Candidate Factors Maintaining Social Anxiety in the Context of Psychotic Experiences: A Systematic Review

Abstract

Social anxiety is common in psychosis and associated with impaired functioning, poorer quality of life, and higher symptom severity. This study systematically reviewed factors maintaining social anxiety in people with attenuated, transient, or persistent psychotic experiences. Other correlates of social anxiety were also examined. MEDLINE, Embase, CENTRAL, and PsycINFO were searched for relevant literature up to October 19, 2020. Forty-eight articles were eligible for narrative synthesis: 38 cross-sectional studies, 8 prospective studies, 1 uncontrolled trial, and 1 qualitative study. From 12060 participants, the majority was general population (n = 8771), followed by psychosis samples (n = 2532) and those at high risk of psychosis (n = 757). The methodological quality and risk of bias were assessed using the Mixed Methods Appraisal Tool. Ninety percent of studies were rated as high to very-high quality. Poorer quality studies typically failed to adequately control for confounds and provided insufficient information on the measurement validity and reliability. Prominent psychological factors maintaining social anxiety included self-perceptions of stigma and shame. Common correlates of social anxiety included poorer functioning and lower quality of life. In conclusion, stigma and shame could be targeted as a causal mechanism in future interventional studies. The integration of findings from this review lead us to propose a new theoretical model to guide future intervention research.

Understanding psychological mechanisms linking social anxiety and paranoia: A cross-cultural general population survey in Thailand and the United Kingdom

“…Because the evolution of shame capacities in humans most probably pre-dating the emergence of cultural differentiation, this pattern of sensitivity to social shame is seen across cultures (Sznycer et al, 2016(Sznycer et al, , 2018. Thus, our findings suggested that shame related cognitions, particularly external shame, could potentially explain social anxiety and paranoia in non-clinical populations, and across the range of severity (e.g., ultra-high risk psychosis or established psychosis) (Aunjitsakul et al, 2021) cross-culturally.…”

“…The next phase of study is warranted to either confirm or disconfirm the speculation of our findings (i.e., external shame, safety behaviours and self-esteem) in clinical populations. This study failed to examine stigma and safety behaviours, despite that they could play a role in understanding social anxiety and paranoia in psychosis (Aunjitsakul et al, 2021); hence, both factors should be repeated. Additionally, although we thoroughly investigated several factors, we failed to notice other important factors related to social anxiety in psychosis.…”

‘I felt like I'd lost control of everything’: An exploration of metacognition and masculinity in men experiencing suicidality

“…The S‐REF model is the basis of metacognitive therapy (MCT) and posits that it is not the content of the person's thoughts that causes distress, but the way in which they think about and respond to thoughts (Wells, 2011). Thought control strategies, such as avoidance and distracting oneself from distressing thoughts, are found in people experiencing social anxiety and paranoia (Aunjitsakul et al., 2021), and are commonly utilised by individuals experiencing suicidality (Hallard et al., 2021). Men experiencing suicidality are more likely to engage in thought control strategies than women (Martin et al., 2013), and this paper seeks to explore which other aspects of the S‐REF model are prevalent in a sample of men experiencing suicidality.…”