of change in exposure-based therapies highlights the need for therapeutic exposures to simulate real-world manifestations of anxiety-provoking social situations. Yet, researchers encounter difficulty with gathering ecologically valid data about social interactions with unfamiliar peers. The lack of these data inhibits building an evidence base for understanding, assessing, and treating adolescent clients whose concerns manifest within these social interactions. Consequently, we developed a paradigm for understanding adolescent social anxiety within social interactions with unfamiliar peers. In this paradigm, we train peer confederates to interact with adolescents as if they were a same-age peer, within a battery of social interaction tasks that mimic key characteristics of therapeutic exposures. Leveraging experimental psychopathology and multi-modal assessment approaches, this paradigm allows for understanding core components of social interactions with unfamiliar peers relevant to exposure-based therapy, including stimuli variability, habituation, expectancy violations, peers’ impressions about socially anxious adolescents, and maladaptive coping strategies that inhibit learning from exposures (e.g., safety behaviors). We detail the conceptual and empirical foundations of this paradigm, highlight important directions for future research, and report “proof of concept” data supporting these research directions. The Unfamiliar Peer Paradigm opens new doors for building a basic science that informs evidence-based services for social anxiety, within clinically relevant contexts in adolescents’ social worlds.
Safety behaviors are subtle avoidance strategies for minimizing distress within social situations (e.g., avoidance of eye contact). These behaviors factor prominently in the development and ...maintenance of social anxiety concerns, and when patients use these behaviors within psychosocial treatments for social anxiety, this may impede treatment response. Prior work supports the need to include measures of safety behaviors within evidence-based assessments of social anxiety. Along these lines, researchers developed the Subtle Avoidance Frequency Examination (SAFE) to assess safety behaviors among adults. However, we know relatively little about the SAFE’s psychometric properties when administered to adolescents. We tested the SAFE’s psychometric properties using adolescent self-reports and parallel parent reports in a mixed-clinical/community sample of 96 14 to 15 year-old adolescents and their parents (33 clinic-referred; 63 community control; 59.4% African American). Adolescent and parent SAFE reports displayed moderate correspondence with each other. Both adolescent and parent SAFE reports related positively to well-established measures of adolescent social anxiety and depressive symptoms. Both reports distinguished adolescents on referral status as well as cut scores on well-established measures of adolescent social anxiety. Further, both adolescent and parent SAFE reports displayed incremental validity in relation to survey reports of adolescent social anxiety, over-and-above survey reports of adolescent depressive symptoms, which commonly co-occur with social anxiety. However, adolescent (but not parent) SAFE reports predicted adolescents’ social anxiety and state arousal as displayed within social interactions with unfamiliar peer confederates. These findings have important implications for leveraging multi-informant approaches to assessing safety behaviors among adolescents.
Fears of negative (FNE) and positive (FPE) evaluation and safety behaviors feature prominently in cognitive-behavioral models of social anxiety. However, we have a poor understanding of their ...associations, particularly given evidence that they both vary in form and function. This study aimed to identify the factor structure of safety behaviors and explore their differential associations with FNE and FPE. We addressed these aims across samples that varied in developmental stage, informant, and assessment modality. We collected self-reported data from college students (n = 349; Mage = 19.42) and adolescent-parent dyads (n = 134; Mage_adolescents = 14.49, Mage_parents = 45.01); parents also completed an ecologically-valid evaluation task. We confirmed a two-factor structure of safety behaviors (i.e., avoidance and impression management) that fit the data well for college students, adolescents, and parents’ self-report, but not for parents’ report about adolescents. Associations between avoidance and impression management and FNE/FPE were significant within-informants but not between-informants. For parents, in-the-moment arousal following receipt of negative, but not positive, feedback was associated with avoidance and impression management. Findings have implications for integrated measurement of FNE, FPE, and safety behaviors, as well as treatments that target social anxiety through each of these domains.
•Subfactors of safety behaviors include avoidance and impression management.•These subfactors differentially relate to fears of negative/positive evaluation.•Differential associations significant for within- but not between-informant models.•Arousal following negative feedback related to both subfactors of safety behaviors.•More testing of multi-informant/multi-modal integrated measurement models is needed.
Assessing youth psychopathology involves collecting multiple informants’ reports. Yet multi-informant reports often disagree, which necessitates integrative strategies that optimize predictive power. ...The trait-score approach leverages principal components analysis to account for the context and perspective from which informants provide reports. This approach may boost the predictive power of multi-informant reports and thus warrants rigorous testing. We tested the trait score approach using multi-informant reports of adolescent social anxiety in a mixed clinical and community sample of adolescents (N = 127). The trait score incrementally predicted observed social anxiety (βs = 0.47–0.67) and referral status (odds ratios = 2.66–6.53) above and beyond individual informants’ reports and a composite of informants’ reports. The trait score predicted observed behavior at magnitudes well above those typically observed for individual informants’ reports of internalizing psychopathology (i.e., rs = .01–.15). Findings demonstrate the ability of the trait score to improve prediction of clinical indices and potentially transform widely used practices in multi-informant assessments.
