Social anxiety refers to intense anxiety triggered by social situations, especially those involving evaluation from others.
Those suffering from social anxiety often fear embarrassing themselves or losing status, leading to avoidance of interactions like public speaking, starting conversations, or asserting opinions around others.
Physiological arousal, distorted negative thoughts about oneself, and self-conscious emotions like shame characterize the condition that affects millions of people to some degree.
Social anxiety varies in severity as an experience common to almost everyone, to the chronic disorder hampering connection.
Azoulay, R., Avigadol, L., & Gilboa-Schechtman, E. (2023). Social anxiety and accumulation of status loss events: The role of adulthood experiences. British Journal of Clinical Psychology, 62(2), 518–524. https://doi.org/10.1111/bjc.12417
Key Points
- Social anxiety (SA) has a robust association with experiencing status loss events (SLEs), such as humiliations or rejection, across the lifespan. However, the current research suggests SLEs in adulthood may have a uniquely strong relationship with SA severity.
- Multiple studies have linked early childhood and adolescent SLEs to later SA, supporting developmental models where early social threats alter socioemotional trajectories. However, the present studies are the first to demonstrate adult SLEs relate to concurrent SA above and beyond the impact of early SLEs.
- These results align with evolutionary models that conceptualize SA as an adaptive strategy to preemptively avoid threats to social status and mitigate damage. From this lens, SA maps onto current levels of perceived social dangers in one’s environment rather than solely stemming from childhood sensitization.
- Monitoring SLE exposure across developmental periods could inform case conceptualization and treatment of SA. Adult SLEs may play an underestimated precipitating and maintaining role for some cases of significantly impairing SA. Interventions may need to address both historical and proximal social threats.
Rationale
Decades of research have shown that childhood social trauma increases the risk for adult social anxiety (SA). However, less is known about the impact of recent adult social threats.
Competing models suggest either early childhood or current social status losses better explain individual differences in SA.
This research directly compared, for the first time, the relative potency of childhood/adolescent traumatic social experiences (SLEs) versus adult SLEs. These SLEs can include traumatic social experiences involving humiliation, rejection, and shame.
Isolating the impact of adult SLEs allowed testing competing predictions on whether proximal or distal social threats better explain variation in SA.
Clarifying the relevance of adult SLEs also addresses a key gap in the literature, which has focused more on distal developmental events.
Understanding the impact of adult versus childhood SLEs significantly advances etiological models of SA and informs interventions by delineating critical sensitive periods across the lifespan.
Testing the competing models – early childhood sensitization versus ongoing adaptation – has important theoretical and clinical implications for conceptualizing SA.
Method
These questions were examined using two questionnaire studies with adult participants. The studies utilized established measures of SA severity and depression proneness, as well as a modified version of the Humiliation Inventory that separated out SLE frequency in childhood, adolescence, and adulthood.
This inventory contained items like “I was laughed at by others” or “I was rejected by peers.” Participants rated how often these experiences occurred within each developmental period.
Utilizing these retrospective self-report measures of lifetime SLEs, the studies tested if SA related more strongly to adult vs early SLEs using hierarchical regression analyses.
Depression was controlled, given its association with both SA and negative life events.
Study 1 had 166 participants, while the replication in Study 2 had a larger sample of 431 adults.
Sample
The participants consisted of 166 (Study 1) and 431 (Study 2) adults recruited from a neutral community setting. The samples appear representative as reflected in the proportion endorsing clinically significant SA (21-28%).
However, no further demographic details were provided in the brief report.
Statistical Analysis
Hierarchical linear regression analyses were utilized in both studies, entering covariates in step 1 (childhood SLEs, adolescent SLEs, depression) before examining if adult SLEs explained additional variance in SA severity in step 2.
This allowed the isolation of the unique impact of adult SLEs above other relevant predictors.
Results
Across both studies, SA severity related positively to SLE frequency within each developmental stage. However, adult SLE frequency predicted residual variance in SA even when accounting for early SLEs, depression, and their interrelationships.
On average, adult SLE frequency accounted for 10-15% of additional variance.
Insight
These studies represent the first empirical separation of distal vs proximal SLEs in predicting concurrent SA.
The results suggest adult SLE exposure has an under-recognized role, consistent with evolutionary models where SA maps onto perceptions of present social dangers.
SA may remain sensitive to current experiences of humiliation and rejection rather than solely tied to childhood calibration.
Strengths
- The studies utilized established measures and sufficiently large sample sizes.
- The design directly compared the relevance of childhood vs adult SLEs by isolating their impact statistically.
- Results were replicated across two independent samples.
Limitations
- The retrospective reporting allows for recall biases.
- The lack of longitudinal assessment makes causal claims difficult.
- Limited demographic details were provided to contextualize the sample.
- Unclear if results generalize to clinical levels of SA.
Implications
These findings substantiate the need to assess adult SLE exposure as part of case conceptualization and treatment planning when working with socially anxious populations. Developmental models have rightfully emphasized early childhood prevention and intervention efforts.
However, a certain subset of adults may develop SA or experience symptom exacerbations predominantly in response to recent SLEs rather than solely as a legacy of childhood sensitization.
For such patients, schema therapy and processing of historical social trauma may fail to improve symptoms if proximal stressors are ignored.
Consequently, psychosocial treatments may require dual attention on increasing resilience to adult SLEs while addressing schematic beliefs shaped by adverse childhood experiences. These could include improving social assertiveness skills and protective self-appraisals in the face of adult humiliations.
Conclusion
In summary, these studies highlight proximal threats to social status that may precipitate or maintain high SA, above and beyond the impact of early adverse events. This observation requires replication using clinical samples and longitudinal methods.
Elucidating the conditions under which distal vs. proximal SLEs contribute to SA has implications for refining case formulation tools and personalizing treatment plans.
Future studies can also examine possible moderators such as temperament traits and self-conceptions.
Overall, these preliminary findings converge with evolutionary models where SA retains adaptive function by scanning for present indicators of social dangers such as rejection and subordination stressors.
The current results suggest this vigilance for status threats persists throughout the lifespan rather than being fixed in childhood.
Moving forward, clinicians and researchers should consider adult SLE exposure as a potentially crucial piece in understanding SA etiology, course, and symptom exacerbations.
References
Azoulay, R., Avigadol, L., & Gilboa-Schechtman, E. (2023). Social anxiety and accumulation of status loss events: The role of adulthood experiences. British Journal of Clinical Psychology, 62(2), 518–524. https://doi.org/10.1111/bjc.12417
Learning check
- How might adult vs childhood SLEs differ in their psychological impact?
- Could other factors moderate the effects of SLE timing on SA?
- What mechanisms might explain the association between adult SLEs and SA?
- What longitudinal questions remain about the causal relationships?
