Research Paper needs to be done asap by Friday! I needs to be 5-7 pages.

ORIGINAL ARTICLE

The Role of Cognitive Factors in Childhood Social Anxiety: Social Threat Thoughts and Social Skills Perception

Rianne E. van Niekerk1,2 • Anke M. Klein1 • Esther Allart-van Dam2 •

Jennifer L. Hudson3 • Mike Rinck1 • Giel J. M. Hutschemaekers1 •

Eni S. Becker1

Published online: 17 November 2016

� The Author(s) 2016. This article is published with open access at Springerlink.com

Abstract Models of cognitive processing in anxiety dis-

orders state that socially anxious children display several

distorted cognitive processes that maintain their anxiety.

The present study investigated the role of social threat

thoughts and social skills perception in relation to child-

hood trait and state social anxiety. In total, 141 children

varying in their levels of social anxiety performed a short

speech task in front of a camera and filled out self-reports

about their trait social anxiety, state anxiety, social skills

perception and social threat thoughts. Results showed that

social threat thoughts mediated the relationship between

trait social anxiety and state anxiety after the speech task,

even when controlling for baseline state anxiety. Further-

more, we found that children with higher trait anxiety and

more social threat thoughts had a lower perception of their

social skills, but did not display a social skills deficit. These

results provide evidence for the applicability of the cog-

nitive social anxiety model to children.

Keywords Social anxiety � Social threat thoughts � Social skills � Speech task � Children

Introduction

Fear in social situations can be very impairing: Having to

give a presentation at school, or being the centre of

attention is a frightening experience for many children. A

persistent strong fear of these types of situations has been

recognized by 22% of the boys and 32% of the girls

between the age of 14–24 (Wittchen et al. 1999). When

social anxiety generalizes, it has a significant impact on

children’s functioning, influencing self-esteem, schooling,

peer relationships, and their family environment (Essau

et al. 2000; Ginsburg et al. 1998). In addition, anxiety that

starts in childhood often persists into adulthood when left

untreated (Kessler et al. 2005). Considering the grave

impact on many life areas and the long lasting effects of

social anxiety, research about factors that underlie and

maintain social anxiety in children is essential.

Why do children become frightened in specific social

situations like giving a presentation? It is to be expected

that children who have a more anxious disposition are the

ones who become more anxious in these situations, because

theoretically ‘‘trait anxiety predicts state anxiety under

conditions of psychological threat, especially conditions of

evaluation’’ (p. 209, Reiss 1997). However, several studies

showed that trait social anxiety alone only moderately

predicts elevated anxiety during a speech. It is of interest to

find more factors that may relate to state anxiety, for this

will offer more insights into the mechanisms by which

anxiety arises. These insights can be used for improving

treatment interventions.

Based on cognitive theories of the development of social

anxiety (Clark and Wells 1995; Hofmann 2007; Rapee and

Heimberg 1997), social threat cognitions might be impor-

tant for predicting which children will become anxious

during a social evaluative task such as giving a speech

& Rianne E. van Niekerk [email protected]; [email protected]

1 Behavioural Science Institute, Radboud University

Nijmegen, P.O. Box 9104, 6500 HE Nijmegen, The

Netherlands

2 Pro Persona, Centre for Anxiety Disorders Overwaal,

Nijmegen, The Netherlands

3 Centre for Emotional Health, Macquarie University, Sydney,

Australia

123

Cogn Ther Res (2017) 41:489–497

DOI 10.1007/s10608-016-9821-x

(Hodson et al. 2008). According to the theory by Rapee and

Heimberg (1997), socially anxious individuals are greatly

concerned that they will be negatively evaluated and see

others as inherently critical. They also tend to perceive

themselves as less socially skilful (Alfano et al. 2006; Foa

et al. 1996; Hofmann 2004). Despite regular exposure to

social situations, anxiety does not decrease, because

socially anxious individuals are convinced that their neg-

ative beliefs are being confirmed (Clark 2001). The

expectancy of social threat, for example expecting to be

bullied or to be rejected (Hofmann 2007) and the antici-

pation of social mishaps is seen as a maintaining factor in

social anxiety, because socially anxious individuals fear

that the next social event will have a negative outcome as

well. As a result, socially anxious individuals engage in

avoidance and safety behaviour, preventing opportunities

in which the negative beliefs can be disconfirmed (Wells

et al. 1995).

