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How do I look with my minds eye: perspective taking in social phobic imagery
BEHAVIOUR RESEARCH AND THERAPY
PERGAMON
Behaviour Research and Therapy 36 (1998) 631±634
Shorter Communication
How do I look with my minds eye: perspective taking in social phobic imagery Adrian Wells a, *, David M. Clark b, Sameena Ahmad b a
Department of Clinical Psychology, University of Manchester, Manchester, UK b Department of Psychiatry, University of Oxford, Oxford, UK Accepted 4 January 1998
Abstract This study explored perspective taking in social phobics' images of past anxiety-provoking social situations and non-social situations. For images of social situations, social phobics were signi®cantly more likely than non-patient controls to take an observer perspective, viewing themselves as if from an external point of view. In contrast, social phobics and controls did not dier in the perspective taken in images of non-social situations, which were generally viewed from a ®eld perspective (seeing the situation as if looking out through their own eyes). The clinical signi®cance of these ®ndings is brie¯y discussed. # 1998 Elsevier Science Ltd. All rights reserved.
1. Introduction Heightened self-focused processing is a characteristic of many emotional disorders (Hartman, 1983; Ingram, 1990; Wells and Matthews, 1994). Recently, Clark and Wells (1995) have suggested that social phobics use self-focused processing as one of the main sources of evidence in support of their negative beliefs about how they appear to other people and what other people may be thinking about them. In particular, Clark and Wells (1995) suggested that when social phobics become concerned that they may fail to make their desired impression on others, their attention shifts to detailed observation and monitoring of themselves. They then use the internal information produced by self-monitoring to construct a negative impression of their public self. Several ways of constructing a negative impression of the public self are discussed. One particularly common example is inferring one looks very anxious because one feels very anxious. An additional suggestion is that social phobics construct observer-perspective visual * Corresponding author. 0005-7967/98/$19.00 # 1998 Elsevier Science Ltd. All rights reserved. PII: S 0 0 0 5 - 7 9 6 7 ( 9 8 ) 0 0 0 3 7 - 0
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A. Wells et al. / Behaviour Research and Therapy 36 (1998) 631±634
images in which they see themselves from an external point of view, looking the way they fear they might appear to others. On the basis of this suggestion, the study reported here tested the hypothesis that, compared to non-patient controls, social phobics will show a marked tendency to recall social situations from an observer perspective. In addition, the speci®city of the observer perspective eect was determined by also investigating recall of anxiety provoking non-social situations. 2. Method 2.1. Participants Twelve outpatients (8 female, 4 male) meeting DSM-IV (APA, 1994) criteria for social phobia and twelve non-patients (8 female, 4 male). Mean ages were: 38.2 years for social phobics and 38.3 for non-patients. 2.2. Procedure All participants were asked to recall and image a recent social situation and a recent nonsocial situation. Within each group, half the participants recalled the social situation ®rst, the other half recalled the non-social situation ®rst. In the social situation condition participants were told, ``I'd like you to recall a recent speci®c occasion when you felt really anxious and uncomfortable in a social situation. That is to say, a situation involving you and one or more other people. You don't have to describe it to me. Once you've got it in mind, close your eyes and get as clear an image as you can''. Each participant was allowed 15±30 seconds for imaging and was then given the following instruction: ``keeping your eyes closed, I want to ask you a question about the image. Thinking about the image you have just had, is your predominant impression one of viewing the situation as if looking out through your eyes, observing the details of what is going on around you or is the predominant impression one in which you are observing yourself; that is, it is as though you were outside yourself, looking at yourself from an external point of view''. After disclosing the predominant impression participants were then asked to rate the degree of observer or ®eld perspective on a seven point scale ranging from: ÿ3 ``entirely looking out through my eyes'' to +3 ``entirely observing myself from an external point of view''. In the non-social situation condition the instructions were identical except that a non-social situation was speci®ed. The instructions therefore started with ``I'd like you to recall a recent speci®c occasion when you felt really anxious and uncomfortable in a non-social situation. That is to say, when you were not in the company of other people....'' 3. Results and discussion Figure 1 shows the image perspective ratings for memories of anxiety-provoking social and non-social situations. As predicted, social phobics diered signi®cantly from non-patient
A. Wells et al. / Behaviour Research and Therapy 36 (1998) 631±634
633
Fig. 1. Means and standard errors for image perspective ratings in memories of anxiety provoking social and nonsocial situations.
