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Australian Journal of Psychology 2014; 66: 139148

doi: 10.1111/ajpy.12053

Emotion beliefs in social anxiety disorder: Associations with

stress, 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
1

Research School of Psychology, Australian National University, Canberra, Australian Capital Territory, Australia,
Clinically 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
2

Abstract
Dysfunctional beliefs play an important role in the aetiology and maintenance of social anxiety disorder (SAD). Despite thisand the
heightened salience of emotion in SADlittle is known about SAD patients beliefs about whether emotions can be influenced or
changed. The current study examined these emotion beliefs in patients with SAD and in non-clinical participants. Overall, patients
were more likely to hold entity beliefs (i.e., viewing emotions as things that cannot be changed). However, this group difference in
emotion beliefs varied by emotion domain. Specifically, SAD patients more readily held entity beliefs about their own emotions and
anxiety than about emotions in general. By contrast, non-clinical participants more readily held entity beliefs about emotions in
general than about their own. Results also indicated that even when controlling for social anxiety severity, patients with SAD differed
in their beliefs about their emotions, and these beliefs explained unique variance in perceived stress, trait anxiety, negative affect, and
self-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 disorder 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 friendships 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).

Correspondence: Krista De Castella, Ph.B (Bachelor of Philosophy,

Honors (Psychology)), BA in Communications, Department of Psychology, Jordan Hall, Bldg. 420, Stanford, CA 94305-2130, USA.
Email: krista1@stanford.edu
The authors of this manuscript do not have any direct or indirect
conflicts of interest, financial, or personal relationships or affiliations
to disclose.
Received 21 May 2013. Accepted for publication 23 January
2014.
2014 The Australian Psychological Society

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 disorders
aetiology and treatmentparticularly 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 ones appearance (Rapee,
Gaston, & Abbott, 2009), and negative core beliefs about
the self (e.g., I am unlovable; I dont 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

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K. De Castella et al.

thought to lead toand perpetuateexaggerated emotional 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 probability and cost biases and on maladaptive self-beliefs, one category 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 emotions (De Castella et al., 2013; Tamir, John, Srivastava, &
Gross, 2007). People holding entity beliefs believe emotions
cannot really be changed or controlled. People holding incremental beliefs, on the other hand, view emotions as malleable 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 ones
shyness (e.g., my shyness is something about me that I cant
change very much) have been linked with greater avoidance 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 independent observers (Beer, 2002). In the context of beliefs
about emotions, students holding entity beliefs report more
emotion regulation difficulties, more negative and less positive 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, peoples beliefs about their ability to control
their own emotions are a stronger predictor of these outcomes 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 examining patients beliefs about their emotions. Patients with SAD
struggle with attending to, describing, expressing, and regulating 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 nonclinical 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 specific 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 peoples beliefs about the controllability of emotions in general differed from their beliefs about the controllability 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 ones 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 wellbeing (positive and negative affect, self-esteem, and satisfaction with life) (Hypothesis 3). In these analyses, we also
conducted hierarchical linear regressions to examine the
extent to which patients emotion beliefs explained unique
2014 The Australian Psychological Society

Emotion beliefs in social anxiety disorder

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 nonclinical 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 interviewthe 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 treatment 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 cognitive 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

141

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 emotions 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 incremental theory of emotions. Cronbachs 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 ones 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, Cronbachs alphas, means, and standard deviations for patients with social anxiety disorder (SAD, n = 75) and
non-clinical participants (NC, n = 42)

Variable
Emotion beliefs
1. Entity beliefs about emotions (General)
2. Entity beliefs about emotions (Personal)
3. Entity beliefs about emotions (Anxiety)
Stress and anxiety
4. Perceived stress (PSS-4)
5. Trait anxiety (STAI-T)
6. Social anxiety (SIAS-S)
7. Social anxiety (LSAS-SR)
Well-being
8. Self esteem (RSES)
9. Life satisfaction (SWLS)
10. Positive affect (PANAS)
11. Negative affect (PANAS)
2014 The Australian Psychological Society

