Thurgood, Emma; (2024) Do symptoms of body dysmorphic disorder moderate distress reduction in social anxiety: an experimental study? Doctoral thesis (D.Clin.Psy), UCL (University College London).

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Abstract

Aims: Social anxiety disorder is a common and highly impairing condition characterised by intense fear of embarrassment and being scrutinised by others. Cognitive behavioural models propose self-focused attention (SFA) as a core maintaining factor for social anxiety disorder. Self-focused attention refers to a perception of internally generated, self-directed information, and can be categorised into different subtypes: focus on the self as a social object (public SFA) and focus on internal aspects of the self (private SFA). Only one previous systematic review has synthesised research findings on SFA and social anxiety, and this was conducted over 20 years ago and did not assess methodological rigour of included studies. The aim of this systematic review was therefore to provide an up-to-date synthesis of the literature on the association between SFA (including its subtypes) and social anxiety, across studies of both adults and children. Method: Search terms were used to identify studies across three databases (Pubmed, PsychINFO and Medline), which were then screened to determine eligibility based on exclusion and inclusion criteria. Study quality was assessed using an adapted version of the Kmet Quality Assessment Tool. Results: A total of 16 studies met inclusion criteria, 3 from a child population and 13 from adult populations. Of the 16 studies included, 8 found evidence of a statistically significant association between social anxiety symptoms and overall SFA, with effect sizes ranging medium (Cohen’s d= 0.47) to large (Cohen’s d= 1.86). Of the 9 studies that examined public SFA, 7 found evidence of a statistically significant association with social anxiety symptoms, with effect sizes ranging from medium (Cohen’s d= 0.47) to large (Cohen’s d= 2.08). Of the 7 studies that examined private SFA, 5 found a statistically significant association with social anxiety symptoms, with effect sizes also ranging small (Cohen’s d=0.30) to large (Cohen’s d= 1.16). Quality assessment highlighted a general insufficiency across studies in reporting on certain areas such as sample selection and research question. Conclusions: Overall, findings demonstrate fairly consistent evidence for an association between SFA and social anxiety, which supports CBT models. Future research would benefit from addressing methodological deficits, as well as measuring data longitudinally to establish causal relationships.

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