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Behavior Therapy 42 (2011) 183 – 196
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The Negative Self-Portrayal Scale: Development, Validation, and Application to Social Anxiety David A. Moscovitch Vanessa Huyder University of Waterloo
The Negative Self-Portrayal Scale (NSPS) is a new questionnaire designed to assess the extent to which individuals are concerned that specific self-attributes they view as being deficient will be exposed to scrutiny and evaluation by critical others in social situations. These concerns have been proposed to drive symptoms of social anxiety and account for individual differences in social fears and avoidance behaviors (Moscovitch, 2009). Here, we introduce the NSPS and examine its factor structure and psychometric properties across two large samples of North American undergraduate students with normally distributed symptoms of social anxiety. Exploratory and confirmatory factor analyses supported a 3-factor solution representing concerns about (a) social competence; (b) physical appearance; and (c) signs of anxiety. The NSPS was found to have good internal consistency and test-retest reliability, strong convergent validity, and adequate discriminant validity. In addition, NSPS total scores accounted for a significant proportion of unique variance in self-concealment (i.e., safety) behaviors over and above established symptom measures of social interaction anxiety, social performance anxiety, and depression. Results are discussed in relation to theoretical models of social anxiety and the potential utility of the NSPS for both clinical research and practice.
This research was supported, in part, thanks to funding from the Canada Research Chairs Program to David A. Moscovitch. We are grateful to Dr. Erik Woody for his helpful suggestions and assistance with the statistical analyses. Address correspondence to David A. Moscovitch, Ph.D., Canada Research Chair in Mental Health Research, Department of Psychology, University of Waterloo, 200 University Ave. West Waterloo, Ontario, Canada N2L 3G1; e-mail:
[email protected]. 0005-7894/10/183–196/$1.00/0 © 2010 Association for Behavioral and Cognitive Therapies. Published by Elsevier Ltd. All rights reserved.
THERE IS A GROWING consensus that the perception of self plays a crucial role in the pathogenesis and persistence of social anxiety (cf. Stopa, 2009a). Although specific conceptualizations of the self differ across contemporary cognitive and interpersonal models of social anxiety (Alden & Taylor, 2004; Clark & Wells, 1995; Hofmann, 2007; Leary & Kowalski, 1995; Rapee & Heimberg, 1997), there is now strong empirical support for the view that symptoms of social anxiety arise from the discrepancy produced by the motivation to convey a desired social impression of oneself to others in combination with the expectation that one will fail to do so (e.g., Schlenker & Leary, 1985). Indeed, numerous studies have shown that highly socially anxious individuals significantly underestimate their social performance abilities as well as other salient social self-attributes, and routinely provide selfratings that fall well below their perception of the standard they believe is required by relevant “audience” evaluators (e.g., for reviews of this literature, see Moscovitch & Hofmann, 2007; Orr & Moscovitch, 2010a; Moscovitch, Orr, Rowa, Gehring Reimer, & Antony, 2009). Under social threat, highly socially anxious and phobic individuals allocate increased attentional resources toward monitoring their internal anxiety cues and other perceived negative features of the self (Rapee & Heimberg, 1997; Spurr & Stopa, 2002). This increase in self-monitoring coincides with the experience of spontaneous, recurrent, intrusive, and often vivid negative mental self-images that are viewed from an observer's perspective (Hackmann, Clark, & McManus, 2000; Hackmann, Surawy, & Clark, 1998). These images tend to be negatively
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distorted and exaggerated representations of the self; nevertheless, they are perceived and processed by socially anxious individuals as being accurate. As a result, these images capture precious emotional and cognitive resources and possibly prevent the encoding of salient positive social and interpersonal cues in the external environment (Clark & Wells, 1995). On the basis of clinical observations and the burgeoning empirical literature on the central role of the self in social anxiety, Moscovitch (2009) recently recommended that scientist-practitioners engaged in assessing and treating patients with social anxiety disorder (SAD) within an exposurebased cognitive behavioral therapy (CBT) framework shift their focus in treatment from targeting patients' feared social situations, to targeting more directly the core feared stimuli in SAD. Moscovitch proposed that the feared stimuli in SAD are specific self-attributes that socially anxious individuals perceive as being flawed or contrary to perceived sociocultural norms, hypothesizing that it might be possible to organize these self-attributes into broad themes that fall across four nonorthogonal dimensions: (a) concerns about social skills and behaviors; (b) concerns about visible signs of anxiety; (c) concerns about physical appearance; and (d) concerns about personality. While research on SAD has historically focused on socially anxious individuals' concerns about social skills/behaviors and signs of anxiety (see Moscovitch, 2009, for a review of this literature), investigators have only recently begun to examine the link between social anxiety and heightened concerns about physical appearance (Hart, Flora, Palyo, Fresco, Holle, & Heimberg, 2008; Izgiç, Akyüz, Dogan, & Kugu, 2004; Rapee & Abbott, 2006) and personality characteristics (Mansell & Clark, 1999; Wilson & Rapee, 2006). Moscovitch's (2009) model offers a potentially useful, theory-guided heuristic for conceptualizing symptom variations and individual differences in social anxiety. Socially anxious people are heterogeneous with respect to the kinds of social situations they fear and avoid (see Hofmann, Heinrichs, & Moscovitch, 2004 for a review of this literature), as well as the types of subtle avoidance or safety behaviors they tend to use (e.g., McManus, Sacadura, & Clark, 2008). According to Moscovitch (2009), variations in social fears and safety behaviors are functionally related to underlying differences in self-attribute concerns across the proposed dimensions. Specifically, social situations that are endorsed as being anxiety-provoking are those which individuals perceive as having the capacity to expose their
