Personal value, self-efficacy, and social acceptability of a social behavior as correlates of behavioral action in social anxiety

Abstract Introduction Current therapies for social anxiety disorder emphasize taking behavioral action; active engagement of a behavior despite any present fear or anxiety that is associated with the behavior, through use of exposures. However, less is known about the mechanisms of behavioral action. The present study aimed to examine personal value, self-efficacy, and the perceived social acceptability of a social behavior as correlates of behavioral action in a high social anxiety sample. Method The present study utilized vignettes and self-report measures to examine self-efficacy, personal value, and the social acceptability of a social behavior as correlates of behavioral action in a high social anxiety sample (N = 92). Results The findings indicated that self-efficacy, but not personal value or social acceptability, was significantly associated with social anxiety. Additionally, with all variables included in the multiple regression model, social anxiety was significantly associated with behavioral action, while personal value and self-efficacy were associated with behavioral action over and above social anxiety. Discussion The results highlight the potential for self-efficacy and personal value as target mechanisms for increasing engagement with exposures and behavioral experiments in treatments for social anxiety.


Introduction
According to models of social anxiety disorder (SAD), one of the key maintenance factors of SAD is behavioral avoidance. [1][2][3] Individuals with SAD typically avoid social situations, as simply removing the feared stimulus eliminates the accompanying fear as well. However, while avoidance initially decreases anxiety, it later serves to maintain or exacerbate symptoms. To target this phenomenon, current therapies for SAD emphasize taking behavioral action, 4 which is active engagement of a behavior despite any present fear or anxiety that is associated with that behavior. 5,6 In effect, the literature consistently highlights actively engaging with a behavior as an important mechanism of a greater cycle of change in psychopathology. However, little attention has been paid to the specific predictors of behavioral action in the context of social anxiety.
One way to examine this may be to consult current social psychology models of behavior, which present specific predictors of a given behavior. [7][8][9] One such model of behavior is the Theory of Planned Behavior (TPB), 7,10,11 which social psychologists have identified as being arguably the most prominent, widely applied, and widely cited model of intentional behavior to date. 12 According to the TPB, behaviors are most likely to occur: if the behavior or its outcome is personally valued, if the behavior is perceived to be socially acceptable, and if individuals have greater self-efficacy for the behavior. Here, self-efficacy is defined as belief in one's ability to perform the behavior successfully.
Although the TPB does not integrate emotional contexts or psychopathology into the model, it has been applied to examine the engagement of several mental health related behaviors. Notably, such studies consistently indicate that, of all the predictors in the TPB, the strongest predictors of the behaviors examined were the personal value of behaviors and self-efficacy. [13][14][15][16][17][18] While the TPB has not been examined in the context of behavioral action in social anxiety, there is evidence that beliefs about self-efficacy, personal value, and the social acceptability of the behavior are relevant to our understanding of behavioral action in social anxiety. For example, with regard to self-efficacy, studies indicate that there is a negative association between greater social self-efficacy and social anxiety. 4,[19][20][21][22] Additionally, self-efficacy has been shown to be negatively associated with social avoidance, 22 and positively associated with behavioral action over and above social anxiety. 4 Further, studies have indicated that changes in social self-efficacy predict changes in social avoidance, 19,20 and that self-efficacy predicts engagement in a speech task. 22 With regard to personal values, studies indicate that therapeutic practices such as acceptance-based behavior therapies (ABBTs), a primary component of which is clarifying and acting in accordance to one's values, predict decreased social anxiety and an increased likelihood of the occurrence of social anxietyprovoking behaviors. [23][24][25][26][27][28][29] However, these studies do not explicitly examine the relations between personal value, social anxiety, and behavioral action. Interestingly, the only study to date that did explicitly examine these relations found that while personal value did predict behavioral action, it was not associated with social anxiety, suggesting that personal value has an effect on behavioral action independent of social anxiety. 29 Taken together, the findings described here may suggest that although ABBTs are an effective treatment for SAD, the personal values component targets individuals' avoidance and action, rather than their anxiety. Finally, with regard to the social acceptability of a behavior, a significant body of literature indicates that the perceived social acceptability of a social behavior is positively associated with that behavior. [30][31][32][33] Additionally, studies and theoretical models indicate a positive association between social anxiety and the social acceptability of a social behavior (e.g. blushing while giving a speech). 2,34,35 Here, the positive associations between social anxiety and social acceptability and the associations between social acceptability and social behavior may indicate that perceived social acceptability is positively associated with the likelihood of a social anxiety-provoking behavior (behavioral action).
In sum, while the literature indicates that selfefficacy for a behavior is negatively associated with social anxiety, there is little empirical evidence on the relations between social anxiety and personal value or the perceived social acceptability of a behavior.

Depression, Anxiety, and Stress Scales -Depression
Subscale (DASS-D) 36 The DASS-D is a 7-item self-report measure evaluating symptoms of depression. Respondents rated how much each item applied to them, on a scale from 0 (did not apply to me at all) to 3 (applied to me very much or most of the time). We utilized DASS-D to control for participants' depression, as depression can influence social engagement and perception. 36 The DASS-D has been shown to have good convergent and discriminant validity and good internal consistency (α = 0.72). 39 Similarly, the DASS-D in our sample displayed good internal consistency (α = 0.86). 38 The SPIN is a self-report measure consisting of 17 statements that evaluate fear, avoidance, and physiological discomfort around social situations (sample items: "Parties and social events scare me"; "I avoid having to give speeches"; "Trembling or shaking in front of others is distressing to me"  38 Similarly, the SPIN in our sample displayed good internal consistency (α = 0.81).

