Abstract
Social anxiety affects millions worldwide and is increasing in prevalence. Resilience factors may be important for managing social anxiety, but currently, our understanding of the relationship between resilience and social anxiety is limited. In this study, we explored associations between social anxiety and two forms of resilience (psychological and social-ecological resilience) through secondary analyses of survey responses from 5880 young people (M = 22.82 years old, SD = 3.95) from seven different countries (Brazil, China, Indonesia, Russia, Thailand, the USA, Vietnam). Social anxiety was measured using the Social Anxiety Interaction Scale and resilience through the Adult Resilience Measure-Revised and the Rugged Resilience Measure. The results indicated that psychological resilience was negatively correlated with social anxiety in males and females in most country contexts, while the association between social-ecological resilience and social anxiety was less consistent across countries. A moderation analysis revealed that interactions between the forms of resilience predicting lower social anxiety were found in males from Brazil, Indonesia, the USA, and Vietnam. These findings indicate the importance of dynamic models of resilience which take account of cultural differences in the context of social anxiety.
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All data files are available from the Open Science Framework repository (DOI: https://doi.org/10.17605/OSF.IO/PMDQH).
References
Acarturk, C., Smit, F., de Graaf, R., van Straten, A., ten Have, M., & Cuijpers, P. (2009). Economic costs of social phobia: A population-based study. Journal of Affective Disorders, 115(3), 421–429. https://doi.org/10.1016/j.jad.2008.10.008.
Asher, M., Asnaani, A., & Aderka, I. M. (2017). Gender differences in social anxiety disorder: A review. Clinical Psychology Review, 56, 1–12. https://doi.org/10.1016/j.cpr.2017.05.004.
Beutel, M. E., Glaesmer, H., Wiltink, J., Marian, H., & Brähler, E. (2010). Life satisfaction, anxiety, depression and resilience across the life span of men. The Aging Male: The Official Journal of the International Society for the Study of the Aging Male, 13(1), 32–39. https://doi.org/10.3109/13685530903296698.
Biggs, B. K., Vernberg, E. M., & Wu, Y. P. (2012). Social anxiety and adolescents’ friendships: The role of social withdrawal. The Journal of Early Adolescence, 32(6), 802–823. https://doi.org/10.1177/0272431611426145.
Blanc, A. L. L., Bruce, L. C., Heimberg, R. G., Hope, D. A., Blanco, C., Schneier, F. R., & Liebowitz, M. R. (2014). Evaluation of the psychometric properties of two short forms of the social interaction anxiety scale and the social phobia scale. Assessment., 21, 312–323. https://doi.org/10.1177/1073191114521279.
Brown, E. J., Turovsky, J., Heimberg, R. G., Juster, H. R., Brown, T. A., & Barlow, D. H. (1997). Validation of the social interaction anxiety scale and the social phobia scale across the anxiety disorders. Psychological Assessment, 9(1), 21–27. https://doi.org/10.1037/1040-3590.9.1.21.
Bystritsky, A., Khalsa, S. S., Cameron, M. E., & Schiffman, J. (2013). Current diagnosis and treatment of anxiety disorders. Pharmacy and Therapeutics, 38(1), 30–57.
Charney, D. S. (2003). The psychobiology of resilience and vulnerability to anxiety disorders: Implications for prevention and treatment. Dialogues in Clinical Neuroscience, 5(3), 207–221.
Chen, J. (2018). Some people may need it, but not me, not now: Seeking professional help for mental health problems in urban China. Transcultural Psychiatry, 55(6), 754–774. https://doi.org/10.1177/1363461518792741.
de Beurs, E., Tielen, D., & Wollmann, L. (2014). The Dutch social interaction anxiety scale and the social phobia scale: Reliability, validity, and clinical utility. Psychiatry Journal, 2014, 1–9. https://doi.org/10.1155/2014/360193.
Dell’Osso, L., Rucci, P., Ducci, F., Ciapparelli, A., Vivarelli, L., Carlini, M., Ramacciotti, C., & Cassano, G. B. (2003). Social anxiety spectrum. European Archives of Psychiatry and Clinical Neuroscience, 253(6), 286–291. https://doi.org/10.1007/s00406-003-0442-5.
Dongmei, Y. E., Qian, M., Liu, X., & Chen, X. (2007). Revision of social interaction anxiety scale and social phobia scale. Chinese Journal of Clinical Psychology, 15(02), 115–117. https://doi.org/10.16128/j.cnki.1005-3611.2007.02.004.