perceived self-deficiencies for public consumption. In the same vein, subtle avoidance and safety behaviors represent attempts to conceal or prevent the public exposure of those self-attributes. Thus, core concerns about self-attribute flaws are proposed to drive the constellation of social anxiety symptoms—subjective distress, avoidance, and self-concealment—that are associated with high levels of functional impairment in the emotional, vocational, and interpersonal lives of individuals with SAD (Ledley & Heimberg, 2005). Although numerous psychometrically validated measures of social anxiety are now widely available, none specifically assesses self-portrayal concerns across the proposed dimensions. Most of the excellent social anxiety self-report measures currently in circulation (e.g., LSAS-SR, SIAS, SPS, SPIN, SPAI, etc.; see Antony, Orsillo, & Roemer, 2001) assess the level or type of social anxiety symptoms that individuals may experience across a variety of social performance and interaction situations. Our objective in designing the Negative Self-Portrayal Scale (NSPS) was not to add another questionnaire to this list. Rather, we wished to create a novel measure that directly assessed the specific types of self-attributes that Moscovitch (2009) proposed would elicit concerns about self-presentation for socially anxious individuals in anxiety-provoking social situations. Being able to identify and measure such concerns might conceivably both enhance our understanding of symptom heterogeneity in social anxiety and guide case conceptualization of SAD in clinical practice. This may, in turn, help facilitate the delivery of CBT for SAD in a more individually customized manner, thereby having the potential to enhance SAD treatment outcomes. Here, we examine the factor structure and psychometric properties of the NSPS in two large samples of individuals with social anxiety symptoms distributed across the normal spectrum and begin to investigate some of the central, but previously untested, theoretical claims of Moscovitch's (2009) model. Despite our theoretical hypotheses about the factor structure of the NSPS across the proposed dimensions, no previous studies have tested these predictions empirically. Thus, we first present an exploratory factor analysis (EFA) of the NSPS in participant Sample 1, as recommended in the early stages of scale development (e.g., Hurley et al., 1997). Next, based on the results from Sample 1, we follow up the EFA in Sample 2 with confirmatory factor analysis (CFA) of the derived model and plausible competing models (Brown, 2006).
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Method participants Two groups of nonoverlapping undergraduate participants (n = 225; n = 316) at a large, urban Canadian university completed a series of online questionnaires in exchange for partial course credit. Initial Item Generation An initial pool of 62 NSPS items was constructed by the authors. These were then sent via electronic mail to three independent Ph.D.-level scientist-practitioners with expertise in social anxiety research and extensive experience treating individuals with SAD in clinical settings. Assessors were given a randomized list of the preliminary items along with an instruction sheet defining the four hypothesized (Moscovitch, 2009) dimensions of self-attribute concerns (i.e., concerns about social skills and behaviors; concerns about visible signs of anxiety; concerns about physical appearance; and concerns about personality). Assessors were instructed to eliminate any items that seemed redundant or unclear, add items they thought were appropriate, and indicate the dimension in which they thought each self-attribute item belonged, according to the definitions given to them. Any items eliminated or misallocated by more than one assessor were removed from the respective inventory. Any new items that were suggested by at least one assessor were added to the NSPS item pool, provided they were face valid and nonredundant with other items already on the list. Following this process, 11 items were removed and 6 items were added, resulting in a total of 57 NSPS items.
measures Negative Self-Portrayal Scale (NSPS) Participants were administered the 57-item NSPS. Instructions to respondents asked them to rate the degree to which they are concerned about certain aspects of themselves when in anxiety-provoking social situations. Response options per item ranged from 1 to 5, with descriptive anchors listed as “not at all concerned” to “extremely concerned.” There were no reverse-scored items; higher scores represented greater self-portrayal concerns. Self-Concealment Behaviors Inventory (SCBI) The SCBI is a self-report measure of self-concealment (i.e., safety) behaviors. This measure is essentially an expanded version of the unpublished Social Behaviour Questionnaire (SBQ; Clark, Butler, Fennell, Hackmann, McManus, & Wells, 1995; see also McManus et al., 2009). Given that the SBQ is an unpublished scale with unknown psychometric properties, we chose to add items deemed by
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experienced clinicians to be relevant to socially anxious individuals. This was done using the expert-guided process described above for the NSPS. Following this process, 2 items were removed and 9 items were added to our original 46-item pool, resulting in a total of 53 SCBI items. Respondents were instructed to rate how frequently they typically engage in each of the listed behaviors before or during anxiety-provoking social situations in order to prevent or alleviate their experience of anxiety.1 Social Phobia Scale (SPS) and Social Interaction Anxiety Scale (SIAS) (Mattick & Clarke, 1998) The SPS and SIAS are companion 20-item selfreport scales that assess social performance and interaction fears, respectively. Each item is rated on a scale from 0 (not at all characteristic or true of me) to 4 (extremely characteristic or true of me), with a combination of sum- and reverse-scored items. Both scales have been found to have good test-retest reliability (r = 0.91-0.93) and convergent validity (r = 0.59-0.77 with other measures of social anxiety), high levels of internal consistency (Cronbach's alpha indices of 0.90 and 0.91), and to distinguish between individuals with and without SAD (Mattick & Clarke, 1998; Osman, Gutierrez, Barrios, Kopper, & Chiros, 1998; Peters, 2000). Liebowitz Social Anxiety Scale–Self Report Version (LSAS-SR; Baker, Heinrichs, Kim, & Hofmann, 2002) The LSAS-SR is a 24-item self-report version of a well-validated clinician-administered instrument (Heimberg et al., 1999) that assesses fear and avoidance, in separate subscales, across a number of social and performance situations. For the fear subscale (LSAS-F), each item is rated on a scale of 0 (none) to 3 (severe). For the avoidance subscale (LSAS-A), each item is rated on a scale of 0 (never) to 3 (usually). Like the clinician-administered version, the LSAS-SR has been shown to have good test-retest reliability (r = 0.83), internal consistency (Cronbach's alpha of 0.95), and convergent and discriminant validity (e.g., among patients with SAD, correlations with other measures of social anxiety were found to be significantly stronger than correlations with measures of depression) (Baker et al., 2002; Fresco et al., 2001). Obsessive Compulsive Inventory–Short Version (OCI-SV; Foa et al., 2002) Originally adapted from the longer 42-item Obsessive-Compulsive Inventory (Foa, Kozak, Salkvoskis, Coles, & Amir, 1998), the OCI-SV is an 18-item 1 A copy of the SCBI is available upon request from the first author.
