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The influence of approaching behavior on the development of likeability in social anxiety.

by Cappendijk, Fieke Lynn, MS

Abstract (Summary)
Introduction: According to the cognitive theory, people with SAD have the basic assumption that they are inadequate and they have negative automatic thoughts, such as “I am stupid”, or “I am boring”. They get stuck into their cognitive circles of anxiety, negative thoughts, self-focused attention, avoidance behavior, and physical reactions. Sadly, a number of studies show that these people are indeed less liked by others than people without SAD. According to the interpersonal perspective this might be caused by their tendency not to show approaching behavior. Therefore, they will be liked less by others. Problems in likeability might be an important maintenance factor in social anxiety. Method: The current study created an unstructured social situation for female undergraduate students of Maastricht University. Two groups were studied: one group with high levels of social anxiety (HSA group, N=24), the other group with low levels of social anxiety (LSA group, N=25). The level of likeability and the level of approaching behavior of the participants have been rated by several scales in this study. Results: The HSA group was rated significant less likeable than the LSA group. The HSA group also showed lower levels of approaching behavior than the LSA group. Across the two groups the level of likeability increased from before to after the waiting room situation. However, this increase was only borderline significant. This development in likeability was moderated by approaching behavior, not by the social anxiety. That is, this relation between approaching behavior and the development of likeability was equal across the two groups. Discussion: Socially anxious individuals are rated lower in the first impression than non-socially anxious individuals. This impression is hard to change, but it is possible by showing approaching behavior. It might be that a higher level of likeability decreases the chance of being socially rejected and reduces the evidence of the negative automatic thoughts in people with SAD. However the development of likeability is independent of the social anxiety, the anxiety relates with a low level of approaching behavior. Therefore, individuals with SAD should learn the impact of approaching behavior on the likeability among others and should be encouraged to show more approaching behavior during social interaction.
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Bibliographical Information:

Advisor:M. Voncken

School:Universiteit Maastricht

School Location:Netherlands

Source Type:Master's Thesis

Keywords:Social anxiety, approaching behavior, likeability,

ISBN:

Date of Publication:10/30/2009

Document Text (Pages 1-10)

Do you like me?

The influence of approaching behavior on the
development of likeability in social anxiety.

Name: F.L. Cappendijk
ID-number: I522325
Master: Mental Health Sciences
Faculty Supervisor: M. Voncken
Second examiner: M. Goossens
Period: 01-2009 – 10-2009
University: Faculty of Health Sciences
Maastricht University


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Abstract

Introduction: According to the cognitive theory, people with SAD have the basic
assumption that they are inadequate and they have negative automatic thoughts, such as “I am
stupid”, or “I am boring”. They get stuck into their cognitive circles of anxiety, negative
thoughts, self-focused attention, avoidance behavior, and physical reactions. Sadly, a number
of studies show that these people are indeed less liked by others than people without SAD.
According to the interpersonal perspective this might be caused by their tendency not to show
approaching behavior. Therefore, they will be liked less by others. Problems in likeability
might be an important maintenance factor in social anxiety.
Method: The current study created an unstructured social situation for female
undergraduate students of Maastricht University. Two groups were studied: one group with
high levels of social anxiety (HSA group, N=24), the other group with low levels of social
anxiety (LSA group, N=25). The level of likeability and the level of approaching behavior of
the participants have been rated by several scales in this study.
Results: The HSA group was rated significant less likeable than the LSA group. The
HSA group also showed lower levels of approaching behavior than the LSA group. Across the
two groups the level of likeability increased from before to after the waiting room situation.
However, this increase was only borderline significant. This development in likeability was
moderated by approaching behavior, not by the social anxiety. That is, this relation between
approaching behavior and the development of likeability was equal across the two groups.
Discussion: Socially anxious individuals are rated lower in the first impression than
non-socially anxious individuals. This impression is hard to change, but it is possible by
showing approaching behavior. It might be that a higher level of likeability decreases the
chance of being socially rejected and reduces the evidence of the negative automatic thoughts
in people with SAD. However the development of likeability is independent of the social
anxiety, the anxiety relates with a low level of approaching behavior. Therefore, individuals
with SAD should learn the impact of approaching behavior on the likeability among others
and should be encouraged to show more approaching behavior during social interaction.