Adolescents experiencing social anxiety often engage in safety behaviors―covert avoidance strategies for managing distress (e.g., avoiding eye contact)―that factor into the development and ...maintenance of their concerns. Prior work supports the psychometric properties of the Subtle Avoidance Frequency Examination (SAFE), a self-report survey of safety behaviors. Yet, we need complementary methods for assessing these behaviors within contexts where adolescents often experience concerns, namely, interactions with unfamiliar peers. Recent work indicates that, based on short, direct social interactions with adolescents, individuals posing as unfamiliar peers (i.e., peer confederates) and without assessment training can capably report about adolescent social anxiety. We built on prior work by testing whether we could gather valid SAFE reports from unfamiliar untrained observers (UUOs), who observed adolescents within archived recordings of these short social interactions. A mixed clinical/community sample of 105 adolescents self-reported on their functioning and participated in a series of social interaction tasks with peer confederates, who also provided social anxiety reports about the adolescent. Based on video recordings of these tasks, trained independent observers rated adolescents’ observed social skills, and an additional set of UUOs completed SAFE reports of these same adolescents. Unfamiliar untrained observers’ SAFE reports (a) related to adolescents’ SAFE self-reports, (b) distinguished adolescents on clinically elevated social anxiety concerns, (c) related to trained independent observers’ ratings of adolescent social skills within interactions with peer confederates, and (d) related to adolescents’ self-reported arousal within these same interactions. Our findings support use of unfamiliar observers’ perspectives to understand socially anxious adolescents’ interpersonal functioning.
•Adolescents commonly display safety behaviors in fear-provoking situations.•We know little about unfamiliar people’s reports about these behaviors.•We tested unfamiliar observers’ reports of adolescent safety behaviors.•Unfamiliar observers’ reports relate to interpersonal functioning.•Findings inform research on safety behaviors’ links to social functioning.
Fears of negative and positive evaluation (i.e., evaluative fears) manifest within performance-based situations (e.g., public speaking, group presentations), particularly among those experiencing ...social anxiety. Within these performance-based situations, individuals experiencing such evaluative fears frequently display a variety of impairments (e.g., avoidance, nervousness) that might manifest within and across various settings (e.g., employment, school). How do those who experience these fears react to in-the-moment feedback about their performance? We constructed the Fear of Evaluation About Performance (FEAP) task to examine ecologically valid experiences with anxiety when reacting to positive and negative feedback. During the task, participants gave a speech, and subsequent to this and in counterbalanced order, received positive and negative feedback about their speech, with continued assessment of anxiety-related arousal throughout the task. We tested the FEAP task among 127 adults, who provided self-reports of fears of positive and negative evaluation before completing the task. Fears of positive evaluation uniquely predicted arousal following receipt of positive feedback, whereas fears of negative evaluation uniquely predicted arousal following receipt of negative feedback. Relative to participants receiving positive feedback first, those receiving negative feedback first experienced elevated post-feedback arousal, followed by a steep decline in arousal post-positive feedback. Conversely, participants receiving positive feedback first experienced a buffer effect whereby arousal post-negative feedback remained low, relative to the arousal experienced post-negative feedback among those who received negative feedback first. We expect the FEAP task to inform basic science on fears of negative and positive evaluation, as well as treatment planning in applied clinical settings.
•Fears of negative and positive evaluation manifest in performance-based situations.•We know little about fears of evaluation in reaction to in-the-moment feedback.•Survey reports of fears of evaluation predict reactions to in-the-moment feedback.•Timing of feedback (negative first vs. positive first) impacts in-the-moment arousal.•Receiving positive feedback first buffers aversive reactions to negative feedback.
Effective mental health services require accurate assessment of psychosocial impairments linked to mental health concerns. Youth who experience these impairments do so within and across various ...contexts (e.g., school, home). Youth may display symptoms of mental health concerns without co-occurring impairments, and vice versa. Yet, nearly all impairment measures presume that those assessed display mental health concerns. Consequently, we recently developed youth and parent versions of a five-item measure of youth psychosocial impairments (i.e., Work and Social Adjustment Scale for Youth WSASY), structured to assess any youth, regardless of mental health status. Across two studies, we developed and tested a WSASY teacher version, in a large sample of 382 student teacher reports (Study 1), and a subsample of 66 youth who, along with their parents and teachers, completed the WSASY and a series of school- and home-based behavioral tasks (Study 2). In Study 1, WSASY teacher reports demonstrated excellent internal consistency and unique relations with teacher reports on well-established measures of psychosocial strengths and difficulties. In Study 2, teacher, youth, and parent WSASY reports demonstrated low correspondence with each other and context-specific relations with criterion variables. This low correspondence allowed us to capitalize on an integrative approach designed to optimize informant-specific variance. Integrative scores demonstrated robust, large-magnitude relations with criterion variables across multiple information sources. These findings provide important psychometric support for use of WSASY teacher reports, and pave the way toward integrating WSASY reports from multiple informants who observe youth psychosocial impairments within different contexts and from different perspectives.