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brief self-report scale that measures concerns associated with obsessive-compulsive disorder (e.g., I get upset if objects are not arranged properly; I collect things I don't need; etc.). Respondents are asked to rate how much each item distresses or bothers them on a scale from 0 (not at all) to 4 (extremely). The OCI-SV has been found to have excellent test-retest reliability (r = 0.82–0.84), good convergent validity (r = 0.53–0.85 with other measures of OCD), and high internal consistency (Cronbach's alpha indices of 0.81 to 0.93) (Foa et al., 2002). Of note, however, was Foa and colleagues' (2002) finding that the OCI-SV had a high correlation (r = 0.70) with the Beck Depression Inventory, a conceptually distinct measure of depression. Beck Depression Inventory II (BDI-II; Beck, Steer, & Brown, 1996) The BDI-II is a 21-item self-report instrument for assessing the intensity of depression in diagnosed patients and detecting symptoms of depression in normal populations. Respondents are instructed to choose the statement amongst a group of statements that best applies to how they generally feel. Each group of statements ranges from 0 (e.g., I do not feel sad) to 3 (e.g., I am so sad or unhappy that I can't stand it). The BDI-II has consistently been shown to have adequate test-retest reliability (r = .60–.83 in nonclinical samples and r = .48–.86 in clinical samples), good convergent and discriminant validity (e.g., the BDI-II has been found to be significantly more strongly correlated with depression relevant measures, such as the Beck Hopelessness Scale, than with measures of anxiety, p b .01), and high internal consistency (Cronbach's alpha indices of 0.76 to 0.95 in clinical populations and .73 to .92 in nonclinical populations; Osman, Barrios, Gutierrez, Williams, & Bailey, 2008).
procedure All questionnaires were administered in online sessions via a standardized web-based automated computer program that was designed to protect
participants’ confidentiality and the security of their data. Participants in Group 1 completed two online sessions. The first session included administration of the BDI-II, LSAS-SR, OCI-SV, SPS, and SIAS. Due to the anticipated length and monotony of completing multiple questionnaires in one sitting, participants were then asked to complete the NSPS and SCBI in a separate session 2 days after Session 1. All measures in both sessions were presented in a randomly counterbalanced order. Our experience from administering the questionnaires to Group 1 indicated that all measures could be completed in a reasonable amount of time without imposing unrealistic demands on the participants. Thus, participants in Group 2 completed all of the counterbalanced measures—BDI-II, LSAS-SR, OCISV, SPS, SIAS, NSPS, and SCBI—in one session. One week prior to this session, we also asked participants to complete the NSPS (but none of the other measures) to enable us to evaluate its test-retest reliability. Preliminary item-by-item frequency analyses for each measure administered in the study indicated that the total proportion of missing data was low (0% to 2% for the vast majority of items) across all measures and participants in both groups. Thus, missing data were imputed for all measures using the expectation-maximization (EM) estimation method in SPSS Statistics 18.0 (2009). Using an iterative process, the EM method estimates the means, the covariance matrix, and the correlation of quantitative (scale) variables of missing values. When imputing these missing values, we included only the measures that were used in each relevant analysis described below.
results Descriptive Analyses Demographic information (reported age, gender, and ethnicity) for participants in Groups 1 and 2 are presented in Table 1. A MANOVA with gender as the grouping variable was conducted for Groups 1 and 2. There were no significant effects of gender on any of the measures, F(6, 218) = 1.67, p N .05, for
Table 1 Demographic Characteristics of Participants
Age (N = 220 for Group 1; 277 for Group 2) Gender (% female) (N = 225 for Group 1; 281 for Group 2) Ethnicity (N=224 for Group 1; 276 for Group 2) Caucasian Asian East Indian Middle Eastern Other
Group 1
Group 2
19.9 years (SD = 3.35) 72.9%
20.6 years (SD = 3.74) 68.3%
45.5% 29.9% 12.9% 3.6% 8.0%
47.8% 32.6% 4.3% 4.3% 10.9%
Note. Due to some missing data that could not be imputed, Ns vary for Groups 1 and 2.
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Table 2 Internal Consistency, Means and (Standard Deviations) of Study Measures Measure
Group 1 Cronbach's α
NSPS SCBI SPS SIAS LSAS-SR-F LSAS-SR-A BDI-II OCI-SV
0.96 0.96 0.93 0.93 0.93 0.91 0.93 0.89
2
Group 2 Mean (SD) 1 57.95 (21.61) 101.64 (23.30) 20.07 (14.74) 29.71 (16.15) 25.41 (12.51) 23.76 (12.93) 11.52 (9.74) 16.64 (10.82)
Cronbach's α 0.96 0.95 0.95 0.90 0.92 0.90 0.93 0.89
2
Mean (SD) 1 60.89 (23.30) 99.21 (22.65) 20.29 (15.88) 31.50 (14.16) 26.06 (11.96) 23.35 (12.13) 11.47 (9.54) 15.90 (10.73)
Note. Ns = 225 (Group1) and 316 (Group 2). NSPS = Negative Self-Portrayal Scale; SCBI = Self-Concealment Behaviors Inventory; SPS = Social Phobia Scale; SIAS = Social Interaction Anxiety Scale; LSAS-SR-F = Liebowitz Social Anxiety Scale – Self Report Version Fear Subscale; LSAS-SR-A= Liebowitz Social Anxiety Scale – Self Report Version - Avoidance Subscale; BDI-II = Beck Depression Inventory II; OCI-SV = Obsessive Compulsive Inventory – Short Version. 1 Based on 27-item NSPS. 2 Despite the high internal consistency values, the highest correlation between any two of the retained NSPS items across both samples was r = .80, suggesting non-redundancy between the items.
