Stress sensitivity and stress generation in social anxiety disorder: a temporal process approach

Dominant theoretical models of social anxiety disorder (SAD) suggest that people who suffer from function-impairing social fears are likely to react more strongly to social stressors. Researchers have examined the reactivity of people with SAD to stressful laboratory tasks, but there is little knowledge about how stress affects their daily lives. We asked 79 adults from the community, 40 diagnosed with SAD and 39 matched healthy controls, to self-monitor their social interactions, social events, and emotional experiences over 2 weeks using electronic diaries. These data allowed us to examine associations of social events and emotional well-being both within-day and from one day to the next. Using hierarchical linear modeling, we found all participants to report increases in negative affect and decreases in positive affect and self-esteem on days when they experienced more stressful social events. However, people with SAD displayed greater stress sensitivity, particularly in negative emotion reactions to stressful social events, compared to healthy controls. Groups also differed in how previous days' events influenced sensitivity to current days' events. Moreover, we found evidence of stress generation in that the SAD group reported more frequent interpersonal stress, though temporal analyses did not suggest greater likelihood of social stress on days following intense negative emotions. Our findings support the role of heightened social stress sensitivity in SAD, highlighting rigidity in reactions and occurrence of stressful experiences from one day to the next. These findings also shed light on theoretical models of emotions and self-esteem in SAD and present important clinical implications.