Mitigating the Mental Health Impact of Marginalization and Discrimination

In honor of the life and work of Aaron T. Beck, this paper describes the application of cognitive therapy to management of marginalization stress among minoritized communities. Collaborative empiricism, cognitive restructuring, and behavioral interventions are highlighted as being particularly useful in a contemporary multicultural approach for the anxiety, depression, stress, and other sequelae of marginalization due to a stigmatized identity. Although primarily illustrated through recent work with transgender and gender diverse adults, the discussion extends to other groups including racial, ethnic, and sexual minorities and immigrants. This work illustrates the power of Dr. Beck’s approach to address the presenting concerns of contemporary clinical work

LGB-Affirmative Cognitive Behavioral Treatment for Social Anxiety: A Case Study Applying Evidence-Based Practice Principles

Guided by the American Psychological Association’s principles of evidence-based practice, this article reviews a single-case treatment outcome study whereby a client characteristic, sexual identity, was integrated into the assessment and treatment of social anxiety symptoms. The case involved a young adult European-American male who presented to a training clinic with a primary diagnosis of social anxiety disorder as well as secondary symptoms of excessive worry and concerns of sexual identity confusion. Recent evidence suggests that gay men report more symptoms of social anxiety when compared to heterosexual men, and those who make more efforts to conceal their sexual identity experience increased anxiety and have greater difficulty committing to a personal identity. Further, it has been hypothesized that fear of rejection from heterosexual individuals underlies this anxiety. The client attended 50 sessions over the course of 18 months. Treatment progress was assessed via self-report questionnaires assessing social anxiety and worry. Consistent with principles of evidence-based practice, a cognitive behavioral treatment protocol was employed at the outset of therapy and resulted in a decline in the client’s social anxiety scores. However, once the case conceptualization and treatment focus shifted to focus on sexual identity, his scores continued to decline at an even steeper rate. He ultimately came to identify himself as having a same-sex sexual orientation, began living his life in a manner consistent with that identification, and reported a number of positive outcomes at termination of therapy. Implications for treatment of social anxiety in sexual minorities are discussed

Are We Certain about Which Measure of Intolerance of Uncertainty to Use Yet?

Intolerance of Uncertainty (IU) has been understood as a dispositional tendency to view the presence of negative events as unacceptable and threatening, regardless of the likelihood of those events occurring. The preference over the 12-item vs. 27-item of the IUS has been central to debate. The goals of the present study were to evaluate two competing models of measuring IU with model-fitting analyses and explore model invariance of gender (e.g., men vs. women). A sample of 980 individuals completed an online IUS survey. Results indicated that the two-factor short-form model provided better fit to the data compared to the full-length two-factor model. Results also indicated that the short-form IUS is gender invariant, suggesting acceptable use among men and women. These findings provide further support of a two-factor structure and suggest that the IUS is appropriate for men and women

Public and Private Self-Consciousness and Social Phobia

The relationship between public and private self-consciousness and self-report questionnaires, clinician ratings, and various measures derived from an individualized simulation of an anxiety-provoking situation was examined in a sample of men and women seeking treatment for social phobia. As predicted, public, not private, self-consciousness was generally related to self-report and naive observer ratings of anxiety and to behavioral disruption during the simulation. The predicted relationship between public self-consciousness and how accurately subjects evaluated their performance in the anxiety-provoking situation was marginally supported. Hypotheses regarding the relationship between private self-consciousness and self-reported anxiety during an anxiety-provoking situation, and between private self-consciousness and the correspondence between physiological assessment and self-report, were not supported. The discussion focuses on methodological issues and the theoretical implications of the relationship between self-consciousness and social anxiety

Fear of Negative Evaluation, Social Anxiety and Response to Positive and Negative Online Social Cues

High social anxiety is associated with negative interpretations of social feedback, maladaptive attributions for success and failure, and excessive attention to internal and external threat cues. In the present study, 40 undergraduate participants with either high or low levels of social anxiety engaged in a series of social interactions with varying types of social feedback: negative, mixed-negative, mixed-positive, and positive. Given the increasing engagement in computer-mediated communication among individuals with high levels of social anxiety, these interactions took place via instant messaging software. Compared to participants with low social anxiety, participants with high social anxiety experienced more self-focused thoughts, negative thoughts, and state anxiety in response to increases in negative feedback. Participants with low social anxiety experienced fewer self-focused thoughts in response to increased negative feedback, resulting in a significant crossover interaction. Qualitative and quantitative differences regarding cognitive processes and computer-mediated communication among individuals with high and low social anxiety are discussed

Differentiating Disclosure and Concealment in Measurement of Outness for Sexual Minorities: The Nebraska Outness Scale