Group 1, and F(6, 274) = .972, p N .05, for Group 2. A MANOVA with ethnicity (Caucasian, Asian, East Indian, Middle Eastern, and Other) as the grouping variable was conducted on the SIAS, SPS, LSAS-F, LSAS-A, NSPS, and SCBI scores for Groups 1 and 2. The results indicated no significant effects of ethnicity on any of the measures, F (36,933) = 1.15, p N .05, for Group 1, and F(36, 1162) = 1.36, p N .05, for Group 2.2 Mean scores, standard deviations, and Cronbach's alphas for each measure in Groups 1 and 2 are presented in Table 2. Scale Item Characteristics and Factor Analysis Group 1 scale item characteristics and exploratory factor analysis. EFA with maximum likelihood extraction was used to examine the underlying structure of the NSPS in the first group of participants. As the hypothesized factors of the NSPS were expected to correlate with each other (Moscovitch, 2009), the NSPS items were subjected to analysis using an oblique (promax) rotation. Items were removed that were cross-loading or unreliable, in accordance with Comrey and Lee's (1992) recommendations for factor analyses involving multiple subscales. All retained items with factor loadings of N.45 on a single factor and b.32 on any other factor were retained, with the exception of the one “blushing” item, which cross-loaded onto two factors but was retained because of its clinical relevance in socially anxious 2 Independent-sample t-tests were also conducted to compare scores across measures for the primary ethnic groups (Caucasian vs. Asian). Results in both Groups indicated that relative to Caucasians, Asian participants reported higher scores on the SIAS (ts N 2.10, ps b .05), and NSPS (ts N 2.15, ps b .05 ). There were no other significant differences.
populations (e.g., Bögels & Reith, 1999; Gerlach, Wilhelm, Gruber, & Roth, 2001). Following this process, 27 items remained, all of which had corrected item-total correlations greater than or equal to .43. An inspection of all eigenvalues greater than 1, as well as the scree plot, indicated that a three-factor solution provided the best fit. The three factors accounted for 55.1% of the total variance. Interpreting the factor loadings, we labeled the first factor, which accounted for 45.4% of the variance, concerns about social competence. The second factor, accounting for 5.6% of the variance, was labeled concerns about physical appearance. Finally, the third factor accounted for 4.1% of the variance and was labeled concerns about showing signs of anxiety. Table 3 presents the rotated factor loadings from the EFA pattern matrix for each of the 27 NSPS items that were retained in the first group of participants (please also see the notes below Table 3 for the NSPS respondent instructions). Group 2 scale item characteristics and confirmatory factor analysis. As indicated above, the one blushing item included in the measure for participants in Group 1 did not load cleanly onto one factor, but instead cross-loaded onto both concerns about social competence (.29) and concerns about showings signs of anxiety (.24). This finding was consistent with those of Schultz and colleagues (2006), who, in their recent psychometric study of the Appraisal of Social Concerns Scale (ASC), reported that the one ASC blushing item was discarded because it cross-loaded both onto a factor related to social competence and a factor related to social anxiety. We chose to retain the blushing item
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Table 3 Rotated Factor Loadings from Pattern Matrix for Non-Discarded Items of the Negative Self-Portrayal Scale for Group 1 Item
Social Competence 21. Socially awkward 24. Lacking social skills 12. Lacking personality 10. Interpersonally ineffective 14. Unable to express myself 18. Reserved 17. Humorless 23. Speaking incoherently 20. Stupid 19. Aloof 3. Boring Physical Appearance 27. Ugly 5. Physically unattractive 11. Weird-looking 13. Fat 26. Unfashionable 9. Blemished (i.e., my appearance) 22. Having a bad hair day 2. Poorly dressed Signs of Anxiety 8. Speaking with a trembling voice 25. Fidgeting 1. Stuttering 15. Twitching (i.e., my facial muscles) 16. Frozen 6. Losing control of my emotions 4. Sweating 7. Blushing
Social Competence
Physical Appearance
Signs of Anxiety
Communalities
1.00 .95 .76 .74 .72 .66 .63 .56 .55 .53 .50
-.07 -.04 .18 .03 -.08 -.02 .08 .09 .24 .13 .13
-.11 -.09 -.08 .09 .13 -.06 .12 .20 -.04 .04 .09
.77 .75 .71 .67 .58 .37 .60 .63 .51 .43 .44
-.01 -.03 .07 -.10 .17 .08 .00 .07
.97 .93 .80 .72 .66 .64 .58 .46
-.12 -.10 .02 .07 -.01 .05 .19 .14
.80 .73 .75 .47 .61 .53 .51 .38
-.02 -.05 -.16 .10 .32 .16 .04 .29
-.02 .02 .01 -.06 .01 .09 .07 -.05
.82 .79 .73 .64 .51 .50 .49 .24
.62 .58 .41 .46 .59 .46 .32 .21 55.11%
Note. NSPS instructions to respondents read: “Using the scale provided above the following list of items, please select the circle under the appropriate number/statement to indicate the degree to which you are concerned about the following aspects of yourself when you are in anxiety-provoking social situations (e.g. talking to someone who is a stranger; giving a speech in front of an audience; answering a question in class; etc.).” For each item, respondents are asked to consider the following statement: “In social situations (in which I feel anxious), it will become obvious to other people that I am ____.” Response options per item range from 1-5, with descriptive anchors including “not at all concerned,” “slightly concerned,” “moderately concerned,” “very concerned,” and “extremely concerned.” The NSPS total score is a sum score of all items. Each subscale can also be summed separately to obtain data on the relative strength of self-portrayal concerns across dimensions within individuals and across individuals within a larger sample.
