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A Review Journal of Anxiety Disorders Journal of Anxiety Disorders 23 (2009) 305–313 Contents lists available at ScienceDirect Journal of Anxiety Disorders Review The relation between public speaking anxiety and social anxiety: A review Anke W. Blo¨te *, Marcia J.W. Kint, Anne C. Miers, P. Michiel Westenberg Leiden University Institute for Psychological Research, Developmental Psychology Unit, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands ARTICLE INFO ABSTRACT Article history: This article reviewed the literature on public speaking anxiety in the context of social phobia subtyping. Received 2 April 2008 In total, 18 empirical studies on subtype issues related to public speaking anxiety were analyzed. Results Received in revised form 12 November 2008 of the reviewed studies are discussed in relation to their research method, that is, whether it focused on Accepted 18 November 2008 qualitative or quantitative aspects of subtype differences and whether it used a clinical or community sample. Evidence supported the premise that public speaking anxiety is a distinct subtype, qualitatively Keywords: and quantitatively different from other subtypes of social phobia. The significance of this finding for Public speaking anxiety social phobia studies using speech tasks to assess participants’ state anxiety and behavioral performance Social Phobia is discussed. Subtypes ß 2008 Elsevier Ltd. All rights reserved. Contents 1. Introduction . 305 1.1. Short history of subtyping . 306 1.2. Subtype and severity continuum models . 306 2. The present study . 307 2.1. Looking for qualitative differences . 307 2.1.1. Clinical studies. 307 2.1.2. Community studies . 307 2.2. Focusing on quantitative differences. 309 2.2.1. Clinical studies. 309 2.2.2. Community studies . 309 2.3. Behavioral assessment studies. 310 3. Discussion . 311 4. Recommendations for future research . 311 References...................................................................................................... 312 1. Introduction Hope, 2001; Perowne & Mansell, 2002; Wenzel & Holt, 2003). However, given that these situations also cause fear in persons The aim of the present review is to clarify the distinction with solely public speaking fears, it is not really clear how suitable between public speaking anxiety and social anxiety within the they are for studying social anxiety. If anxiety that is restricted to framework of social phobia subtyping. Knowledge about this topic public speaking situations and anxiety that is more widespread to is important not only for clinical practice but might also be useful all kinds of social interaction situations relate to two different to improve the validity of empirical studies on social phobia. The subtypes of social anxiety, studies in this domain could be affected reason for this is that impromptu speech tasks and oral in two ways. (1) Speech-anxious-only individuals who do not meet presentations in front of an audience are frequently used in order the criteria of severe impairment and distress needed for a social to study the correlates of social phobia or social anxiety (e.g., Boone phobia diagnosis would participate in normal control groups but et al., 1999; Hirsch, Clark, Mathews, & Williams, 2003; Norton & might be as anxious as or perhaps even more anxious than socially phobic individuals in this kind of situation. (2) On the other hand, speech-anxious-only individuals who do meet the criteria would * Corresponding author. Tel.: +31 71 527 3673; fax: +31 71 527 3619. be assigned the general label of social phobia and be included in an E-mail address: [email protected] (A.W. Blo¨te). experimental group together with generalized social phobics. In 0887-6185/$ – see front matter ß 2008 Elsevier Ltd. All rights reserved. doi:10.1016/j.janxdis.2008.11.007 306 A.W. Blo¨te et al. / Journal of Anxiety Disorders 23 (2009) 305–313 both cases, the results of studies might present an incorrect picture 1.2. Subtype and severity continuum models of the characteristics of socially anxious individuals and therefore hinder our understanding of the disorder (Levin et al., 1993). The alternative to a subtype model of social phobia is a Consequently, evaluation of the position of public speaking anxiety continuum of severity model. In many empirical studies, sheer in social phobia subtyping is very important to clinical studies. quantitative differences – be it in number of fears, severity of symptoms, or other related variables – between social phobia 1.1. Short history of subtyping subgroups are considered as supporting a continuum model (e.g., Stein, Torgrud, & Walker, 2000; Vriends, Becker, Meyer, Michael, & In the frequently made distinction between social phobia and Margraf, 2007). This is in contrast with a subtype model that performance