The link between cognitive factors and state anxiety in

children has been investigated by Tuschen-Caffier et al.

(2011), who focussed on negative self-evaluation in chil-

dren with various levels of social anxiety. They found a

relationship between trait anxiety, state anxiety and nega-

tive thoughts: the higher the trait anxiety, the higher the

state anxiety during a speech task, and the more negative

evaluative thoughts the children experienced. Unfortu-

nately, Tuschen-Caffier et al. (2011) used a non-validated

general measure of negative self-evaluation, consisting of

four questions: ‘‘I can’t manage it’’, ‘‘I’m excited’’, ‘‘I feel

insecure’’, ‘‘I wonder what others watching me would

think’’ (p. 235), which could possibly be too ambiguous as

a measure of negative self-evaluation. Other studies have

investigated social threat thoughts only by means of

questionnaires (Rheingold et al. 2003), or focused on threat

interpretations in imaginary situations (Barrett et al. 1996;

Bögels and Zigterman 2000; Creswell et al. 2005; Muris

et al. 2000). How social threat thoughts relate to anxiety

experienced by children in real life situations could not be

answered by these studies. Neither have they answered the

question whether an increase in anxiety during a social

evaluative task is stronger related to thoughts about social

rejection (social threat thoughts) or thoughts about one’s

own performance (social skills). Therefore, the first goal of

this study was to investigate the relationship between social

threat thoughts, perceived social skills, trait social anxiety

and state anxiety during a social speech task.

If children do indeed have social threat thoughts in

social situations, do they also have an increased chance of

being exposed to those threats? For instance, do they have

less social skills and are they therefore at risk of being

rejected? Despite evidence that socially anxious children

report to have given an inferior performance, it is not clear

if they in fact show social skills deficits, or if their self-

evaluation is biased. Some studies support the hypothesis

that socially anxious children and adolescents have a social

skills deficit (Beidel et al. 1999; Inderbitzen-Nolan et al.

2007), while others find that socially anxious children

underestimate their social skills, while not performing

worse than non-anxious children (Cartwright-Hatton et al.

2005; Morgan and Banerjee 2006). Moreover, there are no

published studies that examined the link between social

threat thoughts and observed social skills, even though this

could give more insight into the relation between threat

cognitions and actual behaviour. Thus, the second goal of

this study was to investigate whether trait social anxiety,

state anxiety and social threat thoughts relate to social skill

deficits.

To summarize, the goals of this study were twofold.

First, we investigated whether social threat thoughts and

social skills perception mediate the relationship between

trait social anxiety and state anxiety following a social

speech task. Following the model of Hofmann (2007), we

hypothesized that both more social threat thoughts and a

more negative social skills perception will mediate a pos-

itive relationship between trait social anxiety and state

anxiety. Our second goal was to test whether trait social

anxiety is related to social skills deficits or an underesti-

mation of social skills and if this relationship is mediated

by social threat thoughts and change in state anxiety during

a social speech task. Since it is unclear whether socially

anxious children underestimate their skills or in fact have

less social skills, we could not formulate a specific

hypothesis for this research question.

Methods

Participants

Participants were 141 children (40 boys) aged between 8

and 13 years (M = 10.1, SD = 1.12), varying in levels of

social anxiety. Children were selected from 718 children

participating in a large study about anxiety and avoidance

behaviour involving 11 different elementary schools. Due

to time constraints, it was not possible to test all children

more extensively, so a selection of 141 children was made.