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Table of contents

1 Introduction ........................................................................................................................ 1
1.1 Social Anxiety Disorder .............................................................................................. 1
1.2 Epidemiology............................................................................................................... 2
1.3 The problem of SAD ................................................................................................... 3
1.4 Cognitive behavioral theory......................................................................................... 3
1.5 The interpersonal perspective ...................................................................................... 8

1.5.1 Behavioral deficits................................................................................................ 8
1.5.2 Approaching behavior .......................................................................................... 8
1.5.3 Interpersonal model of Alden (2001) ................................................................. 10

1.6 Current theory............................................................................................................ 12
1.7 Hypotheses................................................................................................................. 12

2 Methods ............................................................................................................................ 14
2.1 Design ........................................................................................................................ 14
2.2 Participants ................................................................................................................ 14
2.3 Material...................................................................................................................... 14

2.3.1 The Social Interaction Anxiety Scale (SIAS; Mattick & Clarke, 1997)............. 14
2.3.2 The Beck Depression Inventory (BDI; Beck et al., 1988).................................. 15
2.3.3 The Desire for Future Interaction (DFI; Coyne, 1976)....................................... 15
2.3.4 First Impression (FI) and Second Impression (SI) ............................................. 15
2.3.5 Scale of Approaching Behavior (SAB; Cappendijk, 2009)................................ 15
2.3.6 Scale of Functioning of the Confederate (FC; Weijtens, 2009) ......................... 16

2.4 Procedure ................................................................................................................... 16
2.5 Confederates .............................................................................................................. 17
2.6 Examiners .................................................................................................................. 18
2.7 Video observers ......................................................................................................... 18
2.8 Statistical analyses ..................................................................................................... 18


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3 Results .............................................................................................................................. 19
3.1 Descriptive data ......................................................................................................... 19
3.2 Reliability of the scales.............................................................................................. 19
3.3 Influence of one of the confederate ........................................................................... 20
3.4 Differences between the HSA and LSA group on the likeability.............................. 21
3.5 Differences between the HSA and LSA group on approaching behavior ................. 21
3.6 Correlations between likeability and approaching behavior...................................... 22
3.7 The influence of approaching behavior on the likeability ......................................... 22

4 Discussion ........................................................................................................................ 24
4.1 Summary of the results .............................................................................................. 24
4.2 Links with earlier described theories ......................................................................... 25
4.3 Clinical relevance ...................................................................................................... 26
4.4 Limitations................................................................................................................. 27
4.5 Suggestions for further investigation......................................................................... 28

5 References ........................................................................................................................ 29

6 Appendix 1 - Instructions confederate and examiner....................................................... 34

7 Appendix 2 – SIAS (Mattick & Clarke, 1997)................................................................. 36

8 Appendix 3 – BDI (Beck et al, 1988)............................................................................... 38

9 Appendix 4 – List of behaviors (van der Kloet, 2008)..................................................... 42

10 Appendix 5 – Rating instructions behavior (Reichgelt, 2007) ......................................... 43

11 Appendix 6 – Rating form for video observers ................................................................ 46


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1 Introduction

1.1 Social Anxiety Disorder

People need to be liked and approved by others to develop into successful human beings
(Leary & Kowalski, 1995). The need to be liked, to engage in social situations, and to have
social relationships, is high; this can result into fear of negative evaluation (Hofmann & Otto,
2008). This fear of negative evaluation can be seen on a continuum from subclinical issue
(social anxiety), a personal trait (shyness) to a clinical disorder (social anxiety disorder)
(Papsdorf & Alden, 1998). In this study, we enlighten social anxiety disorder (SAD).
According to the DSM-IV, SAD contains different aspects such as: an anxiety for one or more
social situations or events, high levels of fear when exposed to the feared situation,
consciousness of overreacting of the own fear and avoidance of the feared situations (APA,
2007). The fear of people with SAD is to show behavior that leads to criticism by others
(Oosterbaan & Bögels, 2000), and fear of humiliation or embarrassment in interactional or
performance situations (du Toit & Stein, 2003). People with SAD are self-conscious and selfcritical
in social situations and can experience physical reactions, such as blushing, sweating
or trembling (Heckelman & Scheiner, 1995). Furthermore, they are afraid that they will be
negatively evaluated as a consequence of certain behavior, physical reactions, appearance, or
because of their self-esteem (Mulkens, Bögels, de Jong, & Louwers, 2001). Patients with SAD
can worry for hours, days or sometimes even months upfront the feared social or performance
situation (Heckelman & Scheiner, 1995). SAD can be divided in performance anxiety and
interaction anxiety. Performance anxiety is the fear to perform in front of a group, such as
giving a presentation, going to parties, or eating in public (Hofmann & Otto, 2008; Schneier et
al, 1992). Interaction anxiety is fear of personal contacts and interaction behavior such as
starting or maintaining conversations (Schneier et al, 1992; Hofmann & Otto, 2008). The
anxiety leads to the avoidance of situations. This, and the high levels of anxiety, are
impairments in daily life and makes SAD a severe problem (Oosterbaan & Bögels, 2000).

