Reinforcement Sensitivity Theory and Social Anxiety

286 Pages·2011·1.75 MB·English

The Relevance of Reinforcement Sensitivity Theory
to Social Anxiety and Response to Cognitive Behavioural Therapy for
Social Anxiety Disorder

Corina Ly, BA (Hons)

Submitted in fulfilment of the requirements for the Degree of
Doctor of Philosophy (Clinical Psychology)
School of Psychology
University of Tasmania

November 2011
Declaration

This thesis contains no material which has been accepted for a degree or diploma by the
university or any other institution. To the best of my knowledge and belief, this thesis
contains no material previously published or written by another person except where due
acknowledgement is made, nor does it contain any material that infringes copyright. This
thesis may be available for loan and limited copying in accordance with the Copyright Act,
1968.

___________________________ Date ____________________
Corina Ly BA (Hons)

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Statement of Ethical Conduct

The research associated with this thesis abides by the international and Australian codes on
human and animal experimentation, the guidelines by the Australian Government’s Office of
the Gene Technology Regulator and the rulings of the Safety, Ethics and Institutional
Biosafety Committees of the University.

___________________________ Date ____________________
Corina Ly BA (Hons)

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Acknowledgements

I would like to extend an enormous thank you to my supervisor Rapson Gomez for all of his
support, encouragement and wisdom over the years. His guidance has provided me with the
research skills that I have today. I am forever grateful to Mum and Dad for their
unconditional love and support throughout my studies and beyond, and my sister Sue Ly for
her unwavering patience. Also, to all of my amazing friends who have provided me with the
encouragement and fun times to see through the thesis, especially Sara Liu, Anna Wolf,
Chhann Ly, Judith Fernandez, David Phelan, Kayden Walsh and Manal Darwish. A big thank
you to Melanie Irons for her assistance with recruitment, Ivor Conrad Vaz for his help with
advertising, and Michael Quinn for his advice on statistics. Finally, thank you to the 319
participants, especially those in Study 3, who contributed their time and effort. This thesis
was the result of contributions from all of these amazing individuals.

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Abstract

The overall aim of this thesis was to investigate the relevance of Reinforcement Sensitivity
Theory (RST) to social anxiety (SA) in the community and response to cognitive behavioural
therapy (CBT) outcome for social anxiety disorder (SAD). Three studies were conducted to
realise this objective.
Study 1 investigated the relationships between RST traits (and similar personality
variables) and observation anxiety (OA) and interaction anxiety (IA). Participants in the
community (N=200; Age M=26.84) completed questionnaires. The original Behavioural
Inhibition System (o-BIS), revised BIS (r-BIS), Fight-Flight-Freeze System (FFFS),
Sensitivity to Punishment (SP; a measure of BIS), neuroticism, negative affectivity (NA), and
a composite score of all of these personality variables, were all positive predictors of OA.
Fun-Seeking (Fun-S), positive affectivity (PA) and extraversion were negative predictors. For
IA, the same pattern of results was found except that FFFS was not a significant predictor.
Study 2 used an experimental mood-induction procedure to investigate the effects of
RST traits on cognitive, affective and avoidance responses to induced SA with a community
sample (N = 103; Age M=30.22). For affective responses, SP positively and independently
predicted post-induction fear and SP interacted with Sensitivity to Reward (SR; a measure of
BAS) to predict post-induction anxiety. For cognitive responses, SP positively predicted
cognitions I want to leave/exit/escape this situation and People can see that I feel anxious. I
am being judged/evaluated negatively by these people was positively predicted by FFFS and
Fun-S, and negatively predicted by Drive. For avoidance responses, SP positively predicted
desire to avoid but active avoidance was not significantly predicted by any RST trait.
Study 3 investigated how RST traits influenced responses to CBT outcome for SAD.
Sixteen participants (Age M=41.82) attended treatment and completed various pre- and post-
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treatment outcome measures. For IA: r-BIS, o-BIS and SR each moderated relationships
between pre- and post-treatment IA, with high personality scores being associated with
higher post-treatment IA. For OA: Reward-Responsiveness (RR), Drive, and SR each
moderated the relationship between pre- and post-treatment OA with high personality scores
resulting in higher post-treatment OA. For the Cognitive Checklist Anxiety (CCL Anx;
general anxiety cognitions); Drive and FFFS each moderated the relationship between pre-
and post-treatment CCL Anx with low personality scores being associated with higher post-
treatment CCL Anx.
Overall, results suggest that RST traits and SA share dimensional relationships; that
RST traits affect cognitive, affective and avoidance responses to SA; and that high BIS and
BAS scores relate to higher post-CBT outcome scores for SAD.