Dynata. (2020). Panel book. Dynata. http://info.dynata.com/rs/105-ZDT-791/images/Dynata-Panel-Book-2020.pdf. Accessed 05/08/2020.
Fehm, L., Beesdo, K., Jacobi, F., & Fiedler, A. (2008). Social anxiety disorder above and below the diagnostic threshold: Prevalence, comorbidity and impairment in the general population. Social Psychiatry and Psychiatric Epidemiology, 43(4), 257–265. https://doi.org/10.1007/s00127-007-0299-4
Gilbert, P. (2001). Evolution and social anxiety. The role of attraction, social competition, and social hierarchies. The Psychiatric Clinics of North America, 24(4), 723–751. https://doi.org/10.1016/s0193-953x(05)70260-4.
Grant, B. F., Hasin, D. S., Blanco, C., Stinson, F. S., Chou, S. P., Goldstein, R. B., Dawson, D. A., Smith, S., Saha, T. D., & Huang, B. (2005). The epidemiology of social anxiety disorder in the United States: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. The Journal of Clinical Psychiatry, 66(11), 1351–1361. https://doi.org/10.4088/jcp.v66n1102.
Greenberg, D., Stravynski, A., & Bilu, Y. (2004). Social phobia in ultra-orthodox Jewish males: Culture-bound syndrome or virtue? Mental Health Religion & Culture, 7(4), 289–305. https://doi.org/10.1080/13674670310001606496.
Gretarsdottir, E., Woodruff-Borden, J., Meeks, S., & Depp, C. A. (2004). Social anxiety in older adults: Phenomenology, prevalence, and measurement. Behaviour Research and Therapy, 42(4), 459–475. https://doi.org/10.1016/S0005-7967(03)00156-6.
Hampton, N. Z., & Sharp, S. E. (2014). Shame-focused attitudes toward mental health problems: The role of gender and culture. Rehabilitation Counseling Bulletin, 57(3), 170–181. https://doi.org/10.1177/0034355213501722.
Hayes, A. (2017). Fundamentals of moderation analysis. In Introduction to mediation, moderation, and conditional process analysis: A regression-based approach (2nd ed., pp. 219–266). Guildford Publications.
Heeren, A., & McNally, R. J. (2016). A call for complexity in the study of Social Anxiety Disorder. Commentary: The aetiology and maintenance of social anxiety disorder: A synthesis of complementary theoretical models and formulation of a new integrated model. Frontiers in Psychology, 7. https://doi.org/10.3389/fpsyg.2016.01963.
Hofmann, S. G., Asnaani, A., & Hinton, D. E. (2010). Cultural aspects in social anxiety and social anxiety disorder. Depression and Anxiety, 27(12), 1117–1127. https://doi.org/10.1002/da.20759.
Hofstede, G. (2016). Dimension maps of the world: Individualism. https://geerthofstede.com/culture-geert-hofstede-gert-jan-hofstede/6d-model-of-national-culture/. Accessed 14/10/2020
Ij, R., Au, V., Bn, P., Ds, T., Ss, K., Mg, S., & Nn, N. (2017). Association of social anxiety disorder with depression and quality of life among medical undergraduate students. Journal of Family Medicine and Primary Care, 6(2), 243–248. https://doi.org/10.4103/2249-4863.219992.
Jagdeo, A., Cox, B. J., Stein, M. B., & Sareen, J. (2009). Negative attitudes toward help seeking for mental illness in 2 population-based surveys from the United States and Canada. The Canadian Journal of Psychiatry, 54(11), 757–766. https://doi.org/10.1177/070674370905401106.
Jefferies, P., McGarrigle, L., & Ungar, M. (2018). The CYRM-R: A Rasch-validated revision of the child and youth resilience measure. Journal of Evidence-Informed Social Work., 16, 70–92. https://doi.org/10.1080/23761407.2018.1548403.
Jefferies, P., & Ungar, M. (2020). Social anxiety in young people: A prevalence study in seven countries. PLoS One, 15(9), e0239133. https://doi.org/10.1371/journal.pone.0239133.
Jefferies, P., Vanstone, R., & Ungar, M. (under review). The rugged resilience measure: Validation of a brief measure of personal resilience. Quality of Life Research.
Johnson, J. S. (2016). Improving online panel data usage in sales research. Journal of Personal Selling & Sales Management, 36(1), 74–85. https://doi.org/10.1080/08853134.2015.1111611.
Johnson, P. O., & Fay, L. C. (1950). The Johnson-Neyman technique, its theory and application. Psychometrika, 15(4), 349–367. https://doi.org/10.1007/BF02288864.