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1.2 Epidemiology

SAD is the most prevalent disorder of the anxiety disorders with a lifetime prevalence of 13%
and a 1-month prevalence rate of 4.5% (Magee et al. 1996). Other studies show a lifetime
prevalence of 7% to 13% of SAD (Furmark, 2002; Kessler et al. 2005).
According to a large scale study (N=7076) on the prevalence of psychiatric disorders in the
Netherlands, the lifetime prevalence of SAD in the Netherlands is 7.8% (Bijl, Ravelli, &
Zessen van, 1998). They found a lower lifetime prevalence in males (5.9%) than in females
(9.7%). However, in the clinical population the number of female and male patients is equal
(Bijl et al., 1998). Scheiner et al (1992) indicate that less than 5% of the people with SAD
seek treatment for the disorder. However, without treatment, social phobia is a severe disorder
that has a chronic course (Mulkens et al., 2001). Therefore, it is important that people with
SAD seek treatment. There are some explanations why such a low percentage of individuals
with SAD seek treatment. Possible factors are: a low income background, female gender,
culture minority, living in a rural area, environmental recognition of the disorder, the impact
of symptoms on the family, and the degree of impairment (Bussing, Zima, Gary, & Garvan,
2003; Cohen & Hesselbart, 1993; Farmer, Burns, Angold, & Costello, 1997; Teagle, 2002;
Canino et al, 2004; Lyneham & Rapee, 2007).
The average onset of SAD is between the age of 16 and 21 years. The average duration
of the disorder is 20.9 years. Besides the symptoms of SAD, the co-morbidity of SAD makes
the disorder a severe problem. Possible consequences of SAD can be suicide, alcohol abuse,
work problems, and problems with finding a partner. In addition, it is seen that SAD comes
often with depressive symptoms (Bijl et al., 1998).
As described above, SAD can be seen on a continuum with social anxiety. The
difference between SAD and social anxiety is the level of impairment. People with social
anxiety will experience a feeling of uncertainty when facing a feared social situation, but will
not show severe avoidance behavior nor does the anxiety severely impair their daily life. In
contrast, people with SAD are experiencing impairments in their daily lives by their avoidance
behavior and high levels of anxiety before, during, and after the feared social situation (APA,
2007). However, the exact border between social anxiety and social phobia is unclear
(Heckelman & Scheiner, 1995). Heckelman & Scheiner (1995) describe a prevalence rate of
20 to 40% among college students for social anxiety. So, the frequency of social anxiety is far
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more common than the clinical diagnosis of SAD. At the end of the social anxiety continuum,
Avoidant Personality Disorder (APD) is placed. APD can be associated with high levels of
social anxiety, high levels of global impairments on psychosocial and psychopathological
functioning, and depression (Hofmann & Otto, 2008). The difference between SAD and APD
is that in APD the social anxiety is part of personality traits instead of complaints as it is in
SAD (Millon, Grossman, Millon, Meagher, & Ramnath, 2004).

1.3 The problem of SAD

The impressions we make on others affect the development of our relationships with others
and, therefore, affect our happiness and successes in life. When people are not able to make
the impression they wish to make, they will feel nervous and anxious in social situations
(Leary & Kowalski, 1995). Evidence shows that people with social anxiety are less liked by
others, and thus, do not make a good, nor the desired, impression on others. Voncken, Alden,
Bögels, & Roelofs (2008) concluded this by observing patients with SAD (N=63) and control
participants (N=27) in a 5 minutes conversation with a confederate. Social performance,
negative emotions of the video-observers, desire to meet the participant again, and similarity
of the observer with the patients was rated. It is found that, besides the lower level of
likeability, participants with social anxiety were rated less similar, elicit negative feelings in
others, and were found less social skilled than participants without social anxiety. In addition,
other studies confirm this evidence: people with social anxiety are being less liked, similar,
warm, relaxed, attractive, friendly, interested, and less likeable than people without social
anxiety (Meleshko & Alden, 1993; Papsdorf & Alden, 1998; Pilkonis, 1977). This negative
impression made by others might be an important factor in the maintenance of social anxiety.
The following chapter tries to explain why patients with SAD evoke such negative impression
in others.

1.4 Cognitive behavioral theory

The cognitive behavioral theory is a combined vision of the cognitive theory and the
behavioral theory. The way the high levels of anxiety persists by people with SAD and why
they make a negative impression on others, will be explained by means of this vision.