anxiety, public speaking anxiety pertains to perfor- requires the existence of qualitative differences between sub- mance anxiety. Discussions about criteria for the differential groups. It should be noted that conclusions based on the finding of diagnosis of performance anxiety and social phobia have been either quantitative or qualitative differences between subgroups numerous, especially since Heimberg, Holt, Schneier, Spitzer, and are not symmetrical. Mere quantitative differences do not support Liebowitz (1993) wrote their review on subtypes of social phobia. a subtype model but they do not preclude it either. If a study solely The term social phobia had first been introduced in the third finds quantitative differences a severity model suffices to describe edition of DSM (American Psychiatric Association, 1980), where the data. However, if qualitative differences are found the severity the diagnosis was generally intended for individuals whose fear model no longer suffices and therefore a subtype model is was limited to one specific situation like public speaking, eating or supported. drinking with others, or urinating in public restrooms. The Studies looking for qualitatively different subtypes have mainly diagnostic criteria for social phobia were broadened in DSM-IIIR used factor analyses, cluster, and similarity analyses. Clusters of (American Psychiatric Association, 1987). It was recognized that interrelated fears found by factor analyses, or groups of individuals individuals with social phobia may exhibit fears in various with the same patterns of fears found by cluster analyses are interactional situations and a generalized subtype of social phobia regarded to support a subtype model. If subgroups have different was created. Individuals with primary fears of humiliation, patterns of correlations with secondary variables it is also taken as embarrassment and negative evaluation in most social situations evidence for a subtype model. Another criterion points to were brought together under this subtype. The remainder of differences between subgroups that are not in the expected individuals with social phobia has often been referred to as the direction (Hook & Valentiner, 2002), for example, individuals with nongeneralized group. This group consisted of individuals whose performance anxiety show less fear than people with generalized fears were either limited to performance situations or included social anxiety in most social situations, but in some specific several but not ‘most’ social situations. This subtype was not performance situations show more fear. Any differences in causes formally listed in the DSM-IIIR nomenclature. and prognosis of the subgroups would also support a subtype There has been considerable criticism of the treatment of social model. Finally, a comparison of subgroups with a normal control phobia subtypes in the DSM-IIIR. Heimberg et al. (1993) stated that group can bear evidence on qualitative differences between the the two-part structure of generalized versus nongeneralized subgroups involved. If one subgroup differs quantitatively from a subtypes should be rearranged into a three-part structure. normal control group on a certain secondary variable and another According to Heimberg et al. this structure would include (a) a subgroup does not, it suggests that the two subgroups are generalized subtype for persons whose anxiety is evident in most qualitatively different, one having ‘‘abnormal’’ and the other social situations, (b) a nongeneralized subtype for persons who having ‘‘normal’’ responses. experience anxiety in social interaction situations but demonstrate Two review studies concluded that qualitative differences exist at least one broad domain of social functioning in which they do between the generalized social phobia subtype on the one hand not experience clinically meaningful anxiety, and (c) a circum- and nongeneralized or specific subtypes on the other (Hofmann, scribed subtype for persons whose anxiety is evident in a limited Heinrichs, & Moscovitch, 2004; Hook & Valentiner, 2002). Hook number of specific situations (e.g., speaking, eating, or writing in and Valentiner’s conclusion was based on the fact that some public). Subtype (b) was hence filling the apparent gap between studies present evidence consistent with a qualitative but not with fearing a limited number of specific social situations and fearing an exclusively quantitative distinction: (1) The generalized socially most social situations. anxious individuals fear social interaction situations, whereas Due to insufficient empirical evidence, however, there was individuals with specific social anxiety fear performance situa- not enough support for the adoption of a tripartite model tions. (2) In a speech task, individuals with
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