because of its clinical relevance for socially anxious individuals and our overarching theoretical model (i.e., Moscovitch, 2009). In order to explore whether blushing might represent a separate fourth factor, three new blushing items were constructed (i.e., becoming red in the face, becoming hot in the face, and becoming flushed) and added to the NSPS (resulting in a 30-item measure), which we administered to participants in Group 2. CFA was used to analyze this 30-item NSPS scale for participants in Group 2 using Amos 17.0 (a structural equation modeling program; Arbuckle, 2008). Missing data were handled with the full information maximum likelihood method (Anderson, 1957), as implemented in Amos. The data met the criteria for univariate and multi-
variate normality suggested by Kline (1998) and West, Finch, and Curran (1995); for example, values for univariate skew were all less than |1.57| and values for univariate kurtosis were all less than |1.61|. A 4-factor model was evaluated with CFA, which included the 3-factor structure from Group 1 and a separate fourth factor containing the four blushing items. This model was evaluated and fit moderately well, χ2 (399) = 1579.83, p b .001; comparative fit index (CFI) = .846; root-mean-square error of approximation (RMSEA) = .097; probability of close fit (pclose) = .000. However, the four blushing items were highly correlated with each other (r = .76-.88) and deemed redundant; thus, only the one “blushing” item was retained.
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negative self-portrayal scale CFA was then conducted to test the original Moscovitch (2009) 4-factor model with the remaining 27 NSPS items. The model demonstrated good fit, χ2(318) = 948.52, p b .001; CFI = .898; RMSEA = .079; pclose = .000. However, two of the factors—concerns about social skills and behaviors and concerns about personality—were highly corre-
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lated (r = .96), indicating that they were not distinct factors and would be more accurately represented as one factor (concerns about social competence). Thus, a new model was evaluated via CFA, consisting of 27 items loading onto the three factors found in Group 1. The one “blushing” item was constrained to load onto the concerns about signs of
FIGURE 1 Confirmatory factor analysis of the NSPS 3-factor model for Group 2. Items are labelled with I = item and the corresponding number from the NSPS items shown in Table 3. All factor loadings had a p-value b .001 (2-tailed).
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anxiety factor. This 3-factor model fit well, χ2(321) = 974.58, p b .001; CFI = .895; RMSEA = .080; pclose = .000, and is illustrated in Fig. 1 with standardized estimates. The three factors are labeled: (a) Social Competence, (b) Physical Appearance, and (c) Signs of Anxiety. Each item of the scale is identified by number, according to the 27item measure presented in Table 3. Finally, for comparative purposes, an alternative 3-factor model was tested via CFA, consisting of 27 items loading onto the three factors found in Group 1 and the one “blushing” item constrained to load onto the social competence factor. This model did not fit as well, χ2 (321) = 1018.27, p b .001; CFI = .888; RMSEA = .083; pclose = .000. The significance of the difference in model fit between this model and the one displayed in Fig. 1 could not be tested because they are not nested models. However, the Browne-Cudeck Criterion (BCC) and expected cross-validation index (ECVI) values were inspected for each of these models, with smaller values indicating better model fit (Wicherts & Dolan, 2004). Relative to the 3-factor model with blushing loading onto the social competence factor, the 3-factor model with blushing loading on the signs of anxiety factor (displayed in Fig. 1) demonstrated lower BCC (1158.97 vs. 1202.66) and ECVI (3.63 vs. 3.77) values and was, therefore, retained. Intercorrelations between the three NSPS factors modeled in Fig. 1 (social competence, signs of anxiety, and physical appearance) are reported in Table 4. Internal Consistency and Test-Retest Reliability The NSPS demonstrated excellent internal consistency. Cronbach's alphas for the 27-item NSPS in Groups 1 and 2 were both .96. Each factor also demonstrated strong internal consistency, with Cronbach's alpha coefficients for the social competence, physical appearance, and signs of anxiety factors, respectively, of .93 (n = 225), .91 (n = 225), and .85 (n = 225) in Group 1, and .94 (n = 316), .93 (n = 316), and .88 (n = 316) in Group 2. Table 4 Intercorrelations Between the Factors of the Negative Self-Portrayal Scale
Note. Ns = 225 (Group 1) and 316 (Group 2). Group 1 correlations are in the gray-shaded region. *p b .001 (2-tailed).
