Category: Comorbidity - Anxiety and Other
Comorbid alcohol related problems in individuals with Social anxiety disorder (SAD) are known to be related to more serious symptoms and worse prognoses (Buckner, Timpano, Zvolensky, Sachs-Ericsson, & Schmidt, 2008). Previous research has shown that socially anxious individuals chronically experience higher negative emotion and lower positive emotion than normal controls (Kashdan & Collins, 2010). Also, they prefer to apply maladaptive emotion regulation (ER) strategies such as denial, avoidance (Campbell-Sills et al., 2014). Considering negative emotions are related to later alcohol craving (AC) and quantity of drink (Falk, Yi, & Hilton, 2008), effects of emotion and ER on drinking behaviors of individuals with SAD are cardinal. The purpose of the present study was to investigate the effects of emotional experience and ER strategies on drinking episodes and AC among individuals with SAD in daily life. To explore causal relationships between specific emotion experience, ER strategies and contextual factors including social interactions, EMA has been administered.
A sample of one hundred and twenty-eight undergraduates gave a structured clinical interview via the Mini International Neuropsychiatric Interview and completed self-report questionnaires. Participants completed online questionnaires on emotion experience, ER strategies, social interactions and drinking experience 4 times a day for 14 days via their smart phones. One hundred and nineteen participants who uploaded data more than 60% of the total data points were included in the final data analyses. Among the 119 participants, 66 were individuals with SAD and 53 were normal controls. Mean age was 22.03 (SD = 2.44) and 80 (67.2%) were female. Descriptive data analyses were conducted via the SPSS 20 and intensive longitudinal data analyses were administered via the SAS 9.4 and Mplus 7.
Results showed that the SAD group (vs. control group) experienced higher negative affect and lower positive affect respectively, t = 7.60, p < .001, t = -5.26, p < .001. They also applied maladaptive coping strategies more frequently than the control group, t = 6.06, p < .001. In addition, the SAD group reported experiencing higher levels of coping motives during drinking episodes as compared to the control group, t = 2.54, p < .01. Moderation analyses revealed that the SAD group (vs. control group) showed a steeper increase in AC when feeling anxious in real social situations, b = -0.10, t(115)= -2.51, p < .05. Mediation analyses showed that negative affect mediated the relationship between social anxiety and coping motives, b = .10, SE = .04, z = 2.29, p < .05, while maladaptive ER strategies mediated the relationship between social anxiety and conformity motives, b = .50, SE = .06, z = 8.46, p < .001. In sum, negative emotional experience, especially anxiety during social interactions and maladaptive ER lead to increased negative reinforcement motives, which, in turn, lead to alcohol related problems in SAD.