A recent study tested a new experimental procedure that may help researchers investigate treatments for social anxiety disorder. The study authors developed a social stress test that induces symptoms of social anxiety disorder and can be conducted entirely online. The findings were published in the journal Psychiatry Research.
Social anxiety disorder (SAD) is a debilitating disorder marked by a pronounced fear of social interaction. Treatments for social anxiety disorder are lacking and its remission rate is the lowest of all anxiety disorders. Study author Nathan T.M. Huneke (@nathanhuneke) and his coauthors developed a novel experimental procedure that they hoped might be useful for exploring potential treatment options for SAD.
“SAD is one of the most common mental disorders and can be highly disabling,” said Huneke, a MRC Clinical Research Training Fellow at the University of Southampton Faculty of Medicine. “We need new treatments for SAD, because not everyone responds to first line treatments, it can be hard to access psychotherapy, and medications can cause unwanted side-effects. One way we test whether it is worth taking a treatment to a clinical trial is by using an experimental model, where we experimentally re-create the symptoms of a disorder. We were interested in finding out whether we could create an experimental model for SAD using videoconferencing software.”
The researchers designed a social stress test called the Internet-Based Stress Test for Social Anxiety Disorder (ITSSAD). The ITSSAD follows a similar design to the widely used Trier Social Stress Test (TSST), where participants are asked to complete a public speaking task as a stress and anxiety induction. But instead of public speaking, participants are tasked with getting to know another person. Huneke and colleagues proposed that this latter type of task targets a specific feature of SAD, rather than stress that may not be specific to SAD. Notably, the ITSSAD can be employed entirely online, making it cost-effective and a promising option for remote research.
To test their online stress test, the researchers recruited 20 participants with moderate to severe social anxiety symptoms. Subjects were between the ages of 18 and 45 and most (85%) were female. After completing a host of personality questionnaires, participants attended a private, online testing session.
During the session, participants were told that they would soon be taking part in a social interaction task where they would be expected to get to know another person using videoconferencing software. This instruction was followed by a 5-minute anticipation period before participants entered a videoconference and conversed with an experimenter for five minutes. Participants were told that their performance was being recorded by a panel of experts who had their cameras off but were evaluating the performance. In reality, the panel consisted of four dummy accounts controlled by the experimenter.
Subjective anxiety and mood were measured at three time points: at baseline, after the anticipation period, and following the social task. The researchers used various statistical analyses to explore how participants’ anxiety and mood fluctuated throughout the experiment.
As expected, participants’ anxiety increased during the anticipation period and remained high after the social task. Negative affect also increased during the anticipation phase, while positive affect decreased during the anticipation and remained low after the social task.
“We created a task that involves getting to know a researcher while being ‘observed’ by a panel of ‘experts’. In reality, those ‘experts’ can be either real people or ‘dummy’ accounts all logged in by the main researcher,” Huneke told PsyPost. “We found that the task caused significant anxiety, and anxiety was predicted by the level of social anxiety symptoms a person experiences. This is important, as it suggests the task could be used to explore whether treatments would work for SAD.”
The researchers next found evidence that participants’ anxiety was attributed to social anxiety symptoms specifically and not generalized anxiety symptoms. Participants’ baseline scores on the social phobia inventory (SPIN) significantly predicted their anxiety during the social interaction task, but not their anxiety during the anticipation period. The opposite was true of scores on the generalized anxiety disorder (GAD) questionnaire, which positively predicted subjects’ anxiety during the anticipation period but not the social task.
These results demonstrate that social anxiety symptoms can be induced using a social interaction task and videoconferencing software. Social interaction can trigger social-evaluative threat, a critical component in the development of SAD. Having to “get to know” a stranger — albeit through a screen — likely triggered anxiety and negative self-evaluation among participants.
While other online tests have been developed to induce social stress, the authors point out that these tests do not target symptoms of social anxiety specifically. Moreover, the ITSSAD test can be employed online via a single experimenter and a laptop, making it easy to administer and low-cost. Nevertheless, the study was limited by a small, female-only sample, and further research will be needed to validate the ITSSAD as a research tool for investigating SAD.
“A major caveat is that nearly all of our participants were female and all were young adults (under the age of 25 years),” Huneke said. “So more work is needed to find out whether the task also works in other populations.”
The study, “A novel procedure to investigate social anxiety using videoconferencing software: A proof-of-concept study”, was authored by Nathan T.M. Huneke, Hannah Rowlatt, Joshua Hyde, Alexander McEwan, Louise Maryan, David S. Baldwin, and Matthew Garner.