Posttraumatic stress disorder in the emergency room: exploration of a cognitive model.

Ehlers and Clark (Behav. Res. Ther., 38 (2000) 319) recently proposed a cognitive model of posttraumatic stress disorder (PTSD). In this study, we examined two facets of this model, appraisal and peritraumatic dissociation, in the context of a hospital emergency room. Fifty-one emergency room personnel completed questionnaires measuring posttraumatic stress symptoms, interpretations of traumatic events experienced while working in the emergency room and subsequent intrusive recollections, and peritraumatic dissociation. Twelve percent of participants met formal diagnostic criteria for PTSD, and 20% met PTSD symptom criteria. As predicted, both negative appraisals of the trauma and of intrusive recollections were associated with increased PTSD severity. Although peritraumatic dissociation did not correlate with overall PTSD symptom severity, it was associated with the reexperiencing symptom cluster. Discussion focuses on the factors associated with PTSD in emergency room professionals and implications for intervention.

Is acculturation unidimensional or bidimensional? A head-to-head comparison in the prediction of personality, self-identity, and adjustment.

The unidimensional model of acculturation posits that heritage and mainstream culture identifications have a strong inverse relation, whereas the bidimensional model posits that the 2 identifications are independent. The authors compared these models in 3 samples of ethnic Chinese (ns = 164, 150, and 204), 1 sample of non-Chinese East Asians (n = 70), and one diverse group of acculturating individuals (n = 140). Although the unidimensional measure showed a coherent pattern of external correlates, the bidimensional measure revealed independent dimensions corresponding to heritage and mainstream culture identification. These dimensions displayed patterns of noninverse correlations with personality, self-identity, and psychosocial adjustment. The authors conclude that the bidimensional model is a more valid and useful operationalization of acculturation.

Cognitive processes in social anxiety: the effects of self-focus, rumination and anticipatory processing.

We examined three cognitive processes hypothesized to contribute to biases in judgments about and memory for social events: self-focused attention, post-event rumination, and anticipatory processing. Socially anxious (N = 58) and nonanxious (N = 58) subjects participated in a social interaction and then completed measures of self-focused attention and anxiety-related physiological sensations and behavior. The next day, subjects completed measures that assessed frequency of post-event processing and recall of the interaction. The results indicated that selective attention to negative self-related information led to biases in social judgments and recollections and that post-event processing contributed to the recall of negative self-related information. No evidence was found for selective retrieval of negative self-related information prior to a second social interaction. The results reconcile inconsistent previous findings related to memory bias in social anxiety.

Interpersonal consequences of the pursuit of safety.

Socially anxious (N = 41) and non-anxious (N = 41) individuals participated in a getting acquainted situation that was based on the reciprocity self-disclosure paradigm. Subjects' appraisals of the situation were manipulated to be either positive or negative by highlighting the likelihood of positive or negative social outcomes. Subjects' social goals and use of safety behaviors were assessed, as were others' reaction to the subjects. As predicted, socially anxious individuals elicited significantly more negative responses from others in the negative appraisal condition, where they employed safety behaviors, than in the positive appraisal condition, where they did not. The results supported a cognitive model of social anxiety, rather than alternative explanations.

The consequences of perfectionism for patients with social phobia.

OBJECTIVES: To examine levels of perfectionism in social phobics and to explore the consequences of perfectionism for such individuals. DESIGN: A between-groups laboratory design was used to provide a level of comparison between phobic and non-phobic individuals in a controlled setting. METHOD: Participants for the phobic group (N = 28) were recruited from waiting lists for treatment programmes, and matched controls (N = 29) were recruited from community advertisements. Volunteers for the study completed measures of perfectionism (Multidimensional Perfectionism Scale) and then completed a laboratory session in which they were asked to rate others' social standards for them and their own social ability. RESULTS: Social phobic individuals scored higher on socially prescribed perfectionism. Perfectionistic traits were associated with higher standards in social phobics, but not in controls. Finally, social phobia was associated with lowered perceptions of social ability. CONCLUSIONS: Although social phobia and socially prescribed perfectionism were intertwined, the two conditions appeared to contribute to negative self-appraisal through different processes. Social phobics who are perfectionistic are likely not only to have low levels of efficacy, but also to feel that others will have high expectations for them in social situations.

Social phobia and positive social events: the price of success.

Patients with generalized social phobia (N = 32; 16 men, 16 women) and nonclinical control participants (N = 32; 16 men, 16 women) took part in a social interaction that was manipulated to be successful or unsuccessful. Participants rated their ability, perceptions of others' standards, social goals, and emotional responses before and after the interactions. As predicted, the successful social interaction produced a somewhat negative response in patients with social phobia. Social success led to self-protective social goals, negative emotional states and perceptions that others would expect more in future interactions. These results indicate that positive social events may not be processed in a way that leads to a revision of negative self- and social judgments in patients with social phobia.

Social phobia and social appraisal in successful and unsuccessful social interactions.

32 generalized social phobic outpatients and 32 matched nonclinical control subjects participated in a dyadic 'getting acquainted' interaction with an experimental assistant who engaged in either positive or negative social behavior. The accuracy of social phobics' and control subjects' perceptions of themselves and their partners were compared in the two conditions. Relative to observers' ratings, the social phobics displayed a negative bias in their appraisals of some, but not all, aspects of their social performance. These results suggested that social phobics may have particular difficulty gauging the nonverbal aspects of their social behavior. The phobics discounted their social competence to the same extent in the positive interaction, where their behavior was more skillful, as in the negative interaction. The social phobics were also less accurate than nonclinical controls in their appraisals of their partners, however, these phobic subjects displayed a positive bias when appraising their partner's performance.

Anxiety and self-disclosure: toward a motivational model.

The self-disclosures of socially anxious and nonanxious Ss were compared within the framework of R. M. Arkin's (1981) motivational theory of social anxiety. Ss (N = 84 women) were paired with a confederate who disclosed at either a high or a low level of intimacy (i.e., the classic reciprocity paradigm). Consistent with R. M. Arkin's theory, anxious Ss were concerned with self-protection during the task and disclosed at a moderate level of intimacy regardless of their partner's behavior. In addition, anxious Ss did not reciprocate their partners' disclosures as well as did nonanxious Ss. The self-protective behaviors of the anxious Ss were associated with less liking and more discomfort on the part of their partners. This suggests that the adoption of self-protective strategies may elicit negative interpersonal reactions that maintain self-defeating interpersonal patterns in socially anxious people.