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Table of Contents

CHAPTER ONE: Personality and Psychopathology ........................................................... 1
Brief History of the Relationship between Personality and Psychopathology .......................... 1
The Concepts of Personality and Psychopathology ................................................................... 4
Personality .............................................................................................................................. 4
Approach, avoidance and control. ...................................................................................... 9
Psychopathology ................................................................................................................... 10
The Relationship between Personality and Psychopathology ................................................. 13
Models Linking Personality and Psychopathology.................................................................. 17
Chapter Summary and Conclusion .......................................................................................... 20
Overview of the Thesis ............................................................................................................ 21
CHAPTER 2: Reinforcement Sensitivity Theory and Psychopathology .......................... 24
Development of Reinforcement Sensitivity Theory ................................................................ 24
Eysenck‟s Arousal Theory .................................................................................................... 25
Original RST......................................................................................................................... 27
Revised RST: The Relevant Changes for Psychopathology ................................................ 29
The changes to BIS, BAS and FFFS functions. ................................................................ 30
Defensive direction and defensive distance. ..................................................................... 32
RST and Optimal Functioning ................................................................................................. 34
The Role of Cognitive Processes .......................................................................................... 39
The Relationships between RST and the Psychopathologies .................................................. 41
Anxiety Disorders ................................................................................................................. 42
Depression ............................................................................................................................ 43
Bipolar Disorder ................................................................................................................... 44
Attention Deficit Hyperactivity Disorder ............................................................................. 45
Psychopathy .......................................................................................................................... 46
Other Personality Disorders.................................................................................................. 47
Substance Abuse ................................................................................................................... 48
Eating Disorders ................................................................................................................... 49
R-RST and Psychopathology................................................................................................ 50
Summary ............................................................................................................................... 51
Chapter Summary and Conclusion .......................................................................................... 51
CHAPTER 3: Reinforcement Sensitivity Theory and Social Anxiety .............................. 54
Conceptual Issues in Social Anxiety (Disorder) Research ...................................................... 54
What is Social Anxiety and Social Anxiety Disorder? ......................................................... 54
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Prevalence and Effects of Social Anxiety Disorder ............................................................. 55
Subtypes: Generalised Social Phobia and Specific Social Phobia ....................................... 56
Subclinical Social Anxiety ................................................................................................... 58
Etiology of Problem Social Anxiety ........................................................................................ 59
Genetic Inheritance ............................................................................................................... 59
Parenting Styles .................................................................................................................... 61
Personality Factors ............................................................................................................... 62
Behavioural inhibition. ......................................................................................................... 63
Treatment for Problem Social Anxiety .................................................................................... 67
CBT ...................................................................................................................................... 67
CBT for Social Anxiety Disorder ......................................................................................... 68
Pharmacotherapy .................................................................................................................. 69
Factors that Affect CBT Outcome for Social Anxiety Disorder .......................................... 70
Generalised social phobia subtype. .................................................................................. 70
Co-morbid Avoidant Personality Disorder and depression. ............................................. 71
The Role of Harm Avoidance in CBT Outcome for Social Anxiety Disorder ..................... 72
Summary of Social Anxiety ..................................................................................................... 74
RST and Social Anxiety........................................................................................................... 75
Behavioural Inhibition .......................................................................................................... 75
The BIS/FFFS and Social Anxiety ....................................................................................... 77
The BAS and Social Anxiety................................................................................................ 78
Chapter Summary and Conclusion .......................................................................................... 82
CHAPTER 4: STUDY 1 Investigating the Relationships between Social Anxiety and
Reinforcement Sensitivity Theory Traits in a Community Sample .................................. 84
Social Anxiety ...................................................................................................................... 84
The Influence of Personality on Social Anxiety ................................................................... 84
BIS, BAS and FFFS.............................................................................................................. 85