Possible
range

SAD

NC

SAD

NC

SD

SD

420
420
420

.78
.80
.81

.70
.91
.92

9.77
11.40
11.77

3.42
3.54
4.03

8.5
7.43
6.79

3.13
3.17
2.78

416
2080
068
0144

.81
.89
.89
.91

.64
.87
.88
.92

10.21
55.02
44.63
82.78

3.15
9.11
10.21
18.25

6.45
29.19
13.4
15.95

1.99
6.34
8.6
10.24

1040
535
1050
1050

.88
.91
.87
.89

.79
.88
.85
.87

24.92
16.68
28.10
25.64

5.21
5.99
5.70
7.67

35.19
26.62
34.93
14.62

3.74
5.44
6.60
4.89

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K. De Castella et al.

these general and personal beliefs in clinical samples,

research in student samples indicates that the personal scale
is reliable ( = .79) and explains greater variance in wellbeing 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
ones ability to change or control ones 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 cant 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 clinical 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 doesnt 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 original 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 characteristic or true of me) to 4 (Extremely characteristic or true of me).
Summed scores ranged from 0 to 68. The SIAS-S has demonstrated 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 avoidance 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 Satisfaction 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 Likerttype 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 (), and correlations among the three emotion belief domains and measures of clinical symptoms, anxiety, perceived stress, and
well-being are presented in Tables 1 and 2.
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Emotion beliefs in social anxiety disorder

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Table 2 Correlations between measures for patients with social anxiety disorder (SAD, n = 75)
Correlations
Variable

Emotion beliefs
1. Entity beliefs about emotions (General) 1 .65*** .51*** .43*** .11
.01
2. Entity beliefs about emotions (Personal)
1
.79*** .40*** .23*
.15
3. Entity beliefs about emotion (Anxiety)
1
.36*** .24*
.23*
Stress and anxiety
4. Perceived stress (PSS-4)
1
.50*** .29*
5. Trait anxiety (STAI-T)
1
.36***
6. Social anxiety (SIAS-S)
1
7. Social anxiety (LSAS-SR)
Well-being
8. Self esteem (RSES)
9. Life satisfaction (SWLS)
10. Positive affect (PANAS)
11. Negative affect (PANAS)

10

11

.13
.02
.08

.13
.08
.39*** .15
.41*** .17

.09
.07
.06

.17
.26*
.28**

.40***
.32**
.55***
1

.40***
.74***
.38***
.25*

.60***
.66***
.37***
.29**

.42***
.35**
.14
.14

.40**
.57***
.29*
.34***

.60***
1

.34*** .52***
.26*
.42***
1
.14
1

Note. Correlations for patients with social anxiety disorder (n = 75). PSS-4 = Perceived Stress Scale; STAI-T = State Trait Anxiety Inventory (Trait
Scale); SIAS-S = Social Interaction Anxiety Straightforward Scale; LSAS-SR = Liebowitz Social Anxiety Scale (Self-Report); RSES = Rosenberg SelfEsteem Scale; SWLS = Satisfaction with Life Scale; PANAS = Positive and Negative Affect Schedule.
*p < .05, **p < .05, ***p < .001.

Hypothesis 1: Patients with SAD and

non-clinical participants

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Non-clinical Participants
n = 42

Patients with SAD

n = 75

12

10

Entity Theory

To examine whether patients with SAD differed from nonclinical participants (NC) in their beliefs about emotions, we
conducted a 2 group (SAD vs NC) 3 belief domain (personal, general, anxiety) repeated-measures analysis of variance. 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 emotions 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.
Cohens (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

14

General Beliefs

Personal Beliefs

Anxiety Beliefs

Figure 1 Beliefs about emotion in non-clinical (NC) and social

anxiety disorder (SAD) participants.
Note. Patients with SAD held stronger entity beliefs about emotions
than non-clinical participants (in all belief domains), and stronger
entity beliefs on the personal and anxiety scales than on the general
scales. Non-clinical participants, by contrast, held weaker entity
beliefs on the personal and anxiety scales than on the general. For
patients with SAD and non-clinical participants, there was no significant difference between emotion beliefs on the personal and
anxiety scales.

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

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K. De Castella et al.