Research on lesbian, gay, and bisexual (LGB) individuals has long examined outness, or openness about one’s sexual orientation, as an important predictor of health and well-being. The authors reconceptualized outness as a composite of two related but independent constructs: disclosure and concealment of sexual orientation. This conceptualization guided creation of the Nebraska Outness Scale (NOS), a 10-item measure with a concealment (NOS-C) and disclosure (NOS-D) subscale. The scale and subscales showed good internal reliability, discriminant, convergent, and predictive validity. As hypothesized, concealment showed a stronger relationship to mental health and well-being constructs than disclosure. Disclosure, but not concealment, also differed across sexual orientations with bisexual individuals reporting less disclosure and mostly gay/lesbian and gay/lesbian individuals reporting successively higher levels. The authors conclude that concealment and disclosure are separate constructs and that concealment may be more relevant to minority stress processes among LGB individuals and may provide a more comparable measure across sexual orientation categories. Further research is needed to validate the scale and to examine the role that outness plays in minority stress among LGB individuals

Extending Training in Multicultural Competencies to Include Individuals Identifying as Lesbian, Gay, and Bisexual: Key Choice Points for Clinical Psychology Training Programs

Traditional models of multicultural training for professional psychology have focused primarily on racial and ethnic minorities and have not included competencies focused on individuals identifying as lesbian, gay, and bisexual (LGB), despite documented evidence of health disparities for sexual minorities. Ways to adapt models based on Sue’s (1992) 3 × 3 competencies (attitudes and beliefs, knowledge, and skills across the dimensions of awareness of one’s own cultural influences and biases, understanding the client perspective, and appropriate interventions for an individual client) for LGB health are described. This includes the addition of an action/advocacy dimension. Six key choice points for clinical psychology training programs adding LGB competency to a multicultural competency training component are outlined. Potential challenges and solutions for expanding multicultural training are discussed

Kernels of Truth or Distorted Perceptions: Self and Observer Ratings of Social Anxiety and Performance

This study compared self and observer ratings of social performance and anxiety among individuals with social anxiety disorder, nonclinical controls, and participants with dysthymia serving as clinical controls. The purpose was to elucidate whether self-perceptions of individuals with social anxiety disorder reflect observable performance and anxiety differences, negative self-perceptions, or an interaction of the two. Participants engaged in three role-played interactions, and self and observer ratings of performance and anxiety were obtained. In general, self-ratings of anxiety and performance were more negative (greater anxiety and poorer performance) than were observer ratings. Interactions of rating source and diagnosis indicated the discrepancy between self and observer ratings of both anxiety and performance was significantly greater among participants with social anxiety disorder. Observers, however, generally noted differences across the groups in both anxiety and performance. The discrepancies between self and observer ratings of anxiety were related to negative evaluation fears and negative thought patterns, while performance discrepancies were related to negative thought patterns. Treatment implications are discussed

Subjective Anxiety and Behavioral Avoidance: Gender, Gender Role, and Perceived Confirmability of Self-report

Commonly reported gender effects for differential vulnerability for anxiety may relate to gender socialization processes. The present study examined the relationship between gender role and fear under experimental conditions designed to elicit accurate fear reporting. Undergraduate students (N = 119) completed several self-report measures and a behavioral avoidance task (BAT) with a tarantula while wearing a heart rate monitor. Gender roles were operationalized as instrumentality and expressiveness, as measured by the Personal Attributes Questionnaire (Spence, Helmreich, & Stapp, 1975). As expected, women reported greater subjective anxiety and were more avoidant of the tarantula than men. Regardless of gender, low levels of instrumentality were associated with greater avoidance of the tarantula. The hypothesis that men underreport fear compared to women and that gender role differences underlie this reporting bias was not supported. In spite of a ceiling effect on the BAT, results of this study confirm the relevance of gender role in understanding gender effects in fear and anxiety

Relationship among Adolescent Reports of Social Anxiety, Anxiety, and Depressive Symptoms

The present study examines the relationship among self-reported symptoms of social anxiety, anxiety, and depression in the context of Clark and Watson’s tripartite theory of anxiety and depression for a sample of adolescents. Four hundred and twenty-eight 10th-grade students completed three measures: the Social Anxiety Scale for Children–Revised, the Revised Children’s Manifest Anxiety Scale, and the Children’s Depression Inventory. Results suggest that symptoms of social anxiety are distinct from symptoms of depression and unspecified anxiety. In addition, results indicate that in comparison to males, adolescent females report higher levels of social anxiety, anxiety, and depressive symptoms. Conceptual and methodological implications are discussed