controls in their perspective ratings for memories of social situations (t(22)=4.1, p < 0.001) but not in their perspective ratings for memories of non-social situations (t(22)=0.6, p = 0.57). In memories of social situations, social phobics took a markedly observer perspective, whereas controls generally took a ®eld perspective (seeing the situation as if looking out through their own eyes). In memories of non-social situations, both groups tended to take a ®eld perspective. Within group comparisons indicated that the dierence in perspective ratings between social and non-social situations was signi®cant for social phobics (t(11)=3.4, p < 0.01) but not for controls (t(11)=0.2, p = 0.84). The present results would seem most directly relevant to understanding the pathological processes that occur when a social phobic is anticipating a feared social situation or when he or she is thinking about a dicult social interaction after it has happened. In both instances, Clark and Wells (1995) have argued that social phobics tend to dwell on memories of past social interactions, in order to work out how they will come across (anticipatory anxiety) or how they did come across (``post mortem''). If the memories are predominantly from an observer perspective social phobics will have little access to information about how others behaved and hence would be less aware of information indicating that other people responded to them in a better way than they might have feared. In addition, as anxious feelings during the social event seem to be one of the main types of information used to construct observer perspective images, such images are likely to provide an excessively negative impression of how one appeared. A further problem with images which are based on anxious feelings is that anxiety can vary enormously from one situation to another. As a consequence, the images are likely to provide an unstable as well as negative impression of the self. A ®nal problem with the adoption of an observer perspective in memory is that it will heighten self-consciousness when social phobics are anticipating a forthcoming social interaction. This means that when they enter the situation they will already be in a processing mode in which attention is directed away from what actually happens and onto potentially misleading internal information.
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A. Wells et al. / Behaviour Research and Therapy 36 (1998) 631±634
A limitation of the present study was that the content of participants recollections was not formally assessed. In general, social phobics recollections seemed to fall into the category of negative self-perceptions. However, a more systematic investigation of content is required. Acknowledgements This research was supported by the Wellcome Trust. References American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders Ð DSM IV. Washington, DC: Author. Clark, D.M. and Wells, A. (1995). A cognitive model of social phobia. In R.G. Heimberg, M. Liebowitz, D. Hope and F. Schneier (Eds), Social phobia: diagnosis, assessment and treatment (pp. 69±93). New York: Guilford. Hartman, L. M. (1983). A metacognitive model of social anxiety: implications for treatment. Clinical Psychology Review, 3, 435±456. Ingram, R. E. (1990). Self-focused attention in clinical disorders: Review and a conceptual model. Psychological Bulletin, 107, 156±176. Wells, A. and Matthews, G. (1994). Attention and emotion: a clinical perspective. Hove, UK: Lawrence Erlbaum Associates.
PERGAMON
Behaviour Research and Therapy 36 (1998) 631±634
Shorter Communication
How do I look with my minds eye: perspective taking in social phobic imagery Adrian Wells a, *, David M. Clark b, Sameena Ahmad b a
Department of Clinical Psychology, University of Manchester, Manchester, UK b Department of Psychiatry, University of Oxford, Oxford, UK Accepted 4 January 1998
Abstract This study explored perspective taking in social phobics' images of past anxiety-provoking social situations and non-social situations. For images of social situations, social phobics were signi®cantly more likely than non-patient controls to take an observer perspective, viewing themselves as if from an external point of view. In contrast, social phobics and controls did not dier in the perspective taken in images of non-social situations, which were generally viewed from a ®eld perspective (seeing the situation as if looking out through their own eyes). The clinical signi®cance of these ®ndings is brie¯y discussed. # 1998 Elsevier Science Ltd. All rights reserved.