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 participants 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 significant 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 correlated 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 variables (see Table 3). Results revealed that even when controlling for social anxiety, patients beliefs about their emotions
(general, personal, and anxiety belief measures) accounted
for 1123% of unique variance in stress. For trait anxiety,
personal emotion beliefs also contributed 4% of unique variance. 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 correlations 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 positive 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 following 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 1112% of the variance in self-esteem; and 56%
of the variance in negative affect. None of the emotion belief
measures, however, were significant predictors of life satisfaction 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 dysfunctional 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 indicate 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 significantly correlated with positive affect or life satisfaction.
These results are inconsistent with observed links between
emotion beliefs and indices of well-being in larger undergraduate samples (De Castella et al., 2013; Tamir et al.,
2007). However, it is possible that for patients with SAD,
emotion beliefs have a smalleror indirectassociation
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
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Emotion beliefs in social anxiety disorder

145

Table 3 Results of hierarchical regressions predicting variables from emotion beliefs in patients with SAD (n = 75)
Step 1
Dependent variable and step
Stress
Social anxiety (LSAS-SR)
Social anxiety (SIAS)
General emotion beliefs
Personal emotion beliefs
Anxiety emotion beliefs
Trait anxiety
Social anxiety (LSAS-SR)
Social anxiety (SIAS)
General emotion beliefs
Personal emotion beliefs
Anxiety emotion beliefs
Self esteem
Social anxiety (LSAS-SR)
Social anxiety (SIAS)
General emotion beliefs
Personal emotion beliefs
Anxiety emotion beliefs
Life satisfaction
Social anxiety (LSAS-SR)
Social anxiety (SIAS)
General emotion beliefs
Personal emotion beliefs
Anxiety emotion beliefs
Positive affect
Social anxiety (LSAS-SR)
Social anxiety (SIAS)
General emotion beliefs
Personal emotion beliefs
Anxiety emotion beliefs
Negative affect
Social anxiety (LSAS-SR)
Social anxiety (SIAS)
General emotion beliefs
Personal emotion beliefs
Anxiety emotion beliefs

SE B

.05
.02

.02
.04

.09
.26

.02
.20

.01
.25

.03
.05

.11
.12

.07
.13

.04
.08

.05
.10

.04
.09

.06
.11

Step 2

.36**
.05

.18
.26*

.06
.34

.01
.32

.10
.08

.26
.14

SE B

R2 Total

R2 Change

.15**
.37
.31
.22

.07
.07
.07

.49**
.41**
.34**

.39**
.28**
.26**

.23**
.16**
.11**

.38
.53
.41

.29
.28
.25

.14
.21*
.18

.17**
.19**
.18**

.02
.04*
.03

.18
.51
.44

.17
.15
.14

.12
.35**
.34**

.16**
.26**
.26**

.02
.12**
.11**

.13
.14
.09

.23
.23
.20

.07
.07
.05

.10*
.11*
.10*

.00
.01
.00

.18
.11
.05

.20
.19
.17

.11
.06
.03

.04
.03
.03

.01
.00
.00

.46
.54
.44

.25
.24
.21

.20
.25
.23

.17**
.19**
.18**

.04
.06*
.05*

15**

.14**

.10*

.03

.13**

Results from hierarchical regression analyses reported above. Significance levels are based on two-tailed significance tests. Increments for variables
entered at R2 Change significance levels are based upon F-tests for that step.
*p < .05, **p < .01.

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 anxietybelieving them to be stable qualities
or personality traits rather than a treatable psychiatric
disorderthis may help explain why many sufferers fail to
seek treatment (Grant et al., 2005).
Acknowledging discrepancies between peoples 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 considered one of the most potent nonspecific factors in predicting general treatment response (Arnkoff, Glass, & Shapiro,
2002). Such expectations are linked treatment outcomes for
patients with SAD (Safren, Heimberg, & Juster, 1997), and
2014 The Australian Psychological Society

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 interviewing (Miller & Rollnick, 2002). Research indicates that
these approaches are an effective adjunct to CBT for generalised 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

146

K. De Castella et al.

the effectiveness of treatment in teaching skills for controlling 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 symptoms 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 selfreports. 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 evaluations, implicit association tasks, psychophysiological assessments, 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 generalised 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 typically 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 possibleand even likelythat
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 psychological illness.
Third, although the current study documents robust crosssectional associations between emotion beliefs, perceived
stress, anxiety, and well-being, we still know little about the

origins and developmental course of emotion beliefssuch

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, perceived 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 recoveryparticularly in therapeutic
approaches such as CBTs which actively teach patients strategies 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. Cohens
d have been corrected for dependence between the means
(see equation 8, Morris & DeShon, 2002).

