Daily emotional functioning in social anxiety disorder

Social Anxiety Disorder (SAD) is characterised by fear or anxiety around potential judgement, scrutiny and negative evaluation by others in social situations. For those with the disorder, social engagement can lead to considerable distress and functional impairment in daily life. Therefore, how individuals with SAD respond to stress, specifically social stress, is of particular importance to the understanding and treatment of the disorder. Much of the existing SAD research has been conducted in the laboratory setting, which provides optimal experimental control but offers little insight into how the disorder plays out in daily life. The symptoms of SAD are context-dependent and fluctuate over time, making them difficult to assess realistically in the laboratory or using retrospective reporting. Ambulatory assessment could deepen our understanding of the symptoms and experiences of those with SAD through frequent assessments in their naturally occurring environment. However, it is difficult to capture how individuals with SAD respond to social stressors using a traditional ambulatory assessment design, as SAD is associated with avoidance of such situations in daily life. This thesis examined the acute social stress response of those with SAD in daily life. A standardised lab-induced social stressor was embedded within an ambulatory assessment design to study the effect of acute social stress on naturalistic subjective and physiological stress responding among individuals with SAD (n = 40) and healthy controls (n = 41). After completing two days of baseline daily life assessment, participants were informed that they would complete a social stress task (the Trier Social Stress Test; TSST) in two days’ time. Following the TSST, participants continued with daily life assessment for an additional two days. This distinguished the anticipatory (days prior to TSST), acute (during the TSST protocol) and recovery (days after TSST) phases of stress responding. Subjective responses were assessed using a smartphone app called SEMA and physiological responses were collected on three days (once during each phase) through ambulatory saliva sampling. The first empirical study of this thesis (Study 1, Chapter 6) reports on the acute social stress response to the TSST assessed in the lab, compared between individuals with SAD versus healthy controls. The second large scale empirical study (Study 2, Chapter 7) reports the results of naturalistic responding to the TSST in daily life, captured using ambulatory assessment, in the same participants. Results from the two empirical studies demonstrated that overall individuals with SAD reported a significantly worse experience across all measures of affect, self-esteem and threatawareness when compared to healthy controls. Between group comparison during the anticipation of social stress in daily life found those with SAD responded with increased anxiety, reduced happiness and less appearance satisfaction, when compared to healthy controls and baseline. In response to social stress, SAD individuals responded with increased stress sensitivity in their subjective experience in the lab and outside of the lab in daily life, seen in the increased anxiety and anger, reduced happiness and less appearance satisfaction reported during the recovery from a social stressor, compared to healthy controls. However, between group comparison revealed no physiological (salivary cortisol) differences were observed between SAD and healthy controls in either the lab or daily life settings. Overall, this thesis adds novel information to the understanding of SAD, especially to the subjective and physiological experience of SAD in daily life in response to social stress. This thesis supports models of SAD that highlight cognitive, psychological and behavioural factors in the aetiology and maintenance of the disorder. Lastly, this thesis provides a valuable source in the form of a laboratory manual (see Chapter 5) to ease the application of implementing the TSST by other researchers.