To increase the number of anxious children in the sample

and achieve a more even distribution of social anxiety, we

selected children based on the Social Anxiety Scale for

Children-Revised (SASC-R; Ginsburg et al. 1998; La

Greca and Stone 1993), the social anxiety subscale of the

Screen for Child Anxiety Related Emotional Disorders

(SCARED-71; Bodden et al. 2009) and the Behavioral

Inhibition Questionnaire (BIQ; Broeren and Muris 2010),

such that levels of social anxiety were more evenly dis-

tributed and approximately the same number of girls and

490 Cogn Ther Res (2017) 41:489–497

123

boys scored in the lower and higher regions of self-reported

anxiety. Time between screening and individual testing for

the current study was approximately 3 months. To obtain

an indication of the severity of the trait social anxiety of

our sample, we calculated how many children scored above

the clinical cut-off of 8 of the SCARED-71 social anxiety

subscale. We found that 50 children (40%) scored above

this clinical cut-off. The current sample partly overlapped

with the samples in two studies to validate a measure of

spider fear (Klein et al. in press) and a auditory interpre-

tation task measure (Klein et al. 2016a), a study on biases

in spider fear (Klein et al. in press), and a study on the

specificity of interpretation biases (Klein et al. 2016b).

Measures

Screen for Child Anxiety Related Emotional Disorders

(SCARED-71)

The SCARED-71 measures symptoms of DSM-IV anxiety

disorders, including separation anxiety, generalized anxiety

disorder, panic disorder, social phobia, specific phobia,

obsessive–compulsive disorder, post-traumatic stress dis-

order and school phobia (Bodden et al. 2009). Due to time

constraints, we only used the subscale social phobia in the

current study. The SCARED-71 can be used to differentiate

clinically anxious from non-anxious children on a total

score and on all subscales and has a good internal consis-

tency (Bodden et al. 2009). Children score how often they

experience each anxiety symptom on a 3-point Likert scale

(0 = almost never, 1 = sometimes, 2 = often). Internal

consistency of the social anxiety subscale used in the

present study was good (Cronbach’s a = .88). Given that the items in the SCARED are phrased in a general or

chronic way, they are considered to reflect a trait concep-

tualization of social anxiety (Muris et al. 2003).

The Children’s Automatic Thoughts Scale (CATS)

The CATS consists of 40 items that characterize different

negative thoughts (e.g. ‘‘Kids are going to laugh at me’’;

Schniering and Rapee 2004). Social threat thoughts were

measured with five items of the social threat scale of this

questionnaire, supplied by Dodd et al. (2011) together with

their social speech protocol: ‘‘I’m worried that I’m going to

get teased; I’m going to look silly; People are thinking bad

things about me; I look like an idiot; I’m afraid I will make

a fool of myself’’. The items are scored on a five-point

scale from 0 (not at all) to 4 (all the time). The CATS has

consistently shown good internal reliability, with Cron-

bach’s alphas ranging from .82 to .96 (Schniering and

Lyneham 2007; Schniering and Rapee 2002, 2004).

Cronbach’s alpha of the subset of the social threat scale in

this study was .78.

State Anxiety

State anxiety was measured with six statements addressing

different elements of anxiety. Children were asked to rate

the following items on a scale from 0 to 10: anxious,

excited, palpitations, funny feeling in stomach, sweating

and shaking (based on: In-Albon et al. 2009). All items had

two little drawings of a figure that depicted a neutral state

on the left side (0) and the specific feeling on the right side

(e.g. a scared expression with the item ‘anxious’; 10). Both

measures of state anxiety, before and after the speech task,

had good internal consistency (a = .87 and a = .88).

Social Speech Task

The procedure of the two minute speech task was similar to

the protocol of the high anxiety condition used by Dodd

et al. (2011). All children performed the task individually

in a separate room at school, together with a trained

research assistant. The children were told that the speech

would be recorded on video and that adults would watch

the videos. The children were allowed to talk about any-

thing they wanted and the assistant gave a few examples of

possible subjects. The child stood straight up, facing two

cameras, one of which recorded the whole body, while the

other one recorded the facial expression. The assistant sat

behind the child, was not visible for the child, and did not

react to the child’s utterances. When the child was silent

for 10 s, the assistant gave a standardized prompt (e.g.

‘‘Could you tell something about your hobby?’’). There

was a maximum of three prompts, each given after 10 s of

silence. The researcher wrote down how many prompts

were given. The assistant ended the task if the child had not

spoken after the third prompt.