Johnson, P. O., & Neyman, J. (1936). Tests of certain linear hypotheses and their application to some educational problems. Statistical Research Memoirs, 1, 57–93.
Kanai, Y., Sasagawa, S., Chen, J., Suzuki, S., Shimada, H., & Sakano, Y. (2004). Development and validation of the Japanese version of social phobia scale and social interaction anxiety scale. Japanese Journal of Psychosomatic Medicine, 44, 841–850.
Kato, T. A., Kanba, S., & Teo, A. R. (2018). Hikikomori: Experience in Japan and international relevance. World Psychiatry, 17(1), 105–106. https://doi.org/10.1002/wps.20497.
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 593–602. https://doi.org/10.1001/archpsyc.62.6.593.
Kleinknecht, R. A., Dinnel, D. L., Kleinknecht, E. E., Hiruma, N., & Harada, N. (1997). Cultural factors in social anxiety: A comparison of social phobia symptoms and Taijin Kyofusho. Journal of Anxiety Disorders, 11(2), 157–177. https://doi.org/10.1016/S0887-6185(97)00004-2.
Knappe, S., Beesdo, K., Fehm, L., Lieb, R., & Wittchen, H.-U. (2009). Associations of familial risk factors with social fears and social phobia: Evidence for the continuum hypothesis in social anxiety disorder? Journal of Neural Transmission, 116(6), 639–648. https://doi.org/10.1007/s00702-008-0118-4.
Ko, C.-Y. A., & Chang, Y. (2018). Investigating the relationships among resilience, social anxiety, and procrastination in a sample of college students. Psychological Reports, 122, 231–245. https://doi.org/10.1177/0033294118755111.
Kraines, M. A., White, E. J., Grant, D. M., & Wells, T. T. (2019). Social anxiety as a precursor for depression: Influence of interpersonal rejection and attention to emotional stimuli. Psychiatry Research, 275, 296–303. https://doi.org/10.1016/j.psychres.2019.04.001.
Liebenberg, L., & Moore, J. C. (2018). A social ecological measure of resilience for adults: The RRC-ARM. Social Indicators Research, 136(1), 1–19. https://doi.org/10.1007/s11205-016-1523-y.
Lindner, P., Martell, C., Bergström, J., Andersson, G., & Carlbring, P. (2013). Clinical validation of a non-heteronormative version of the Social Interaction Anxiety Scale (SIAS). Health and Quality of Life Outcomes, 11(1), 209. https://doi.org/10.1186/1477-7525-11-209.
Marx, M., Young, S. Y., Harvey, J., Rosenstein, D., & Seedat, S. (2017). An examination of differences in psychological resilience between social anxiety disorder and posttraumatic stress disorder in the context of early childhood trauma. Frontiers in Psychology, 8. https://doi.org/10.3389/fpsyg.2017.02058.
Masten, A. S. (2014). Global perspectives on resilience in children and youth. Child Development, 85(1), 6–20. https://doi.org/10.1111/cdev.12205.
Mattick, R. P., & Clarke, J. C. (1998). Development and validation of measures of social phobia scrutiny fear and social interaction anxiety. Behaviour Research and Therapy, 36(4), 455–470. https://doi.org/10.1016/s0005-7967(97)10031-6.
Mayo-Wilson, E., Dias, S., Mavranezouli, I., Kew, K., Clark, D. M., Ades, A. E., & Pilling, S. (2014). Psychological and pharmacological interventions for social anxiety disorder in adults: A systematic review and network meta-analysis. The Lancet Psychiatry, 1(5), 368–376. https://doi.org/10.1016/S2215-0366(14)70329-3.
McNeil, D. W. (2010). Evolution of terminology and constructs in social anxiety and its disorders. In Social anxiety: Clinical, developmental, and social perspectives (2nd ed., pp. 3–21). Elsevier Academic Press. https://doi.org/10.1016/B978-0-12-375096-9.00001-8.
Merikangas, K. R., He, J.-P., Burstein, M., Swanson, S. A., Avenevoli, S., Cui, L., Benjet, C., Georgiades, K., & Swendsen, J. (2010). Lifetime prevalence of mental disorders in U.S. adolescents: Results from the National Comorbidity Survey Replication--Adolescent Supplement (NCS-A). Journal of the American Academy of Child and Adolescent Psychiatry, 49(10), 980–989. https://doi.org/10.1016/j.jaac.2010.05.017.
