Category: Comorbidity - Anxiety and Other
Among individuals with social anxiety disorder (SAD), alcohol use disorder is one of the most common comorbid disorders (Kessler et al., 1994, 2005; Stein, Torgrud, & Walker, 2000). Socially anxious individuals tend to use alcohol as a coping strategy to reduce tension and to facilitate social interaction. However, this leads to alcohol related problems (ARP) in the long run (Carrigan & Randall, 2003). Previous research has focused on alcohol related cognitive variables such as drinking motives (DM) in the relationship between SAD and ARP (Ham, Zamboanga, Bacon, & Garcia, 2009; Howell, Buckner, & Weeks, 2016). Recently, researchers began to suggest theoretical models on ARP in individuals with SAD (e.g. Bacon & Ham, 2010; Buckner Heimberg, Ecker, & Vinci, 2013; DeMartini & Carey, 2011). However, there are few empirical studies investigating clinical characteristics of SAD in the relationship between SAD and ARP. The purpose of the present study was to investigate mechanisms of ARP in individuals with SAD in Korea. A moderated mediation model linking clinical characteristics of SAD and negative reinforcement DM was tested. This model was modified from the biopsychosocial model of Buckner, Heimberg, Ecker, and Vinci (2013). It was postulated that fear of negative evaluation (FNE), social avoidance and concerns of physical symptoms would predict negative reinforcement DM and lead to ARP. Furthermore, difficulties in emotion regulation (DER) were supposed to moderate the paths from each characteristics of SAD to DM.
A sample of 647 undergraduates completed a packet of self-report questionnaires assessing social anxiety, ARP, DM, and DER. Four hundred and forty five were female (68.8%) and the mean age was 20.92 (SD=3.20) ranged from 17 to 48. The overall model fit was good, χ2 (370, N = 647) = 1247.499, TLI = .913, CFI = .926, RMSEQ = .061 (90% CI = .057-.064). Results showed that social anxiety positively predicted three clinical characteristics of social anxiety: FNE, social avoidance, and concerns of physical symptoms. Furthermore, FNE and concerns of physical symptoms predicted APR and these relationships were mediated by negative reinforcement DM. Specifically, FNE was mediated by conformity motives which were moderated by DER. Concerns of physical symptoms were meditated by coping motives which were also moderated by DER. In contrast, both negative reinforcement DMs did not mediate the relationship between social avoidance and ARP.
In sum, cognitive and physiological characteristics of SAD predicted ARP through negative reinforcement DM, and the effect of these clinical characteristics on drinking motives was moderated by DER.