REFERENCES
American Psychiatric Association (1994). Diagnostic and statistical
manual of mental disorders (DSM-IV) (4th ed.). Washington, DC:
American Psychiatric Publishing.
American Psychiatric Association (2013). Diagnostic and statistical
manual of mental disorders (DSM-V) (5th ed.). Arlington, VA:
American Psychiatric Publishing.
Arnkoff, D. B., Glass, C. R., & Shapiro, D. A. (2002). Expectations
and preferences. In J. C. Norcross (Ed.), Psychotherapy relationships
that work (pp. 335356). Oxford: University Press.
Barlow, D. H. (2000). Unraveling the mysteries of anxiety and its
disorders from the perspective of emotion theory. The American
Psychologist, 55(11), 12471263. doi:10.1016/01650327(90)
90005-S
Beer, J. S. (2002). Implicit self-theories of shyness. Journal of Personality and Social Psychology, 83(4), 10091024. doi:10.10371/002235l4.83.4.1009
Boden, M. T., John, O. P., Goldin, P. R., Werner, K., Heimberg, R. G.,
& Gross, J. J. (2012). The role of maladaptive beliefs in cognitive 2014 The Australian Psychological Society

Emotion beliefs in social anxiety disorder

behavioral therapy: Evidence from social anxiety disorder. Behaviour Research and Therapy, 50(5), 287291. doi:10.1016/j.brat
.2012.02.007
Brown, T. A., DiNardo, P., & Barlow, D. H. (1994). Anxiety disorders
interview schedule lifetime version (ADIS-IV-L) specimen set: Includes
clinician manual and one ADIS-IV-L client interview schedule. Boulder,
CO: Graywind Publications.
Brozovich, F. A., & Heimberg, R. (2011). A treatment refractory case
of social anxiety disorder: Lessons learned from a failed course of
cognitive-behavioral therapy. Cognitive and Behavioral Practice,
18(3), 316325. doi:10.1016/j.cbpra.2010.07.003
Bruch, M. A., Fallon, M., & Heimberg, R. G. (2003). Social
phobia and difficulties in occupational adjustment. Journal
of Counseling Psychology, 50(1), 109117. doi:10.1037/0022
0167.50.1.109
Buckner, J. D., & Schmidt, N. B. (2009). A randomized pilot study of
motivation enhancement therapy to increase utilization of
cognitive-behavioral therapy for social anxiety. Behaviour Research
and Therapy, 47(8), 710715. doi:10.1016/j.brat.2009.04.009
Clark, D. M. (2001). A cognitive perspective on social phobia. In W.
R. Crozier & L. E. Alden (Eds.), International handbook of social
anxiety: Concepts, research and interventions relating to the self and
shyness. New York: John Wiley & Sons.
Clark, D. M., & Wells, A. (1995). A cognitive model of social phobia.
In R. G. Heimberg, M. R. Liebowitz, D. A. Hope, & F. R. Schneier
(Eds.), Social phobia: Diagnosis, assessment and treatment (pp. 6993).
New York: The Guilford Press.
Cohen, J. (1988). Statistical power analysis for the behavioral sciences.
Hillsdale, New Jersey: Lawrence Erlbaum Associates Publishers.
Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure
of perceived stress. Journal of Health and Social Behavior, 24(4),
385396. doi:10.2307/2136404
Crawford, J. R., & Henry, J. D. (2004). The positive and negative
affect schedule (PANAS): Construct validity, measurement properties and normative data in a large non-clinical sample. The
British Journal of Clinical Psychology / the British Psychological Society,
43(3), 245265. doi:10.1348/0144665031752934
De Castella, K., Goldin, P., Jazaieri, H., Ziv, M., Dweck, C. S., &
Gross, J. J. (2013). Beliefs about emotion: Links to emotion
regulation, well-being, and psychological distress. Basic and
Applied Social Psychology, 35(6), 497505. doi:10.1080/01973533
.2013.840632
Diener, E., Emmons, R. A., Larsen, R. J., & Griffin, S. (1985). The
satisfaction with life scale. Journal of Personality Assessment, 49(1),
7175. doi:10.1207/s15327752jpa4901_13
Dweck, C. S. (1999). Self-theories: Their role in motivation, personality,
and development. Philadelphia: Psychology Press.
Fresco, D. M., Coles, M. E., Heimberg, R. G., Liebowitz, M. R., Hami,
S., Stein, M. B., & Goetz, D. (2001). The Liebowitz social anxiety
scale: A comparison of the psychometric properties. Psychological
Medicine, 31(6), 10251035. doi:10.1017\S003329170105405
Gaudiano, B. A., & Herbert, J. D. (2003). Preliminary psychometric
evaluation of a new self-efficacy scale and its relationship to
treatment outcome in social anxiety disorder. Cognitive Therapy
and Research, 27(5), 537555. doi:10.1023/A:1026355004548
Goldin, P. R., Ziv, M., Jazaieri, H., Werner, K., Kraemer, H.,
Heimberg, R. G., & Gross, J. J. (2012). Cognitive reappraisal
self-efficacy mediates the effects of individual cognitivebehavioral therapy for social anxiety disorder. Journal of Consulting and Clinical Psychology, 80(6), 10341040. doi:10.1037/
a0028555
Grant, B. F., Hasin, D. S., Blanco, C., Stinson, F. S., Chou, S. P.,
Goldstein, R. B., & Huang, B. (2005). The epidemiology of social
anxiety disorder in the United States: Results from the national
epidemiologic survey on alcohol and related conditions. Journal of
Clinical Psychiatry, 66(11), 13511361. doi:PMID:16420070
2014 The Australian Psychological Society