Mills, A. C., Grant, D. M., Lechner, W. V., & Judah, M. R. (2014). Relationship between trait repetitive negative thinking styles and symptoms of psychopathology. Personality and Individual Differences, 71, 19–24. https://doi.org/10.1016/j.paid.2014.07.022.
Mohr, J. W., & Rawlings, C. (2012). Four ways to measure culture: Social science, hermeneutics, and the cultural turn. In J. C. Alexander, R. N. Jacobs, & P. Smith (Eds.), The Oxford handbook of cultural sociology (pp. 70–113). Oxford University Press.
Mörtberg, E., Reuterskiöld, L., Tillfors, M., Furmark, T., & Öst, L.-G. (2017). Factor solutions of the Social Phobia Scale (SPS) and the Social Interaction Anxiety Scale (SIAS) in a Swedish population. Cognitive Behaviour Therapy, 46(4), 300–314. https://doi.org/10.1080/16506073.2016.1258723.
National Collaborating Centre for Mental Health (UK). (2013). Social anxiety disorder: Recognition, assessment and treatment (NICE Clinical Guidelines, No. 159.). British Psychological Society. https://www.ncbi.nlm.nih.gov/books/NBK327674/. Accessed 27/01/2020.
Osman, A., Gutierrez, P. M., Barrios, F. X., Kopper, B. A., & Chiros, C. E. (1998). The social phobia and social interaction anxiety scales: Evaluation of psychometric properties. Journal of Psychopathology and Behavioral Assessment, 20(3), 249–264. https://doi.org/10.1023/A:1023067302227.
R Core Team. (2020). R: A language and environment for statistical computing (4.0.0) [Computer software]. R Foundation for Statistical Computing. https://www.R-project.org/. Accessed 11/05/2020
Rapee, R. M. (1995). Descriptive psychopathology of social phobia. In Social phobia: Diagnosis, assessment, and treatment (pp. 41–66). The Guilford Press.
Resilience Research Centre. (2003). International Resilience Project. http://www.resilienceresearch.org/research/projects/international-resilience. Accessed 01/11/2018.
Rodebaugh, T. L., Heimberg, R. G., Brown, P. J., Fernandez, K. C., Blanco, C., Schneier, F. R., & Liebowitz, M. R. (2011). More reasons to be straightforward: Findings and norms for two scales relevant to social anxiety. Journal of Anxiety Disorders, 25(5), 623–630. https://doi.org/10.1016/j.janxdis.2011.02.002.
Rodebaugh, T. L., Woods, C. M., & Heimberg, R. G. (2007). The reverse of social anxiety is not always the opposite: The reverse-scored items of the Social Interaction Anxiety Scale do not belong. Behavior Therapy, 38(2), 192–206.
RStudio Team. (2020). RStudio: Integrated Development for R (1.2.5042) [Computer software]. RStudio, Inc.
Rubin, K. H., & Burgess, K. B. (2001). Social withdrawal and anxiety. In The developmental psychopathology of anxiety (pp. 407–434). Oxford University Press. https://doi.org/10.1093/med:psych/9780195123630.003.0018.
Sakurai, A., Nagata, T., Harai, H., Yamada, H., Mohri, I., Nakano, Y., Noda, Y., Ogawa, S., Lee, K., & Furukawa, T. A. (2005). Is ‘relationship fear’ unique to Japan? Symptom factors and patient clusters of social anxiety disorder among the Japanese clinical population. Journal of Affective Disorders, 87(1), 131–137. https://doi.org/10.1016/j.jad.2005.03.003.
Schneier, F. R., Heckelman, L. R., Garfinkel, R., Campeas, R., Fallon, B. A., Gitow, A., et al. (1994). Functional impairment in social phobia. The Journal of Clinical Psychiatry, 55(8), 322–331.
Sheerin, C. M., Lind, M. J., Brown, E. A., Gardner, C. O., Kendler, K. S., & Amstadter, A. B. (2018). The impact of resilience and subsequent stressful life events on MDD and GAD. Depression and Anxiety, 35(2), 140–147. https://doi.org/10.1002/da.22700.
Sosik, J. J., Koul, R., & Cameron, J. C. (2017). Gender and contextual differences in social responsibility in Thai schools: A multi-study person versus situation analysis. Journal of Beliefs & Values, 38(1), 45–62. https://doi.org/10.1080/13617672.2016.1237251.
Spence, S. H., & Rapee, R. M. (2016). The etiology of social anxiety disorder: An evidence-based model. Behaviour Research and Therapy, 86, 50–67. https://doi.org/10.1016/j.brat.2016.06.007.
