par Angela Kyparissis Département

272 Pages·2014·1.15 MB·English

Université de Montréal

Is social phobia characterized by a distinct interpersonal pattern?

par Angela Kyparissis

Département de psychologie, Faculté des arts et des sciences

Thèse présentée à la Faculté des études supérieures et postdoctorales en vue de l’obtention du
grade de Philosophae Doctorate (Ph.D.) en psychologie – recherche et intervention, option
psychologie clinique

mai, 2014

© Angela Kyparissis, 2014

RÉSUMÉ

Traditionnellement, le construit de la phobie sociale a été défini selon une vision
intrapersonnelle, en tant que trouble de l’anxiété. Une autre conception se propose de la définir
d’un point de vue interpersonnel, comme un pattern global d’autoprotection. L’objectif
principal de cette thèse est de tester des hypothèses tirées du modèle interpersonnel de la
phobie sociale.

Deux études, présentées sous forme d’articles, ont permis d’examiner si des patterns
spécifiques d’autoprotection, tels que l’impuissance et la soumission, caractérisent le mode de
fonctionnement des phobiques sociaux. Les études ont également évalué si l’autoprotection et
l’anxiété sont interreliées.

Pour la première étude, les patterns interpersonnels de 132 phobiques sociaux, évalués
à l’aide d’une mesure dérivée du Circumplex interpersonnel, ont été comparés à ceux de 85
individus célibataires ayant une dysfonction sexuelle et 105 sujets normaux. La relation entre
les patterns d’autoprotection, l’anxiété sociale, la détresse générale et le fonctionnement social
a également été examinée chez les phobiques sociaux.

La seconde étude a permis d’examiner l’évolution des patterns d’autoprotection ainsi
que de l’anxiété sociale, de la détresse générale et du fonctionnement social, chez 85
phobiques sociaux à quatre moments : avant et après un traitement d’approche
interpersonnelle, ainsi qu’aux relances de six mois et d’un an. L’étude a également comparé
les participants en rémission et ceux satisfaisant les critères de la phobie sociale un an suivant
la fin du traitement.

Les résultats suggèrent que les patterns d’impuissance et de soumission sont
caractéristiques de la phobie sociale. Plus précisément, ces patterns décrivent davantage les
comportements des phobiques sociaux plutôt que ceux des groupes de comparaison. De plus,
une réduction significative de l’autoprotection a été notée au post-traitement et maintenue
jusqu’au suivi d’un an, surtout chez les participants en rémission.
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En outre, une relation entre l’autoprotection, l’anxiété sociale et la détresse générale a
été mise en évidence chez les phobiques sociaux. Une amélioration de l’anxiété, de la détresse
subjective et du fonctionnement social cohérente avec la dissolution des patterns
d’autoprotection a également été obtenue au post-traitement.

En conclusion, les résultats des deux études appuient une conception interpersonnelle
de la phobie sociale.

MOTS CLÉS :

phobie sociale ; approche interpersonnelle ; pattern d’autoprotection ; impuissance ;
soumission ; Circumplex Interpersonnel.
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SUMMARY

Traditionally, the construct of social phobia has been viewed intra-personally, as a
disorder of anxiety. In recent years, an alternative interpersonal account of the concept has
been proposed, whereby social phobia is characterized as an overall self-protective pattern of
specific fearfully self-protective patterns of interpersonal behaviour. The main objective of
this dissertation was to test hypotheses drawn from this interpersonal approach.

Two studies, presented in the form of research articles, were devised to examine
whether specific self-protective interpersonal patterns of powerlessness and submissiveness
are characteristic of the overall socially phobic pattern. The studies also examined whether
self-protectiveness is interrelated with anxiousness.

The first study compared the interpersonal patterns, assessed using an Interpersonal
Circumplex measure, of 132 socially phobic individuals to those of 85 single sexually
dysfunctional and 105 normal control participants. The relationship between self-protective
patterns and social anxiety, general distress, and social functioning were also examined in the
socially phobic group.

The second study examined the evolution of self-protectiveness, as well as social
anxiety, general distress, and social functioning, in 85 socially phobic individuals at four time-
points: Prior to being treated by an interpersonal approach, post-treatment, as well as at a six-
month and one-year follow-up. Remitted and non-remitted participants at the one-year follow-
up were also compared.

Results support the hypothesis that social phobia is characterized by self-protective
patterns of powerlessness and submissiveness. Specifically, these interpersonal patterns were
found to characterize the socially phobic group to a larger extent than either of the two
contrast groups. They were also shown to improve meaningfully after treatment, especially in
participants who achieved remission one year later.

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In addition, a relationship between the self-protective patterns and increased levels of
social anxiety and subjective distress was found in the socially phobic group. Results also
showed an improvement in anxiety, general distress, and social functioning consistent with the
shrinking in self-protectiveness after treatment.

In conclusion, the findings are consistent with predictions drawn from an interpersonal
approach and provide support for this alternative conceptualization of social phobia.