Additional questions
As a part of the demographic questionnaire, individuals were asked to indicate if they had ever been diagnosed with an Asperger's or autism spectrum disorder (ASD), as symptoms of these disorders can influence social engagement or perceptions. 40 No participants endorsed a history of ASD.

Vignettes
We presented participants with a series of eight vignettes, taken from a similar vignette study conducted by Lee and Hayes-Skelton. 4 These vignettes were specifically designed to reflect either a social interaction (going to a party, talking with a classmate you do not know very well, talking to people you know and do not know at a party, and disagreeing with a

Vignette scoring
We totaled participants' answers to all eight vignettes to yield separate total scores for personal value, social acceptability, self-efficacy, and behavioral action. The total scores yielded acceptable to good internal consistencies (α = 0.70, 0.85, 0.71, and 0.70, respectively).

Manipulation check
After each vignette, we asked participants a manipulation check question, asking "what was the situation about?" Participants who answered incorrectly had that vignette's answers dropped from the analysis.
Participants who failed at least one manipulation check were dropped from the study, leading to eight participants being dropped from the final analysis.

Procedures
Participants provided informed consent for this IRB approved study, before completing a comprehensive demographics questionnaire, followed by the vignette survey, the SPIN, and the DASS.

Preliminary analyses
The means, standard deviations, and correlation matrix for all measures are presented in Table 2.
All variables were examined for assumptions of normality. All skewness and kurtosis values were within acceptable ranges. 41 In addition, we examined personal value, social acceptability, self-efficacy, SPIN, and DASS-D by age, race/ethnicity, and gender using a series of ANOVAs and found no significant differences between groups in any of these variables (ps = 0.07 -0.80).

Hypothesis 1
To test the hypothesis that social acceptability and self-efficacy, but not personal value, would be negatively associated with social anxiety, we conducted a multiple regression analysis. Here, the independent variables were personal value, social acceptability, and self-efficacy, with DASS-D as a covariate, and the dependent variable was the SPIN (See Table 3). With all variables entered, the full model was significant and accounted for 14% of the variance of the SPIN (R 2 = 0.14, F(4, 88) = 3.50, p = 0.01). In this model, selfefficacy was significantly associated with the SPIN (β = -0.36, p < 0.01), while personal value and social acceptability were not (β = -0.06, p < 0.01; β = 0.59, p = 0.08, respectively).

Hypothesis 2
To examine personal value, social acceptability, and self-efficacy as correlates of behavioral action

Discussion
Although models of SAD implicate behavioral action as a key mechanism of change in psychopathology, there has been little attention to the factors associated with behavioral action itself. As noted above, one framework to better understand the mechanisms of behavioral action may be the TPB, which highlights self-efficacy, personal value, and the social acceptability of the behavior as predictors of general social behavior. However, these predictors have yet to be fully examined together in the context of behavioral action in social anxiety. As such, the present study investigated self-efficacy, personal value, and the perceived social acceptability of a behavior as correlates of both social anxiety and behavioral action in the context of social anxiety.
Results partially supported Hypothesis 1, which proposed that when examined together, greater perceived social acceptability and self-efficacy, but not personal value, would each be uniquely associated with lower levels of social anxiety. As predicted, selfefficacy was significantly associated with social anxiety. This is consistent with both models of SAD and studies indicating that self-efficacy is negatively associated with social anxiety. [1][2][3][4][19][20][21][22] Our results also indicated that personal value was not associated with social anxiety. The findings here support Lee's findings that when personal value is examined outside of the context of ABBTs, it exists independent from social anxiety. 29 As noted by Lee, 29 this explanation is consistent with acceptance-based theories that indicate that anxiety does not change a value, but rather gets in the way of individuals acting in accordance with their values. [42][43][44] Contrary to our hypothesis, the perceived social acceptability of a behavior was not significantly associated with social anxiety. Although this appears to be in direct contrast to the existing literature in the field, the difference may be a result of the way our social situations were presented. For example, Dijk et al. 34 presented social behaviors that were paired with a relatively ambiguous, yet typically feared performance outcome in individuals with SAD (e.g. blushing while giving a speech). In contrast, our behavioral actions were not paired with a feared performance outcome (e.g. giving a speech). When taken with models of SAD [1][2][3] that indicate that individuals with SAD have more rigid  is that participants may have rated their likelihood to take the behavioral action based on how they believed they should react, rather than how they would react. As

Clinical implications
Despite its limitations, the current study adds to the present literature on behavioral treatments for SAD by highlighting potential mechanisms leading to engagement with feared stimuli. For example, exposures, which involve individuals facing or being exposed to feared social stimuli, emphasize increasing behavioral action and decreasing behavioral avoidance. As such, our results may suggest that increasing self-efficacy is the most effective way to increase engagement in exposures through known methods of increasing self-efficacy such as modeling, encouragement, and practice. 49 However, because one's ability to increase self-efficacy is likely impacted by social anxiety severity, doing so may prove challenging in clients with higher levels of SAD. Encouragingly, since personal value is not associated with social anxiety, another method of increasing engagement in exposures may be to increase personal value regardless of social anxiety severity. For example, clinicians might consider utilizing values work to explicitly frame exposure engagement as a valued action.

Disclosure
No conflicts of interest declared concerning the publication of this article.