147

Heimberg, R. G., Brozovich, F. A., & Rapee, R. M. (2010). A

cognitive-behavioral model of social anxiety disorder: Update and
extension. Social Anxiety: Clinical, Developmental, and Social Perspectives, 2, 395422. doi:10.1016/B978-0-12-375096-9.00015-8
Hewitt, P. L., Flett, G. L., & Mosher, S. W. (2012). The perceived
stress scale: Factor structure and relation to depression symptoms
in a psychiatric sample. Journal of Psychopathology and Behavioral
Assessment, 14(3), 247257. doi:10.1007/BF00962631
Hofmann, S. G. (2000). Treatment of social phobia: Potential mediators and moderators. Clinical Psychology, 7(1), 316. doi:10.1093/
clipsy.7.1.3
Hofmann, S. G. (2004). Cognitive mediation of treatment change in
social phobia. Journal of Consulting and Clinical Psychology, 72(3),
393399. doi:10.1037/0022-006X.72.3.393
Hofmann, S. G. (2005). Perception of control over anxiety mediates
the relation between catastrophic thinking and social anxiety
in social phobia. Behaviour Research and Therapy, 43(7), 885
895.
Hofmann, S. G. (2007). Cognitive factors that maintain social
anxiety disorder: A comprehensive model and its treatment
implications. Cognitive Behaviour Therapy, 36(4), 193209. doi:10
.1080/16506070701421313
Kashdan, T. B., & Herbert, J. D. (2001). Social anxiety disorder in
childhood and adolescence: Current status and future directions.
Clinical Child and Family Psychology Review, 4(1), 3761.
doi:10.1023/A:1009576610507
Kessler, R., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., &
Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the national comorbidity
survey replication. Archives of General Psychiatry, 62(6), 593602.
doi:10.1001/archpsyc.62.6.593
Kuo, J. R., Goldin, P. R., Werner, K., Heimberg, R. G., & Gross, J. J.
(2011). Childhood trauma and current psychological functioning
in adults with social anxiety disorder. Journal of Anxiety Disorders,
25(4), 463473. doi:10.1016/j.janxdis.2010.11.011
Ledley, D. R., Erwin, B. A., Morrison, A. S., & Heimberg, R. G.
(2013). Social anxiety disorder. In W. E. Craighead, D. J.
Miklowitz, & L. W. Craighead (Eds.), Psychopathology: History,
theory, and empirical foundations (2nd ed., pp. 147192). New York:
John Wiley & Sons.
Leung, A. W., & Heimberg, R. G. (1996). Homework compliance,
perceptions of control, and outcome of cognitive-behavioral.
Behaviour Research and Therapy, 34(56), 423432. doi:10.1016/
00057967(96)00014-9
Liebowitz, M. R. (1987). Social phobia. Modern Problems of
Pharmacopsychiatry, 22, 141173.
Manser, R., Cooper, M., & Trefusis, J. (2011). Beliefs about emotions
as a metacognitive construct: Initial development of a self-report
questionnaire measure and preliminary investigation in relation
to emotion regulation. Clinical Psychology and Psychotherapy, 19(3),
235246. doi:10.1002/cpp.745
Mattick, R. P., & Clarke, J. C. (1998). Development and validation of
measures of social phobia scrutiny fear and social interaction
anxiety. Behaviour Research and Therapy, 36(4), 455470.
doi:S00057967(97)10031-6 [pii]
Mennin, D. S., McLaughlin, K. A., & Flanagan, T. J. (2009). Emotion
regulation deficits in generalized anxiety disorder, social anxiety
disorder, and their co-occurrence. Journal of Anxiety Disorders,
23(7), 866871. doi:10.1016/j.janxdis.2009.04.006
Miller, W. R., & Rollnick, S. (2002). Motivational interviewing: Preparing people for change (2nd ed.). New York: The Guilford Press.
Miller, W. R., Zweben, A., DiClemente, C. C., & Rychtarik, R. G.
(1992). Motivational enhancement therapy manual: A clinical research
guide for therapists treating individuals with alcohol abuse and dependence. Rockville, MD: National Institute on Alcohol Abuse and
Alcoholism (NIAAA).

