Mental Imagery in Social Anxiety in Children and Young People: A Systematic Review

Current cognitive models of social anxiety disorder (SAD) in adults indicate that negative self-images play a pivotal role in maintaining the disorder. However, little is known about the role of negative imagery in the maintenance of social anxiety for children and young people. We systematically reviewed studies that have investigated the association between imagery and social anxiety in children and young people. Four databases were searched for 'social anxiety' and related terms (including 'social phobia' and 'performance anxiety') combined with 'imagery', 'representation*', and 'observer perspective'. The nine studies that met the inclusion criteria provided some evidence that children and young people with higher social anxiety report more negative, observer's perspective images, and some evidence to support the cognitive models of SAD's conceptualisation of imagery. Only two studies included samples with pre-adolescent children. The literature is limited by a number of methodological issues, including inconsistencies in, and a lack of good psychometric measures for, imagery in children and young people. More conclusive evidence is needed to develop significant and robust conclusions.