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According to the behavioral theory, based on the learning theory, people with SAD avoid
social situations caused by the relief of anxiety on the short-term (Hofmann & Otto, 2008). On
the short term, SAD patients feel positive effects of their avoidance behavior, but the long
term effects are negative. This leads to impairments in the daily lives of a person with SAD.
This can be resumed in figure 1. An example of this theory is written in case 1.

Situation

Anxiety

Long-Term
Negative
Avoidance
Short-Term
Positive

Figure 1
Vicious circle of avoidance

Case 1 Avoidance behavior
John is having a birthday party the following day (social situation), but already starts worrying
and is feeling nervous (anxiety). Finally, he calls the party off; he will not come (avoidance). On
the short-term, John is relieved (short-term positive), but on the long-term he gets to know less
people, his environment is getting smaller, he is experiencing a higher threshold for the next party
and he is having higher levels of anxiety (long-term negative).

Looking at case 1, John is supposed to face the social situations to decrease his anxiety instead
of calling off the party. However, this is not what always happens by people with SAD. There
are people who face feared social situations regularly, but still remain to have high levels of
anxiety. This can be explained by the cognitive theory. This theory can be seen as an addition
and refinement of the learning theory. First, the cognitive theory will be described. Then, the
reason for the maintenance of the high level of anxiety within SAD will be described.

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According to the cognitive theory (Clark & Wells, 1995), people with high levels of social
anxiety have the assumption that they are inadequate to function socially and overestimate the
negative reactions of others on certain behavior. They have the thoughts that they will not be
liked and, therefore, they will withdraw themselves from social interaction and avoid contact.
As a consequence of avoidance of social interactions and increased self-consciousness, their
assumptions of being disliked by others maintain and do not habituate: they do not incorporate
new information to correct their dysfunctional assumptions (Oosterbaan, & Bögels, 2000).
When avoiding contact, people with high levels of social anxiety do not learn that their basic
assumption, that others do not like them, does not have to be correct. Therefore, they will not
learn that others are willing to go in conversations with them instead of rejecting them. So,
using avoidance behavior leads to the confirmation that they are not interesting because they
will not start a conversation with someone in the first place (Oosterbaan, & Bögels, 2000).
Furthermore, the cognitive theory states that schemes are like personal rules that
organize information to an interpretation and activation of the relevant information. Those
schemes are personal from person to person. Those schemes structure knowledge and give
meaning to all incoming information (Bögels, 1997). It is a needful structure to organize the
great amount of information that a person receives every day, but it can have an erroneous
impact on the vision of the world. Such as by people with SAD, they have the assumption that
others do not like them, thereby, they are in a constant state of vulnerability. They see the
world as a dangerous place where they have to be aware of the threat of rejection. Those
schemes can cause wrong interpretation of neutral signals and ignorance of positive signals
(Scholing, & Emmelkamp, 1995).
Additionally, self-consciousness is another symptom of SAD. When facing a social
situation, people with SAD focus their attention on themselves. They withdraw themselves
internally and focus on their thoughts and body. This will increase the physical symptoms
which they interpret as evidence as social inadequate behavior, and, therefore, they will find
evidence that they are indeed socially inadequate (Bögels, 1997; Baars, 1993).
Even more importantly, the cognitive theory describes that SAD patients show safety
behaviors. Safety behaviors are strategies developed to try to prevent the feared rejection and
to avoid negative evaluation by others. However, it leads to more inappropriate social
behavior, and, therefore, less likeability by the other and more social rejection (Clark & Wells,

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1995; Voncken, et al., 2008). Safety behaviors are for instance: looking down in order to
avoid eye contact or holding a cup tight to prevent shaking movements (Stagier, Heidenreich
& Schermelleh-Engel, 2006).
The cognitive theory of SAD can be resumed in the model of figure 2.

Social situation

Activation assumptions

Perceived social danger
(negative automatic thoughts)

Safety
behaviors

Processing
self as a Social
Object
Somatic and cognitive
symptoms

Figure 2
Cognitive model of SAD (Clark & Wells, 1995)

As described in the behavioral theory, in contrast with other anxiety disorders, SAD does not
decrease after a while when exposed to a feared (social) situation. This can be explained by
the cognitive theory: as a result of the persistence of cognitive vicious circles, safety
behaviors, and self-consciousness in a social situation, the attention of people with SAD
decreases on the social environment. They do not search nor find evidence on how others
respond to them. This will be seen as evidence of not being liked and, therefore, people with
SAD will withdraw themselves within the situation. This behavior prevents exposure to the
feared situations and prohibits extinction of the anxiety. Thereby, they will not have the right
exposure in the situation, so the levels of anxiety will not decrease (Ly & Roelofs, 2009).
Case 2 describes the persistence of the cognitive model of SAD according to an example.
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