RST and Social Anxiety ....................................................................................................... 86
The Present Study ................................................................................................................. 87
Method ..................................................................................................................................... 89
Participants ........................................................................................................................... 89
Measures ............................................................................................................................... 89
Procedure .............................................................................................................................. 92
Statistical Analyses ............................................................................................................... 92
Results ...................................................................................................................................... 93
Discussion .............................................................................................................................. 101
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CHAPTER 5: STUDY 2 Investigating the Effects of Reinforcement Sensitivity Traits on
Cognitive, Affective and Avoidance Responses to Induced Social Anxiety .................... 104
Reinforcement Sensitivity Theory Mood Induction Studies .............................................. 104
Reinforcement Sensitivity Cognitive Model of Psychopathology ..................................... 105
The Present Study ............................................................................................................... 106
Method ................................................................................................................................... 108
Participants ......................................................................................................................... 108
Materials ............................................................................................................................. 108
Procedure ............................................................................................................................ 110
Statistical Analyses ............................................................................................................. 112
Results .................................................................................................................................... 112
Discussion .............................................................................................................................. 128
CHAPTER 6: STUDY 3 The Effects of Reinforcement Sensitivity Theory Traits on
Response to Cognitive Behavioural Therapy Outcome for Social Anxiety Disorder .... 132
Cognitive Behavioural Group Therapy .............................................................................. 133
Personality as a Predictor of CBT Outcome ....................................................................... 134
The Present Study ............................................................................................................... 135
Method ................................................................................................................................... 137
Participants ......................................................................................................................... 137
Assessment ......................................................................................................................... 138
Outcome Measures ............................................................................................................. 140
Treatment ............................................................................................................................ 142
Statistical Analyses ............................................................................................................. 144
Results .................................................................................................................................... 145
Discussion .............................................................................................................................. 165
CHAPTER 7: GENERAL DISCUSSION ......................................................................... 170
Summary of Results ............................................................................................................... 170
Implications of Study 1 .......................................................................................................... 172
BIS and FFFS Relationships with Social Anxiety.............................................................. 172
BAS Relationships with Social Anxiety ............................................................................. 175
Implications of Study 2 .......................................................................................................... 176
Effect of RST traits on Cognitive Reponses ....................................................................... 176
Effect of RST traits on Affective Responses ...................................................................... 178
Effect of RST traits on Avoidance Responses .................................................................... 179
Implications of Study 3 .......................................................................................................... 179
Interaction Anxiety Outcome ............................................................................................. 180
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Observation Anxiety Outcome ........................................................................................... 182
Cognition Outcomes ........................................................................................................... 183
General Implications .............................................................................................................. 185
Personality and Psychopathology Share a Dimensional Relationship ............................... 185
Normal Personality Traits can be used to inform Treatment Outcome for Psychopathology
............................................................................................................................................ 185
How can RST Personality Traits Inform Treatment Outcome? ......................................... 188
The Important Role of Effortful Control ............................................................................ 189
Limitations and Future Research ........................................................................................... 191
Limitations .......................................................................................................................... 191
Future Directions ................................................................................................................ 194
Summary and Conclusion ...................................................................................................... 196
References ............................................................................................................................. 198
List of Appendices ................................................................................................................ 255

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