Video Ratings

The Performance Questionnaire

The PQ is a nine-item instrument that measures perfor-

mance evaluation after a public speaking task (Cartwright-

Hatton et al. 2005). There are two versions: the PQ-C for

the subjective experience of the child and the PQ-O for the

observer. Items are scored on a four-point scale ranging

from not very (much) to very (much). Following the pro-

cedure by Miers et al. (2009), the questionnaire was split

up into two scales: a social skills scale and a nervousness

scale. The internal consistency for the resulting two sub-

scales of the PQ-C in the present study was adequate

(Cronbach’s a = .71 for social skills and .61 for

Cogn Ther Res (2017) 41:489–497 491

123

nervousness). Two trained observers (master-students)

watched the videos of the speeches and rated the partici-

pants’ performance using this questionnaire. They were

blind to the anxiety level of the children and worked inde-

pendently of each other. Cronbach’s alpha calculation and a

regression analysis were performed to analyse the interrater

agreement over a subset of 20% of the cases. Cronbach’s

alpha of the nervousness scale rated by the observers was not

sufficient (Cronbach’s a = .34), therefore this scale was left out of the data analysis. Cronbach’s alpha of the social skills

scale was comparable with findings in previous research

(a = .72). Regression analyses of the social skills scale showed that the observers did not systematically differ in

their scores, and that agreement was high (b = .917,

t(22) = 9.40, p \ .001). The ratings of the first observer were a good predictor of the variance of the ratings of the

other observer, R 2 = .794, F(1,24) = 88.43.

Procedure

For all participants, parental active consent was acquired in

writing prior to the study. After establishing active verbal

consent from the children as well, children were individ-

ually tested in a quiet room away from the main classroom.

As part of the large study, the children participated in two

sessions of 1 h each. In the second session, the participants

gave the 2 min impromptu speech and filled out the

questionnaires. Right before the social speech task

instructions, the children filled out the first state anxiety

measurement. Directly after having finished the speech

task, the children were asked to fill out the state anxiety

measure again, as well as the social threat questions and the

rating of their own performance. Trained master students

supervised the sessions.

Data Analysis

There were five children who did not fill out the social

threat scale, and 12 children whose video of the social

speech task was not usable for rating, so they were

excluded from the data analyses. To investigate our

research questions, two mediation analyses were performed

with the use of the SPSS add-on PROCESS (Hayes 2013).

This program is preferable over the causal steps approach

of Baron and Kenny (1986), for it is a more advanced

method of quantifying the intervening variable models

(Hayes 2009). We used bootstrapping analysis with 5000

bootstrap resamples to generate estimates of indirect

effects (Preacher and Hayes 2004). Bootstrapping is a

nonparametric resampling procedure that creates an

approximation of the sampling distribution of a statistic

from the available data. The procedure generates point

estimates and 95% confidence intervals for the indirect

effects and does not require assumptions about a normal

sample distribution that underlie the Sobel test. In boot-

strapping analysis, the test of an indirect effect (mediation)

is if the value of 0 is not between the lower and upper

bound of the 95% bias corrected confidence intervals.

Bootstrapping can also be useful when data is skewed,

which was the case with the scores on the social threat

thoughts scale. Several children did not experience social

threat thoughts at all. Since bootstrapping does not require

a normal distribution, it is one of the advised methods of

analysing this type of data (Delucchi and Bostrom 2004).

For the second mediation analysis, two difference scores

were used. Change in state anxiety was calculated by

subtracting the baseline state anxiety score from the post

speech task state anxiety score. The difference between

self-perception of social skills by the child and the ratings

of social skills by the observers were calculated by sub-

tracting the observer score from the child score. As a result,

underestimation of social skills by the child was indicated

by a negative score.

