Cognition, Imagery and Coping among Adolescents with Social Anxiety and Phobia: Testing the Clark and Wells Model in the Population

Authors

  • Klaus Ranta,

    Corresponding author
    1. Department of Adolescent Psychiatry, Helsinki University Hospital, Helsinki, Finland
    2. Department of Adolescent Psychiatry, Tampere University Hospital, Tampere, Finland
    • Correspondence to: Klaus Ranta, Department of Adolescent Psychiatry, Helsinki University Central Hospital, P.O. Box 590, FI-00029, Helsinki, Finland.

      E-mail: klaus.ranta@hus.fi

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  • Martti T. Tuomisto,

    1. School of Social Sciences and Humanities, University of Tampere, Tampere, Finland
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  • Riittakerttu Kaltiala-Heino,

    1. Department of Adolescent Psychiatry, Tampere University Hospital, Tampere, Finland
    2. Medical School, University of Tampere, Tampere, Finland
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  • Päivi Rantanen,

    1. Department of Adolescent Psychiatry, Tampere University Hospital, Tampere, Finland
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  • Mauri Marttunen

    1. Department of Adolescent Psychiatry, Helsinki University Hospital, Helsinki, Finland
    2. Department of Adolescent Psychiatry, University of Helsinki, Helsinki, Finland
    3. Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland
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Abstract

The Clark and Wells' cognitive model of social phobia suggests that self-focused attention, negative observer-perspective images of oneself and safety behaviours maintain anxiety in subjects with SP. Empirical research among adults supports the model, but limited evidence for it has been obtained in other age groups or in the general population. We examined automatic thoughts, imagery, safety behaviours and general coping of adolescents with social anxiety and phobia. These were elicited by a thought listing procedure in a recalled, distressing social situation. The target variables were compared between adolescents with high versus normal self-reported social anxiety (HSA/NSA) and between adolescents with clinical/subclinical SP (SP/SSP) versus no diagnosis. Adolescents with HSA reported overall negative thoughts, negative observer-perspective images and safety behaviours more frequently than adolescents with NSA. The SP/SSP group displayed the same difference, and clearer, relative to the no diagnosis group, but additionally reported negative thoughts focused more often on self. Minor differences in coping were found between the groups. The study suggests that adolescents with SP already display the negative self-focused cognitions, observer-perspective imagery and behavioural pattern found among adults with SP. Copyright © 2013 John Wiley & Sons, Ltd.

Key Practitioner Message

  • Social anxiety associates with observer-perspective imagery and safety behaviours in adolescence.
  • Adolescents with clinical social phobia report frequent negative self-focused thoughts.
  • However, such negative cognitions focused on self do not associate to self-reported social anxiety.
  • The cognitive model of social phobia (Clark & Wells, 1995) is applicable to adolescents.

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