148

K. De Castella et al.

Montesi, J. L., Conner, B. T., Gordon, E. A., Fauber, R. L., Kim, K.

H., & Heimberg, R. G. (2012). On the relationship among social
anxiety, intimacy, sexual communication, and sexual satisfaction
in young couples. Archives of Sexual Behavior, 42(1), 8991.
doi:10.1007/s10508-012-9929-3
Monti, J. D., Rudolph, K. D., & Abaied, J. L. (2013). Contributions of maternal emotional functioning to socialization of
coping. Journal of Social and Personal Relationships, 31(2), 247
269.
Morris, S. B., & DeShon, R. P. (2002). Combining effect size
estimates in meta-analysis with repeated measures and
independent-groups designs. Psychological Methods, 7(1), 105125.
doi:10.1037/1082-989X.7.1.105
Moscovitch, D. A., Gavric, D. L., Merrifield, C., Bielak, T., &
Moscovitch, M. (2011). Retrieval properties of negative versus
positive mental images and autobiographical memories
in social anxiety: Outcomes with a new measure. Behavior
Research and Therapy, 49(8), 505517. doi:10.1016/j.brat.2011.05
.009
Pavot, W., & Diener, E. (2008). The Satisfaction With Life Scale and
the emerging construct of life satisfaction. The Journal of Positive
Psychology, 3, 137152. doi:10.1080/17439760701756946
Price, M., & Anderson, P. L. (2011). Outcome expectancy as a
predictor of treatment response in cognitive behavioral therapy
for public speaking fears within social anxiety disorder. Psychotherapy (Chicago, Ill.), 49(2), 17. doi:10.1037/a0024734
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(2),
317327. doi:10.1037/a0014800
Rodebaugh, T. L. (2009). Social phobia and perceived friendship
quality. Journal of Anxiety Disorders, 23(7), 872878. doi:10.1016/
j.janxdis.2009.05.001
Rodebaugh, T. L., Woods, C. M., Heimberg, R. G., Liebowitz, M. R.,
& Schneier, F. R. (2006). The factor structure and screening utility
of the Social Interaction Anxiety Scale. Psychological Assessment,
18(2), 231237. doi:10.1037/10403590.18.2.231
Rodebaugh, T. L., Woods, C. M., & Heimberg, R. G. (2007). The
reverse of social anxiety is not always the opposite: The reversescored items of the social interaction anxiety scale do not belong.
Behavior Therapy, 38(2), 192206. doi:10.1016/j.beth.2006.08
.001
Rosenberg, M. (1965). Society and the adolescent self-image. Princeton,
NJ: Princeton University Press.
Rudolph, J., & Zimmer-Gembeck, M. J. (2013). Parent relationships
and adolescents depression and social anxiety: Indirect associations via emotional sensitivity to rejection threat. Australian
Journal of Psychology. doi: 10.1111/ajpy.12042.
Safren, S. A., Heimberg, R. G., & Juster, H. R. (1997). Clients
expectancies and their relationship to pretreatment symptomatology and outcome of cognitive-behavioral group treatment for
social phobia. Journal of Consulting and Clinical Psychology, 65(4),
694. doi:10.1037/0022-006X.65.4.694
Schneier, F. R., Johnson, J., Hornig, C. D., Liebowitz, M. R., &
Weissman, M. M. (1992). Social phobia. Comorbidity and morbidity in an epidemiologic sample. Archives of General Psychiatry,
49(4), 282288. doi:10.1001/archpsyc.1992.01820040034004