Results

Table 1 presents mean scores and standard deviations for all

questionnaires. First, we examined whether social threat

thoughts and self-perceived social skills mediated the rela-

tionship between trait social anxiety and state anxiety. To

explore this first goal, we estimated a serial multiple medi-

ator model with these two theoretically-derived mediators

(M1: social threat thoughts and M2: social skill child per-

ception) using PROCESS (Hayes 2013). This enabled us to

test the serial indirect effects of trait social anxiety on state

anxiety scores via social threat thoughts and social skills

perception (see Fig. 1). Baseline state anxiety score was

entered as a covariate. Results indicated that the total effect

of trait social anxiety on post-state anxiety scores was sig-

nificant (b = 0.21, t = 4.11, SE = .05, p \ .001). As

Table 1 Means and standard deviations

Scale M SD

SCARED-soc (sumscore) 6.76 4.96

Social threat thoughts 1.14 1.63

SA baseline 0.87 1.15

SA post 1.51 1.80

D SA 0.63 1.07

PQ-C skills 2.21 0.52

PQ-O skills 2.33 0.50

D PQ skills -.12 0.79

SCARED-soc = trait social anxiety; SA = state anxiety; PQ-C

skills = social skills child perception; PQ-O skills = social skills

observer perception

492 Cogn Ther Res (2017) 41:489–497

123

expected, we found that the indirect effect of trait social

anxiety on state anxiety via social threat thoughts was sta-

tistically different from zero (b = .24, 95% CI = .10 to .40). The indirect effect of trait social anxiety on state anxiety via

self-perceived social skills was not significant (b = .001, 95% CI = -.02 to .05). Furthermore, the predicted model of

the serial indirect effect of trait social anxiety on state anxiety

via social threat thoughts and self-perceived social skills was

not supported, as the indirect effect was not statistically

different from zero (b = .003, 95% CI = -.02 to .04). This means that social threat thoughts mediated the relationship

between trait social anxiety and state anxiety, as well as the

relationship between trait social anxiety and self-perceived

social skills, even while controlling for baseline state anxi-

ety. Contrary to our expectations, negative self-perceived

social skills did not relate to a higher state anxiety after the

task.

Our second research goal was to test whether trait social

anxiety is related to social deficits or an underestimation of

skills and if this relationship is mediated by social threat

thoughts and change in state anxiety on the social speech

task. First, to investigate if trait anxiety is related to social

skill deficits or an underestimation of skills, we calculated

correlations to investigate whether children with higher

trait social anxiety were rated lower by the observers on

their social skills than low trait anxious children, or if these

children underestimated their skills. As is shown in

Table 2, none of the anxiety-related measures correlated

with the rating of social skills by the observer (trait social

anxiety: r = .03, p = .76). However, trait social anxiety

did correlate significantly with the difference score of the

social skills rating (child rating minus observer rating),

showing a negative relationship (r = -.18, p = .042),

which indicates that children with higher trait anxiety rated

their social skills lower than the observers. When looking

at the slope of this relationship (y = 0.08-0.03*x), we

found that children with a trait social anxiety score of 2.67

score or lower, rated themselves higher or equal to the

observers. When trait social anxiety was higher than 2.67,

children underestimated their social skills compared to

observers. Since the clinical cut-off for this subscale is 8,

we found that children scoring under this cut-off score also

had the tendency to slightly underestimate their social

skills compared to the observers. These results indicate that

trait socially anxious children do not demonstrate a social

skills deficit, but underestimate their social skills.

To further examine whether the relationship between

trait social anxiety and social skills underestimation is

mediated by social threat thoughts and change in state

anxiety during the speech task, we performed a serial

multiple mediation analysis with two mediators (M1: social

threat thoughts and M2: change in state anxiety; see

Fig. 2). Results showed that the total effect of trait social

anxiety on the social skills difference score was significant

(b = -0.18, t = -2.06, SE = .09, p = .042). The indirect effect of trait social anxiety on social skills difference score

via social threat thoughts was not statistically different

from zero (b = .07, 95% CI = -0.21 to 0.60). Also, the indirect effect of trait social anxiety on social skills dif-

ference score via state anxiety change score was not sta-

tistically different from zero (b = .004, 95% CI = -0.02 to 0.05). Finally, the predicted model of the serial indirect

effect of trait social anxiety on social skills difference score

via social threat thoughts and state anxiety change score

was not supported, as the indirect effect was not statisti-

cally different from zero (b = .01, 95% CI = -0.05 to 0.7). These results demonstrate a relationship between trait

social anxiety and social skills underestimation: the higher

the trait social anxiety, the more children underestimated

their social skills. This effect was not mediated by social

threat thoughts or change in state anxiety.