Stein, D. J., Lim, C. C. W., Roest, A. M., de Jonge, P., Aguilar-Gaxiola, S., Al-Hamzawi, A., Alonso, J., Benjet, C., Bromet, E. J., Bruffaerts, R., de Girolamo, G., Florescu, S., Gureje, O., Haro, J. M., Harris, M. G., He, Y., Hinkov, H., Horiguchi, I., Hu, C., et al. (2017). The cross-national epidemiology of social anxiety disorder: Data from the World Mental Health Survey Initiative. BMC Medicine, 15(1), 143. https://doi.org/10.1186/s12916-017-0889-2.
Stein, M. B., & Stein, D. J. (2008). Social anxiety disorder. Lancet (London, England), 371(9618), 1115–1125. https://doi.org/10.1016/S0140-6736(08)60488-2.
Stein, M. B., Torgrud, L. J., & Walker, J. R. (2000). Social phobia symptoms, subtypes, and severity: Findings from a community survey. Archives of General Psychiatry, 57(11), 1046–1052. https://doi.org/10.1001/archpsyc.57.11.1046
Theron, L. C., & Liebenberg, L. (2015). Understanding cultural contexts and their relationship to resilience processes. In L. C. Theron, L. Liebenberg, & M. Ungar (Eds.), Youth resilience and culture (pp. 23–36). Springer. https://doi.org/10.1007/978-94-017-9415-2_2.
Theron, L. C., & Ungar, M. (2018). Limiting the impacts of child abuse and neglect by understanding which supports matter most: A differential impact approach. Child Abuse & Neglect, 78, 1–3. https://doi.org/10.1016/j.chiabu.2018.01.018.
Ungar, M. (2008). Resilience across cultures. The British Journal of Social Work, 38(2), 218–235. https://doi.org/10.1093/bjsw/bcl343.
Ungar, M. (2011). The social ecology of resilience: Addressing contextual and cultural ambiguity of a nascent construct. The American Journal of Orthopsychiatry, 81(1), 1–17. https://doi.org/10.1111/j.1939-0025.2010.01067.x.
Ungar, M. (2012). Social ecologies and their contribution to resilience. In The social ecology of resilience: A handbook of theory and practice (pp. 13–31). Springer. https://doi.org/10.1007/978-1-4614-0586-3_2.
Vandenbroucke, J. P., von Elm, E., Altman, D. G., Gøtzsche, P. C., Mulrow, C. D., Pocock, S. J., Poole, C., Schlesselman, J. J., Egger, M., & STROBE Initiative. (2007). Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): Explanation and elaboration. PLoS Medicine, 4(10), e297. https://doi.org/10.1371/journal.pmed.0040297.
Vriends, N., Pfaltz, M. C., Novianti, P., & Hadiyono, J. (2013). Taijin Kyofusho and Social Anxiety and Their Clinical Relevance in Indonesia and Switzerland. Frontiers in Psychology, 4. https://doi.org/10.3389/fpsyg.2013.00003.
Wellcome Trust. (2020). Low- and middle-income Countries. https://wellcome.org/grant-funding/guidance/low-and-middle-income-countries. Accessed 12/10/2020.
World Health Organization. (2017). Building resilience: A key pillar of health 2020 and the sustainable development goals – Examples from the WHO Small Countries Initiative (2017). World Health Organization. http://www.euro.who.int/en/publications/abstracts/building-resilience-a-key-pillar-of-health-2020-and-the-sustainable-development-goals-examples-from-the-who-small-countries-initiative-2017. Accessed 28/05/2020.
Yngve, A. (2016). Resilience against social anxiety: The role of social networks in social anxiety disorder [Master’s Thesis, Linköping University]. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-131140. Accessed 28/05/2020.
Acknowledgements
The authors would like to acknowledge the role of Edelman Intelligence in collecting the data and Unilever and CLEAR for funding and commissioning the overarching project as part of their mission to support the resilience of young people experiencing social anxiety.
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No funding was provided for this research. However, the lead author is supported by a Mitacs Industrial Fellowship, which is contributed to by Unilever Plc. However, in no way was the design or analysis of this study directed or influenced by Unilever Plc. The second author’s position was funded by the Swiss National Science Foundation (grant number P2ZHP1_184004).
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Jefferies, P., Höltge, J. & Ungar, M. Social Anxiety and Resilience: Associations Vary by Country and Sex. ADV RES SCI 2, 51–62 (2021). https://doi.org/10.1007/s42844-020-00026-2
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DOI: https://doi.org/10.1007/s42844-020-00026-2