KEYWORDS:

social phobia; interpersonal approach; self-protective pattern; powerlessness; submissiveness;
Interpersonal Circumplex.
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TABLE OF CONTENTS

Résumé ....................................................................................................................................... ii
Summary .................................................................................................................................... iv
Table of Contents ....................................................................................................................... vi
List of Tables ........................................................................................................................... xii
List of Figures ......................................................................................................................... xiii
List of Acronyms and Abbreviations ....................................................................................... xiv
Dedication ................................................................................................................................ xvi
Acknowledgments .................................................................................................................. xvii

Introduction ................................................................................................................................. 1
Document Organization ......................................................................................................... 2
REFERENCES ........................................................................................................................... 4

PART I
GENERAL THEORETICAL CONTEXT

Chapter 1
Evolution of the Concept of Social Phobia ............................................................................. 6
The History of the Construct of Social Phobia ...................................................................... 6
To Generalize or Not to Generalize? ............................................................................ 9
With or Without Avoidant Personality Disorder? ..................................................... 11
Current Defining Criteria used to Assess the Construct of Social Phobia .......................... 12
Summary and Conclusion .................................................................................................... 13
REFERENCES ......................................................................................................................... 16

Chapter 2
Social Phobia Viewed Intra-Personally: A Critical Review of the Literature .................. 20
A Comparison between Sub-Types of Social Phobia ........................................................... 21
A Comparison between Socially Phobic and Normal Individuals ....................................... 22
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A Comparison between Socially Phobic, Normal, and Other Clinical Contrast Groups .... 28
Summary and Conclusion .................................................................................................... 30
REFERENCES ......................................................................................................................... 34

Chapter 3
An Interpersonal Conceptualization of Social Phobia ........................................................ 37
An Interpersonal Perspective ............................................................................................... 37
Social Phobia: A Self-Protective Interpersonal Pattern ...................................................... 39
Aim of the Present Study ...................................................................................................... 40
REFERENCES ......................................................................................................................... 42

PART II
METHODOLOGY BACKGROUND, ARTICLES, AND ADDITIONAL ANALYSES

Chapter 4
The Interpersonal Circumplex: A Method for Quantifying Patterns of Interpersonal
Behaviour ................................................................................................................................. 44
A Circumplex Classification of Interpersonal Behaviour .................................................... 44
Interpersonal Circumplex Measures .................................................................................... 47
The “Test d’évaluation du répertoire des construits interpersonnels” ............................... 49
REFERENCES ......................................................................................................................... 52

Chapter 5
Is Social Phobia Characterized by a Distinct Interpersonal Pattern? A Comparison
between Socially Phobic, Single Sexually Dysfunctional, and Normal Individuals .......... 55
Abstract ................................................................................................................................ 56
Introduction .......................................................................................................................... 57
Method .................................................................................................................................. 62
Results .................................................................................................................................. 71
Discussion ............................................................................................................................ 77
REFERENCES ......................................................................................................................... 83
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Chapter 6
Does an Interpersonal Approach to Treatment Improve the Dysfunctional
Interpersonal Pattern in Social Phobia? A One-Year Follow-Up ...................................... 88
Abstract ................................................................................................................................ 89
Introduction .......................................................................................................................... 91
Method .................................................................................................................................. 94
Results ................................................................................................................................ 104
Discussion .......................................................................................................................... 112
REFERENCES ....................................................................................................................... 117

Chapter 7
Additional Results ................................................................................................................. 122
Socially Phobic Participants One Year Post-Treatment versus Normal Participants ...... 122
Remitted and Non-Remitted Participants One Year Post-Treatment versus Normal
Participants ........................................................................................................................ 123
REFERENCES ....................................................................................................................... 125

PART III
GENERAL DISCUSSION

Chapter 8
An Integration of the Findings ............................................................................................. 127
Review of the Purpose of the Study .................................................................................... 127
Summary of the Findings ................................................................................................... 128
REFERENCES ....................................................................................................................... 132

Chapter 9
The Findings in Relation to the Literature ......................................................................... 133
An Evolutionary Model of Social Interactions ................................................................... 133
A Social Skills Deficits Model of Social Phobia ................................................................ 134
A Cognitive Model of Social Phobia .................................................................................. 135
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A Neurobiological Perspective on Social Phobia .............................................................. 136
Summary and Conclusion .................................................................................................. 137
REFERENCES ....................................................................................................................... 138

Chapter 10
Contributions, Limitations, and Directions for Future Research .................................... 141
Contributions of the Study ................................................................................................. 141
Limitations of the Study ..................................................................................................... 142
Directions for Future Research ......................................................................................... 145
Formality of the Situation ......................................................................................... 146
Complementarity ...................................................................................................... 147
REFERENCES ....................................................................................................................... 150

Conclusion .............................................................................................................................. 155

APPENDIX A
Authorization Letter to Write the Current Dissertation in English .......................................... xix

APPENDIX B
DSM-5 Criteria for Social Phobia (Adults) .............................................................................. xxi

APPENDIX C
ICD-10 Criteria for Social Phobia ........................................................................................ xxiii

APPENDIX D
Authorization Letter to Present the Current Work in Article Format ..................................... xxv

APPENDIX E
Test d’Évaluation du Répertoire des Construits Interpersonnels (TERCI) ......................... xxvii

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