Public Significance Statement
Effectively addressing the needs of youth clients who receive mental health services requires accurately measuring how their behavior gets in the way or impairs their daily life. We evaluated a measure for assessing school-based impairments, and demonstrated a new strategy for accurately combining data from school-based and home-based impairment measures.
Adolescents frequently experience social anxiety, with parents often serving as the primary source of clinical referral. Yet, adolescents’ needs for services often revolve around social anxiety that ...manifests when interacting with unfamiliar peers. Emerging work indicates that parents’ reports about adolescent social anxiety fail to predict adolescents’ self-reported experiences in these unfamiliar peer interactions. Detecting modifiable factors in the family environment may facilitate accurate detection of social environments that contribute to adolescents’ anxiety-related needs, and thus inform the goals of anxiety-related services. Low levels of one such family factor—parental monitoring (i.e., parental efforts to track adolescents’ whereabouts and activities)—robustly pose risk for adolescent maladjustment across various domains. Further, emerging work highlights the value of understanding patterns of discrepancies between parents’ and adolescents’ reports about parental monitoring. In this study, 134 adolescents and their parents completed parallel reports on a widely used survey measure of parental monitoring. Adolescents also participated in a controlled laboratory task (i.e., Unfamiliar Peer Paradigm) that simulates how adolescents interact with same-age, unfamiliar peers. Using recommended regression-based procedures for testing discrepancy hypotheses (i.e., polynomial regression and response surface analyses), we found that the interaction between low levels of either adolescent- or parent-reported parental monitoring (i.e., relative to each other) predicted increased adolescent social anxiety, based on trained independent observers’ ratings of adolescents’ behavior within the Unfamiliar Peer Paradigm. These findings have important implications for delivering mental health services for adolescent social anxiety, and accurately interpreting discrepancies between parents’ and adolescents’ reports about parental monitoring.
Abstract Adolescent social anxiety (SA) assessments often include adolescent and parent reports, and low reporting correspondence results in uncertainties in clinical decision-making. Adolescents ...display SA within non-home contexts such as peer interactions. Yet, current methods for collecting peer reports raise confidentiality concerns, though adolescent SA assessments nonetheless would benefit from context-specific reports relevant to adolescent SA (i.e., interactions with unfamiliar peers). In a sample of 89 adolescents (30 Evaluation-Seeking; 59 Community Control), we collected SA reports from adolescents and their parents, and SA reports from unfamiliar peer confederates who interacted with adolescents during 20-minute mock social interactions. Adolescents and parents completed reports on trait measures of adolescent SA and related concerns (e.g., depressive symptoms), and adolescents completed self-reports of state arousal within mock social interactions. Adolescents’ SA reports correlated with reports on parallel measures from parents in the .30s and with peer confederates in the .40s to .50s, whereas reports from parent-confederate dyads correlated in the .07 to .22 range. Adolescent, parent, and peer confederate SA reports related to reports on trait measures of adolescent SA and depressive symptoms, and distinguished Evaluation-Seeking from Community Control Adolescents. Confederates’ SA reports incrementally predicted adolescents’ self-reported SA over and above parent reports, and vice versa, with combined R s ranging from .51 to .60. These combined R s approximate typical correspondence levels between informants who observe adolescents in the same context (e.g., mother-father). Adolescent and peer confederate (but not parent) SA reports predicted adolescents’ state arousal in social interactions. These findings have implications for clarifying patterns of reporting correspondence in clinical assessments of adolescent SA.
Safety behaviors are subtle avoidance strategies used to manage distress in social situations. Inconsistent findings create uncertainty about whether safety behavior use leads to poorer outcomes. To ...reconcile these inconsistencies, we leveraged a theoretical model of safety behaviors that classifies safety behaviors according to function using two categories: active behaviors that aim to enhance social performance, and restrictive behaviors that aim to reduce involvement within social situations. This informed development of a measurement model tested with a confirmatory bifactor approach in a mixed-clinical/community sample of 127 adolescent reports of safety behavior engagement. We identified two distinct factors of safety behaviors (i.e., active and restrictive). These factors predicted differential outcomes: increased restrictive safety behaviors predicted increased internalizing concerns and poorer social skills, and increased active safety behaviors predicted higher substance use. These findings have important implications for understanding conceptual and measurement models of safety behaviors in research and clinical contexts.