Though not measured in Group 1, the test-retest reliability of the 27-item NSPS in Group 2 was satisfactory (r = .75; n = 316) over a 1-week interval. The SCBI also demonstrated excellent internal consistency. Cronbach's alphas for the 53-item SCBI in Groups 1 and 2, respectively, were .96 (n = 225) and .95 (n = 316). Convergent and Discriminant Validity As depicted in Table 5, NSPS total scores for Groups 1 and 2 demonstrated significantly higher zero-order correlations with measures of social anxiety, including LSAS-SR-F, LSAS-SR-A, SPS, and SIAS scores (r = .63–.73) than with measures of theoretically distinct constructs such as OCD (r = .40–.47) (p-values b.01; n = 225 and 316). Although the NSPS in Group 2 was significantly more strongly correlated with measures of social anxiety than with the theoretically distinct construct of depression, as measured by BDI-II depression scores (r = .53) (pdifference b .001; n = 316), the NSPS in Group 1 was not more strongly correlated with other measures of social anxiety than with the BDIII (r = .65) (pdifference N .05; n = 225). For Groups 1 and 2, the 53-item version of the SCBI total score demonstrated significantly higher zeroorder correlations with measures of social anxiety, including LSAS-SR-F, LSAS-SR-A, SPS, and SIAS scores (r =.71–.77) than with measures of theoretically distinct constructs, including both the OCI-SV (r = .43-.45) (pdifference b .001; n = 225 and 316) and BDI-II (r = .50-.61) (pdifference b .05; n = 225 and 316). Construct Validity Moscovitch (2009) theorized that self-portrayal concerns and self-concealment (i.e., safety) behaviors are functionally related to one another, such that self-concealment is used in a strategic manner by socially anxious individuals to prevent others from observing their negative self-attributes in social situations. We were, therefore, interested in examining the hypothesis that the NSPS would be a useful measure that would help account for the wide-ranging use of self-concealment behaviors, over and above established symptom measures of social anxiety and depression. Thus, we predicted that self-concerns (even in the unselected samples in the present study) would account for a significant amount of variance in self-concealment behaviors over and above the influence of symptoms of social interaction anxiety, social performance anxiety, and depression. To this end, we conducted a hierarchical multiple regression analysis with SCBI scores as the criterion variable and four predictor variables (SIAS, SPS, BDI-II, and NSPS scores) entered in four separate steps. Tolerance values were
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negative self-portrayal scale Table 5 Zero-Order Correlations Between the NSPS Total Score, NSPS Subscales, SCBI, and Other Self-Report Measures Measures SCBI Group 1 Group 2 SPS Group 1 Group 2 SIAS Group 1 Group 2 LSAS-SR-F Group 1 Group 2 LSAS-SR-A Group 1 Group 2 BDI-II Group 1 Group 2 OCI-SV Group 1 Group 2
NSPS Total
NSPS Social Competence
NSPS Physical Appearance
NSPS Signs of Anxiety
SCBI
.77 ⁎ .73 ⁎
.73 ⁎ .72 ⁎
.62 ⁎ .58 ⁎
.72 ⁎ .64 ⁎
– –
.69 ⁎ .73 ⁎
.65 ⁎ .67 ⁎
.58 ⁎ .62 ⁎
.64 ⁎ .68 ⁎
.77 ⁎ .76 ⁎
.69 ⁎ .71 ⁎
.71 ⁎ .73 ⁎
.55 ⁎ .55 ⁎
.58 ⁎ .61 ⁎
.71 ⁎ .75 ⁎
.68 ⁎ .67 ⁎
.66 ⁎ .68 ⁎
.56 ⁎ .52 ⁎
.60 ⁎ .59 ⁎
.76 ⁎ .76 ⁎
.63 ⁎ .65 ⁎
.62 ⁎ .66 ⁎
.52 ⁎ .51 ⁎
.57 ⁎ .56 ⁎
.75 ⁎ .75 ⁎
.65 ⁎ .53 ⁎
.60 ⁎ .50 ⁎
.54 ⁎ .45 ⁎
.58 ⁎ .48 ⁎
.61 ⁎ .50 ⁎
.47 ⁎ .40 ⁎
.44 ⁎ .37 ⁎
.33 ⁎ .35 ⁎
.49 ⁎ .37 ⁎
.45 ⁎ .43 ⁎
Note. Ns = 225 (Group 1) and 316 (Group 2). NSPS = Negative Self-Portrayal Scale; SCBI = Self-Concealment Behaviors Inventory; SPS = Social Phobia Scale; SIAS = Social Interaction Anxiety Scale; LSAS-SR-F = Liebowitz Social Anxiety Scale – Self Report Version Fear Subscale; LSAS-SR-A= Liebowitz Social Anxiety Scale – Self Report Version - Avoidance Subscale; BDI-II = Beck Depression Inventory II; OCI-SV = Obsessive Compulsive Inventory – Short Version. All correlations for Groups 1 and 2 are based on the 27-item NSPS. ⁎ p b .001 (2-tailed).
Table 6 Summary of Hierarchical Regression Analysis for Variables Predicting Levels of Social Self-Concealment on the SCBI Predictor
Step 1 SIAS Step 2 SIAS SPS Step 3 SIAS SPS BDI Step 4 SIAS SPS BDI NSPS
B
SE B
ß
Group 1
Group 2
Group 1
Group 2
Group 1
Group 2
1.04
1.02
0.07
0.05
0.72 ⁎⁎
0.75 ⁎⁎
0.44 0.83
0.57 0.63
0.10 0.10
0.07 0.07
0.31 ⁎⁎ 0.53 ⁎⁎
0.42 ⁎⁎ 0.45
0.41 0.65 0.55
0.55 0.59 0.16
0.09 0.11 0.12
0.07 0.08 0.10
0.28 ⁎⁎ 0.41 ⁎⁎ 0.23 ⁎⁎
0.41 ⁎⁎ 0.42 ⁎⁎ 0.07
0.22 0.54 0.25 0.39
0.44 0.46 0.08 0.24
0.09 0.10 0.12 0.06
0.07 0.08 0.09 0.05
0.15 ⁎ 0.34 ⁎⁎ 0.10 ⁎ 0.36 ⁎⁎
0.32 ⁎⁎ 0.32 ⁎⁎ 0.03 0.24 ⁎⁎
Note. SIAS = Social Interaction Anxiety Scale; SPS = Social Phobia Scale; BDI-II = Beck Depression Inventory II; NSPS = Negative SelfPortrayal Scale; SCBI = Self-Concealment Behaviors Inventory. Group 1: N = 225; R2 = .516 for Step 1 (p b .001); R2change = .108 for Step 2 (p b .001); R2change = .035 for Step 3 (p b .001); R2change = .050 for Step 4 (p b .001). Group 2: N = 316; R2 = .565 for Step 1 (p b .001); R2change = .087 for Step 2 (p b .001); R2change = .003 for Step 3 (p N .05); R2change = .024 for Step 4 (p b .001). ⁎ p b .05. ⁎⁎ p b .001.