Schneier, F. R., Heckelman, L. R., Garfinkel, R., Campeas, R., Fallon,

B. A., Gitow, A., & Liebowitz, M. R. (1994). Functional impairment in social phobia. The Journal of Clinical Psychiatry, 55(8),
322331. doi:199504074-001
Schreiber, F., Bohn, C., Aderka, I. M., Stangier, U., & Steil, R.
(2012). Discrepancies between implicit and explicit self-esteem
among adolescents with social anxiety disorder. Journal of
Behavior Therapy and Experimental Psychiatry, 43(4), 10741081.
doi:10.1016/j.jbtep.2012.05.003
Schulz, S. M., Alpers, G. W., & Hofmann, S. G. (2008). Negative
self-focused cognitions mediate the effect of trait social anxiety on
state anxiety. Behaviour Research and Therapy, 46(4), 438449.
doi:10.1016/j.brat.2008.01.008
Simon, N. M., Otto, M. W., Korbly, N. B., Peters, P. M., Nicolaou, D.
C., & Pollack, M. H. (2002). Quality of life in social anxiety
disorder compared with panic disorder and the general population. Psychiatric Services (Washington, D.C.), 53(6), 714718.
doi:10.1176/appi.ps.53.6.714
Smits, J. A. J., Julian, K., Rosenfield, D., & Powers, M. B. (2012).
Threat reappraisal as a mediator of symptom change in cognitivebehavioral treatment of anxiety disorders: A systematic review.
Journal of Consulting and Clinical Psychology, 80(4), 624635.
doi:10.1037/a0028957
Spielberger, C. D., Gorsuch, R. L., Lushene, P. R., Vagg, P. R., &
Jacobs, G. A. (1983). Manual for the state-trait anxiety inventory. Palo
Alto, CA: Consulting Psychologists Press.
Tamir, M., & Mauss, I. B. (2011). Social cognitive factors in emotion
regulation: Implications for well-being. In I. Nyklicek, A.
Vingerhoets, M. Zeelenberg, & J. Donellet (Eds.), Emotion regulation and well-being (pp. 3147). New York: Springer.
Tamir, M., John, O. P., Srivastava, S., & Gross, J. J. (2007). Implicit
theories of emotion: Affective and social outcomes across a major
life transition. Journal of Personality and Social Psychology, 92(4),
731. doi:10.1037/00223514.92.4.731
Wagner, R., Silove, D., Marnane, C., & Rouen, D. (2006). Delays in
referral of patients with social phobia, panic disorder and generalized anxiety disorder attending a specialist anxiety clinic.
Journal of Anxiety Disorders, 20(3), 363371. doi:10.1016/
j.janxdis.2005.02.003
Watson, D., Clark, L. A., & Tellegen, A. (1988). Development and
validation of brief measures of positive and negative affect: The
PANAS scales. Journal of Personality and Social Psychology, 54(6),
10631070. doi:10.1037/00223514.54.6.1063
Werner, K. H., Goldin, P. R., Ball, T. M., Heimberg, R. G., & Gross, J.
J. (2011). Assessing emotion regulation in social anxiety disorder:
The emotion regulation interview. Journal of Psychopathology and
Behavioral Assessment, 33(3), 346354. doi:10.1007/s10862-0119225-x
Westra, H. A., Arkowitz, H., & Dozois, D. J. (2009). Adding a motivational interviewing pretreatment to cognitive behavioral
therapy for generalized anxiety disorder a preliminary
randomized controlled trial. Journal of Anxiety Disorders, 23(8),
11061117. doi:10.1016/j.janxdis.2009.07.014
Wong, Q. J. J., & Moulds, M. L. (2011). The relationship between
the maladaptive self-beliefs characteristic of social anxiety and
avoidance. Journal of Behavior Therapy and Experimental Psychiatry,
42(2), 171178. doi:10.1016/j.jbtep.2010.11.004

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