The moderating role of avoidance behavior on anxiety over time: Is there a difference between social anxiety disorder and specific phobia?

Summary & key facts

This study followed women with diagnosed social anxiety disorder (n = 91) or specific phobia (n = 130) for 18 months. It found that higher general anxiety at the start predicted higher general anxiety 18 months later in both groups. Clinician-rated avoidance of feared situations changed that pattern only for specific phobia: when avoidance was high, the link between starting anxiety and later anxiety was stronger. Avoidance did not show this moderating effect in the social anxiety group. The study used the ADIS-IV-L to rate avoidance and the Beck Anxiety Inventory to measure general anxiety, and it was observational and included only women.

Key facts:

• The study followed 221 women total: 91 with social anxiety disorder and 130 with specific phobia, with an 18-month follow-up period.
• General anxiety measured at baseline predicted general anxiety 18 months later in both the social anxiety disorder group and the specific phobia group.
• Avoidance behavior (clinician-rated using the ADIS-IV-L) moderated the baseline-to-follow-up anxiety link in the specific phobia group but not in the social anxiety disorder group.
• In the specific phobia group, high avoidance amplified the relationship between baseline anxiety and anxiety at 18 months (those with more avoidance showed a stronger carry-over of initial anxiety).
• General anxiety was measured with the Beck Anxiety Inventory (BAI).
• The sample came from a prospective study of young adult women (the Dresden Prediction Study), and the study was observational, so it cannot prove that avoidance causes changes in anxiety over time.

Abstract

Theories of anxiety disorders and phobias have ascribed a critical role to avoidance behavior in explaining the persistence of fear and anxiety, but knowledge about the role of avoidance behavior in the maintenance of anxiety in social anxiety disorder relative to specific phobia is lacking. This study examined the extent to which avoidance behavior moderates the relationship between general anxiety at baseline and 18 months later in women with a diagnosed social anxiety disorder (n = 91) and women with a diagnosed specific phobia (n = 130) at baseline. Circumscribed avoidance of social and specific situations were clinician-rated using the Anxiety Disorders Interview Schedule-Lifetime (ADIS-IV-L), and general anxiety was measured using the Beck Anxiety Inventory (BAI). Moderated regression analyses revealed that (a) general anxiety at baseline predicted general anxiety at follow-up in both women with a specific phobia and women with a social anxiety disorder and (b) avoidance behavior moderated this relationship in women with a specific phobia but not in women with a social anxiety disorder. Specifically, high avoidance behavior was found to amplify the effect between general anxiety at baseline and follow-up in specific phobia. Reasons for the absence of a similar moderating effect of avoidance behavior within social anxiety disorder are discussed.

Topics

Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes Child and Adolescent Psychosocial and Emotional Development Perfectionism, Procrastination, Anxiety Studies

Categories

Experimental and Cognitive Psychology Psychology Social Sciences

Tags

Anxiety Anxiety disorder Beck Anxiety Inventory Beck Depression Inventory Clinical psychology Environmental health Injury prevention Medicine Phobias Phobic disorder Poison control Psychiatry Psychology Safety behaviors Shyness Social anxiety Social inhibition Specific phobia