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examined prior to this analysis to assess for the potential impact of multicolinearity and were found to be no less than .33 for all predictor variables, which is well above the minimum criteria of .10 (Cohen, Cohen, West, & Aiken, 2003). SIAS scores were entered in step 1, SPS scores in Step 2, BDI-II scores in Step 3, and NSPS total scores in Step 4. The total Ns were 225 and 316 for Groups 1 and 2, respectively. As shown in Table 6, social interaction anxiety, social performance anxiety, and depression symptoms each accounted significantly and uniquely for variance in SCBI scores in Steps 1, 2 and 3 for Group 1. For Group 2, only social interaction and performance anxiety (but not depression symptoms) accounted significantly and uniquely for variance in SCBI scores. Importantly, for both Groups 1 and 2, the addition of NSPS scores to the regression equation in Step 4 accounted for a significant proportion (2.4%– 5.0%) of the variance (in the use of self-concealment behaviors over and above the contributions of SIAS, SPS and BDI-II scores).3
Discussion The results of the present study suggest that the NSPS is a psychometrically strong and potentially useful instrument for measuring concerns that individuals have about exposing specific negative self-attributes to critical others in anxiety-provoking social situations. The NSPS represents a novel assessment tool in the social anxiety field that goes beyond measuring the level or types of social
3
We also analyzed the psychometric properties of the NSPS for the Caucasian (n = 102 in Group 1; n = 132 in Group 2) and Asian (n = 67 in Group 1; n = 90 in Group 2) groups separately: (1) NSPS total score internal consistency: Group 1 (Caucasians = .96; Asians = .95) and Group 2 (Caucasians = .95; Asians = .97). (2) NSPS internal consistency for the 3 factors: Group 1 (Caucasians = .93 SocCom, .91 PhyApp, .86 SigAnx.; Asians = .93 SC, .92 PA, .84 SA) and Group 2 (Caucasians = .93 SC, .94 PA, .84 SA; Asians = .95 SC, .94 PA, .91 SA). (3) NSPS test-retest reliability: Group 2 (Caucasians = .74; Asians = .75). (4) SCBI internal consistency: Group 1 (Caucasians = .96; Asians = .95) and Group 2 (Caucasians = .95; Asians = .96). (5) NSPS convergent/discriminant and construct validity: Space limitations prevent us from reproducing the correlational matrices and regression results here, which were conducted for the Caucasian and Asian groups separately across both samples. The overall pattern of results between the groups was similar. Any differences that emerged between ethnic groups were not found consistently across the two samples and may have been affected by sample size considerations, making these post-hoc analyses difficult to interpret. The full set of results is available by request from the first author.
anxiety symptoms respondents experience across different situations. It enables the specific assessment of the core negative features of the self that are thought to underlie self-presentational concerns that drive social anxiety (e.g., Leary & Kowalski, 1995; Stopa, 2009a) and to account for observed heterogeneity in situational fears, avoidance, and self-concealment behaviors amongst socially anxious individuals (Moscovitch, 2009). Moreover, the development of this measure represents a crucial first step in the process of testing Moscovitch's model of social anxiety. Empirical evidence obtained across two independent undergraduate samples in the present study indicated that NSPS items developed to tap concerns about social skills and concerns about personality loaded jointly onto a single factor, which we labeled concerns about social competence. Whereas psychologists might distinguish between social skills and behaviors, on one hand, and personality, on the other, it is likely that NSPS respondents simply considered social skill/behaviors to be observable indices of personality. Thus, respondents may be indicating that concerns about appearing “socially awkward” or “speaking incoherently” (both originally social skills/behaviors items) have the same negative social impact as appearing “aloof” or “boring” (both originally personality items); in other words, exhibiting flaws in social skills/behaviors or flaws in personality leads essentially to the same concern: appearing socially incompetent. Alongside concerns about social competence and in support of Moscovitch's (2009) theory, concerns about signs of anxiety and concerns about physical appearance emerged as separate (nonorthogonal) factors in the EFA. This 3-factor solution was associated with good model fit in the subsequent CFA. It was surprising that the blushing item crossloaded relatively weakly onto both the signs of anxiety and social competence factors in the EFA, but we chose to retain the blushing item for the CFA due to its empirically supported relevance in social anxiety research and practice. In the subsequent CFA, we found reasonably strong model fit when we constrained the blushing item to load only onto the signs of anxiety factor. Future research is needed to replicate this finding. While the observed factors of the NSPS across both groups in the present study did not map perfectly onto the predicted dimensions, the emergent factor structure of the NSPS appears to be valid, reliable, fairly stable over a 1-week period, and conceptually sound. A test-retest correlation of .75 is consistent with our expectations that the NSPS reflects relatively stable
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negative self-portrayal scale concerns about self-attributes that ought not to change significantly over short time intervals in the absence of treatment. The new measure demonstrated adequate concurrent validity across both samples and explained significant variance in the use of self-concealment behaviors over and above that accounted for by social interaction anxiety, social performance anxiety, and depression symptoms. Although we hypothesized that the NSPS would correlate more strongly with measures of social anxiety than with measures of depression, the observed correlations in our study between the NSPS and measures of both social anxiety and depression were quite robust. A possible reason for this finding is that the NSPS and BDI-II capture overlapping components of the self-critical cognitive style that is characteristic of—and may serve as a common cognitive diathesis underlying—both syndromes (see Ingram, Ramel, Chavira, & Scher, 2005). Indeed, previous research has highlighted the central role of negative self-related cognitions in the phenomenology of both social anxiety and depression (e.g., Dozois & Frewen, 2006; Moscovitch, Hofmann, Suvak, & In-Albon, 2005). Another possibility is that the NSPS might have good discriminant validity in relation to some measures (e.g., OCISV) but poor discriminant validity in relation to others (e.g., BDI-II). More research is required to better understand the unique cognitive features of social anxiety and depression and whether the NSPS is capable of distinguishing between them. The present study was not without its limitations. Notwithstanding the recent publication of the Subtle Avoidance Frequency Examination (SAFE; Cuming, Rapee, Kemp, Abbott, Peters, & Gaston, 2009), no validated, published measure of safety behaviors existed when our data were collected; thus, we adapted the SCBI from a previously unpublished measure of safety behaviors and used it as our measure of self-concealment behaviors in the present study. Our results suggested that the SCBI is a valid and reliable measure, with high Cronbach's alphas across both samples and adequate convergent and discriminant validity. We assessed the discriminant validity of the NSPS in relation to the BDI-II and the OCI-SV, but it will be important in future studies to determine how the NSPS correlates with measures of constructs—for example, worry, panic, or higher-order dimensions (e.g., Brown & Barlow, 2009)—that might be even more similar to social anxiety both conceptually and clinically than depression or OCD per se. Since all questionnaires were administered online, it is possible that participants felt less accountable to answer questions as carefully as participants who
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complete pencil-and-paper measures in the laboratory might feel. Consequently, although previous studies comparing online and paper administrations of questionnaires have shown that online measures are highly reliable (e.g., Luce, Winzelberg, Das, Osborne, Bryson, & Taylor, 2007), it would be prudent to replicate our study with paper questionnaires. In addition, our use of multiple sessions for completion of the study measures may have introduced additional variability into the study associated with participants’ fluctuating circumstances and moods across testing sessions. Furthermore, despite the wide range of reported symptoms of anxiety and depression in our study, the overall mean levels of these symptoms were quite low; thus, it is impossible to know whether and how the NSPS findings reported here would generalize from the present participants to clinical samples. Moreover, because our unselected samples of participants were comprised predominantly of young, female, university-educated, and socioeconomically advantaged individuals, we cannot infer that the results would generalize to samples of individuals with different compositions of demographic characteristics. As highlighted by some of the reported differences between Asian and Caucasian participants in the present study, it is crucial to note that, because individuals’ self-portrayal concerns depend on the standards and norms for social behavior and because such standards and norms vary considerably across cultures (e.g., Markus & Kitayama, 1991), it is likely that the NSPS is a culturally bound measure. Thus, whereas the values of one culture might dictate that its members make humorous remarks or witty conversation during social gatherings in order to appear socially competent, the values of another culture might dictate that social competence is reflected in one's ability to remain silent during social gatherings, constrain the desire to speak out, and practice listening respectfully to the elders of the community. In other words, what might appear socially incompetent according to the norms of one society might appear quite competent according to the norms of another. Similarly, there are, no doubt, variations across cultures in standards of physical appearance and norms associated with showing signs of anxiety, which in turn would dictate cross-cultural differences in the relevance of and responses to the present version of the NSPS. Therefore, it would be both interesting and important to examine the cross-cultural applicability of the NSPS in future research. Although replication of our results is clearly required in both clinical samples of SAD patients and community samples of healthy and anxious
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control participants (an endeavor that is currently in progress in our laboratory), the preliminary validation of the NSPS enables us to envision its future use as a clinical tool to guide the assessment and treatment of SAD. We hypothesize that clinical outcomes in SAD will be improved by practitioners’ assessment of the nature of their patients’ self-portrayal concerns and the subsequent selection of specific interventions to target those concerns across the dimensions of the NSPS. It might be worthwhile to remain attuned to the potentially useful distinction between concerns about social skills/behaviors and concerns about personality in the context of SAD, even though this distinction is not captured in the factor structure of the NSPS. In our clinical experience, concerns about social skills/behaviors that are endorsed by patients with SAD tend to be most responsive to interventions such as video feedback (e.g., Harvey, Clark, Ehlers, & Rapee, 2000; McManus et al., 2009) and similar types of behavioral experiments (Bennett-Levy et al., 2004) that are designed to improve the self-other discrepancy in imagined behavioral deficits (e.g., Rodebaugh & Rapee, 2006). Conversely, concerns about signs of anxiety or personality flaws in the context of SAD may be more resistant to change with video feedback (see Orr & Moscovitch, 2010b; Stopa, 2009b) and, therefore, might require therapeutic intervention with a different set of intervention strategies. Finally, we are currently working on adapting the current version of the NSPS to investigate in future studies not only how concerned socially anxious individuals are about publicly exposing feared negative self-attributes, but also how much they might overestimate the probability and social costs associated with revealing each self-attribute to critical others. We hope to track how such probability and cost estimates might differ across the NSPS dimensions and change as a result of treatment. In closing, the preliminary validation of the NSPS enables us to renew our call for a paradigm shift in treating SAD (e.g., Moscovitch, 2009). Traditional conceptualizations of exposure-based CBT for SAD (e.g., Heimberg, 2009) are guided by a therapeutic mindset that is characterized by the question: “What types of feared social situations must be confronted in the service of anxiety reduction?” Confronting social situations is indeed necessary in the treatment of social anxiety, but it is not sufficient. We hypothesize that the extinction of learned fear in patients with SAD vis-à-vis the principles of emotional processing theory (Foa & Kozak, 1986; Foa & McNally, 1996; see also Moscovitch, Antony, & Swinson, 2009) will be
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