1. Introduction Heightened self-focused processing is a characteristic of many emotional disorders (Hartman, 1983; Ingram, 1990; Wells and Matthews, 1994). Recently, Clark and Wells (1995) have suggested that social phobics use self-focused processing as one of the main sources of evidence in support of their negative beliefs about how they appear to other people and what other people may be thinking about them. In particular, Clark and Wells (1995) suggested that when social phobics become concerned that they may fail to make their desired impression on others, their attention shifts to detailed observation and monitoring of themselves. They then use the internal information produced by self-monitoring to construct a negative impression of their public self. Several ways of constructing a negative impression of the public self are discussed. One particularly common example is inferring one looks very anxious because one feels very anxious. An additional suggestion is that social phobics construct observer-perspective visual * Corresponding author. 0005-7967/98/$19.00 # 1998 Elsevier Science Ltd. All rights reserved. PII: S 0 0 0 5 - 7 9 6 7 ( 9 8 ) 0 0 0 3 7 - 0
632
A. Wells et al. / Behaviour Research and Therapy 36 (1998) 631±634
images in which they see themselves from an external point of view, looking the way they fear they might appear to others. On the basis of this suggestion, the study reported here tested the hypothesis that, compared to non-patient controls, social phobics will show a marked tendency to recall social situations from an observer perspective. In addition, the speci®city of the observer perspective eect was determined by also investigating recall of anxiety provoking non-social situations. 2. Method 2.1. Participants Twelve outpatients (8 female, 4 male) meeting DSM-IV (APA, 1994) criteria for social phobia and twelve non-patients (8 female, 4 male). Mean ages were: 38.2 years for social phobics and 38.3 for non-patients. 2.2. Procedure All participants were asked to recall and image a recent social situation and a recent nonsocial situation. Within each group, half the participants recalled the social situation ®rst, the other half recalled the non-social situation ®rst. In the social situation condition participants were told, ``I'd like you to recall a recent speci®c occasion when you felt really anxious and uncomfortable in a social situation. That is to say, a situation involving you and one or more other people. You don't have to describe it to me. Once you've got it in mind, close your eyes and get as clear an image as you can''. Each participant was allowed 15±30 seconds for imaging and was then given the following instruction: ``keeping your eyes closed, I want to ask you a question about the image. Thinking about the image you have just had, is your predominant impression one of viewing the situation as if looking out through your eyes, observing the details of what is going on around you or is the predominant impression one in which you are observing yourself; that is, it is as though you were outside yourself, looking at yourself from an external point of view''. After disclosing the predominant impression participants were then asked to rate the degree of observer or ®eld perspective on a seven point scale ranging from: ÿ3 ``entirely looking out through my eyes'' to +3 ``entirely observing myself from an external point of view''. In the non-social situation condition the instructions were identical except that a non-social situation was speci®ed. The instructions therefore started with ``I'd like you to recall a recent speci®c occasion when you felt really anxious and uncomfortable in a non-social situation. That is to say, when you were not in the company of other people....'' 3. Results and discussion Figure 1 shows the image perspective ratings for memories of anxiety-provoking social and non-social situations. As predicted, social phobics diered signi®cantly from non-patient
A. Wells et al. / Behaviour Research and Therapy 36 (1998) 631±634
633
Fig. 1. Means and standard errors for image perspective ratings in memories of anxiety provoking social and nonsocial situations.
controls in their perspective ratings for memories of social situations (t(22)=4.1, p < 0.001) but not in their perspective ratings for memories of non-social situations (t(22)=0.6, p = 0.57). In memories of social situations, social phobics took a markedly observer perspective, whereas controls generally took a ®eld perspective (seeing the situation as if looking out through their own eyes). In memories of non-social situations, both groups tended to take a ®eld perspective. Within group comparisons indicated that the dierence in perspective ratings between social and non-social situations was signi®cant for social phobics (t(11)=3.4, p < 0.01) but not for controls (t(11)=0.2, p = 0.84). The present results would seem most directly relevant to understanding the pathological processes that occur when a social phobic is anticipating a feared social situation or when he or she is thinking about a dicult social interaction after it has happened. In both instances, Clark and Wells (1995) have argued that social phobics tend to dwell on memories of past social interactions, in order to work out how they will come across (anticipatory anxiety) or how they did come across (``post mortem''). If the memories are predominantly from an observer perspective social phobics will have little access to information about how others behaved and hence would be less aware of information indicating that other people responded to them in a better way than they might have feared. In addition, as anxious feelings during the social event seem to be one of the main types of information used to construct observer perspective images, such images are likely to provide an excessively negative impression of how one appeared. A further problem with images which are based on anxious feelings is that anxiety can vary enormously from one situation to another. As a consequence, the images are likely to provide an unstable as well as negative impression of the self. A ®nal problem with the adoption of an observer perspective in memory is that it will heighten self-consciousness when social phobics are anticipating a forthcoming social interaction. This means that when they enter the situation they will already be in a processing mode in which attention is directed away from what actually happens and onto potentially misleading internal information.
634
A. Wells et al. / Behaviour Research and Therapy 36 (1998) 631±634
A limitation of the present study was that the content of participants recollections was not formally assessed. In general, social phobics recollections seemed to fall into the category of negative self-perceptions. However, a more systematic investigation of content is required. Acknowledgements This research was supported by the Wellcome Trust. References American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders Ð DSM IV. Washington, DC: Author. Clark, D.M. and Wells, A. (1995). A cognitive model of social phobia. In R.G. Heimberg, M. Liebowitz, D. Hope and F. Schneier (Eds), Social phobia: diagnosis, assessment and treatment (pp. 69±93). New York: Guilford. Hartman, L. M. (1983). A metacognitive model of social anxiety: implications for treatment. Clinical Psychology Review, 3, 435±456. Ingram, R. E. (1990). Self-focused attention in clinical disorders: Review and a conceptual model. Psychological Bulletin, 107, 156±176. Wells, A. and Matthews, G. (1994). Attention and emotion: a clinical perspective. Hove, UK: Lawrence Erlbaum Associates.