Video feedback has been shown to help people with social anxiety disorder correct distorted self-perceptions. A recent study suggests that offering additional group feedback leads to further improvements, decreasing perceptions of anxiety and social concerns and increasing perceptions of performance. The findings were published in the journal Behavior Modification.
People with social anxiety disorder (SAD) feel intense anxiety during social interactions and are deeply afraid of being judged by others. They also tend to have distorted perceptions of themselves, imagining that others hold negative opinions of them even when that is not the case. These negative self-beliefs cause them to be overly concerned with their behavior, which helps perpetuate their anxiety.
To help correct this distorted self-image, researchers and clinicians have used video feedback. For example, a participant performs a short speech and then watches a playback of their performance. This technique has proven effective in helping people with SAD re-evaluate their negative self-beliefs and improve the accuracy of their self-ratings.
Study authors Judith M. Laposa and Neil A. Rector wanted to explore whether audience feedback — in addition to video feedback — might further improve outcomes among patients with SAD. To test this, the researchers conducted a clinical study.
“Clinically, I have been struck by the fact that many people with social anxiety perform much better in social situations than they think they do,” explained Laposa, an associate professor at the University of Toronto and adjunct professor at York University.
“Videotape feedback is a way to examine the accuracy of self-perceptions. There is a large body of research showing that for those with social anxiety, watching a tape of oneself leads to positive improvements. We wanted to know whether getting feedback about a taped exposure from others also attending a social anxiety treatment group, would have an additional incremental benefit.”
The study sample included 67 individuals with SAD who had been referred to cognitive behavior therapy (CBT) treatment. The average age of participants was 33, and 49% of the participants identified as female, 49% identified as male, and 2% identified as transgender. In groups of 8–10, the participants attend group CBT sessions.
During one of these group sessions, each subject participated in a social anxiety exposure that was about 3 minutes long. The exposures were tailored to each participant, and examples included giving a monologue or maintaining a conversation. Importantly, the exposure was video recorded.
Before and after the exposure, the participants completed several ratings concerning their anxiety and performance during the task. They also completed the Appraisal of Social Concerns Scale (ASC) where they read a list of about 20 social concerns (e.g., appearing incompetent, poor voice quality) and indicated whether each outcome had occurred during their exposure.
A week later, the participants viewed the video feedback of their performance and then listened to feedback from other group members regarding their video performance. The group feedback was a mix of positive feedback and notes for improvement. After viewing their video feedback, and again after listening to the group feedback, the participants repeated the self-ratings of anxiety and performance and indicated whether each of the 20 social concerns had occurred during the exposure.
The researchers analyzed how participants’ ratings changed across all of these time points. They found that after viewing the video feedback, participants’ anxiety ratings decreased significantly, self-ratings of performance increased significantly, and ASC scores improved. Moreover, after hearing the audience feedback, participants’ anxiety ratings decreased even lower, self-ratings of performance increased even more, and ASC scores further improved.
“For those with social anxiety disorder, watching a video of themselves doing an exposure exercise that targets their social anxiety, tends to help correct distorted perceptions of how they think they come across in social situations,” Laposa told PsyPost. “Having feedback from therapy group members about that same video, enhances those effects even further.”
The largest effect size was for anxiety. As Laposa and Rector report, “The mean difference between anxiety ratings after taping versus after group feedback was more than double in comparison to the difference between the anxiety ratings after taping versus after self-viewing.”
These findings demonstrate that the group feedback led to improved outcomes, over and above the video feedback. In other words, after hearing others’ feedback, participants felt better about their performance and felt they had exhibited less observable and non-observable symptoms of anxiety. The authors note that the intervention took little time and would be easy to incorporate into clinical practice as part of CBT group therapy.
“It was noteworthy that the incremental benefits of receiving feedback from group members and the therapists had such a large additional effect, in comparison to just watching the video themselves,” Laposa said.
One notable limitation was that the study design lacked a control group. For future research, the study authors say it would be interesting to explore whether the group feedback brought participants’ self-ratings of performance closer to observer performance ratings and whether peer feedback might be more influential than therapist observation or self-observation.
“The study used a within-subjects design, so there was no control condition with random assignment,” Laposa explained. “However, the findings replicate experimental work on the impact of audience feedback with non-clinical populations, that included random assignment and control groups. A next step in this line of research would be to determine how enduring is the positive impact of group feedback following videotaped exposures.”
The study, “The Impact of Group Feedback on Self-Perceptions Following Videotape Exposure in CBT for Social Anxiety Disorder”, was authored by Judith M. Laposa and Neil A. Rector.
