The role of shame, schemas, cognitions, paranoia and memories in social anxiety following psychosis: a comparison with typical social anxiety

Objectives. This study aimed to investigate the nature of social anxiety in psychosis through comparison with individuals with social anxiety without psychosis. Extending the work of Lockett (2011), it explored factors associated with both cognitive models of social anxiety (Clark & Wells, 1995; Rapee & Heimberg, 1997) and models of social anxiety in psychosis (Birchwood et al., 2006; Lockett, 2011). Methods. The study employed a quantitative cross-sectional design to compare participants with social anxiety and psychosis (SAp group, n = 30) with participants with social anxiety and no psychosis (SA group, n = 35) on measures of shame, socially anxious cognitions, schemas and paranoia. A semi-structured interview elicited images and memories experienced in social situations. A self-report measure compared the groups in relation to trauma symptoms associated with reported memories. Results. Participants in the SAp group experienced significantly higher levels of shame, negative self-schemas and PTSD symptoms than participants in the SA group. There were no significant differences between the groups on measures of socially anxious cognitions, negative otherschemas and self/other focus of memories. Participants in both groups scored highly for paranoia, with the scores for the SAp group being significantly higher. When the sample was split based on level of paranoia (regardless of psychosis), paranoid participants had significantly higher scores for shame, negative self and other schemas, depression and PTSD. Data suggested paranoid participants are more likely to experience images associated with memories focused on threatening others. Conclusions. The findings suggested two possible pathways to the development of social anxiety. Paranoia may differentiate social anxiety as part of complex emotional dysfunction from social anxiety as conceptualised within existing cognitive models (Clark & Wells, 1995; Rapee & Heimberg, 1997). A number of limitations are discussed to enable a balanced interpretation of the study findings. These included the small sample size; characteristics of the participants, particularly the number of students in the SA group; and the violation of parametric assumptions in the data for depression and negative schemas. Clinical implications are discussed, including the need for thorough assessment of paranoia, trauma and shame and the importance of the therapeutic relationship and assertive engagement of complex clients.

Name dc:type.qualificationname

other

Level dc:type.qualificationlevel

doctoral

Grantor dc:publisher.institution

University of East Anglia

Year dc:date.issued

2012

Author dc:creator

• Cooke, Sarah

Language dc:language

en