Discussion

The first goal of this study was to investigate whether

social threat thoughts and social skills perception of the

child mediated the relationship between trait social anxiety

.59** -.11

-.30*

.25**

-.01

.21* (.06)

Trait social anxiety

Social threat thoughts Social skills rating child

State anxiety (post)

Fig. 1 Beta values for the relationship between trait social anxiety and state anxiety as mediated by social threat thoughts and social

skills rating of the child, controlled for baseline state anxiety. The

beta value of the direct effect between trait anxiety and state anxiety,

controlling for the mediation effect, is in parentheses. *p \ .05; **p \ .001

Cogn Ther Res (2017) 41:489–497 493

123

and state anxiety after a social speech. We found that social

threat thoughts were related to lower self-perception of

social skills. Furthermore, we found that social threat

thoughts mediated the relationship between trait social

anxiety and state anxiety after a speech task, even when

controlling for baseline state anxiety. Self-perception of

social skills did not mediate the relationship between trait

and state anxiety. It is important however, to keep in mind

that the two mediators were examined at the same time-

point, meaning that it is not possible to derive any causal

hypotheses from this model. The second goal was to test

whether trait social anxiety is related to a social skills

deficit or to an underestimation of social skills, and if this

relationship is mediated by social threat thoughts and

change in state anxiety on the social speech task. We found

that children with higher trait social anxiety tended to

underestimate their performance, but they were not

observed to have poorer social skills than children with

lower trait social anxiety. Moreover, the relationship

between trait social anxiety and underestimation of skills

was not mediated by social threat thoughts or change in

state anxiety.

The present study provides evidence that two important

aspects of the most influential social anxiety theories are

applicable to children (Clark and Wells 1995; Hofmann

2007; Rapee and Heimberg 1997). First, the current results

support that social threat thoughts are contributing to the

prediction of state anxiety of children in social evaluative

situations. Second, social skills perception did not relate to

change in state anxiety, which indicates that social threat

thoughts are more relevant in the process of elevated state

anxiety in trait socially anxious children than social skills

perception. However, we did find that these two cognitive

factors had a significant negative correlation; children who

displayed more social threat thoughts perceived their social

skills as being lower. This result is in line with other

studies that show that socially anxious children have a

specific negatively biased cognitive processing style (Fer-

reri et al. 2011) and is an addition to the already existing

child literature about the importance of threat-based

interpretations and threat responses as maintaining factor in

anxiety disorders (Manassis 2013). This finding also cor-

responds with adult studies that found that individuals with

a social anxiety disorder form negative mental represen-

tations, which is based on how they think potential eval-

uators would view them (Hackmann et al. 1998; Wells

et al. 1998). It would be worthwhile for further research to

explore if the presence of social threat thoughts is a

prognostic risk factor or maintaining factor for the devel-

opment of social anxiety.

.62** .12

.43**

-.10

.04

-.18* (-.13)

Trait social anxiety

Social threat thoughts Δ State anxiety

Δ Social skills rating

Fig. 2 Beta values for the relationship between trait social anxiety and difference score of social skills rating as mediated by social threat

thoughts and change in state anxiety. The beta value of the direct

effect between trait anxiety and the difference score of social skills

rating, controlling for the mediation effect, is in parentheses.

*p \ .05; **p \ .001

Table 2 Bivariate correlations between measures of cognitions, affect and behaviour

SCARED-soc Social threat thoughts SA baseline SA post D SA PQ-C skills PQ-O skills

Social threat thoughts .63**

SA baseline .34** .31**

SA post .47** .52** .82**

D SA .39** .51** .24* .74**

PQ-C skills -.25* -.33** .01 -.10 -.16

PQ-O skills .03 -.08 .03 -.01 -.06 -.21*

D PQ skills -.18* -.17 -.02 -.06 -.07 .79* -.76**

SCARED-soc = trait social anxiety; SA = state anxiety; PQ-C = skills social skills child perception; PQ-O skills = social skills observer

perception

* p \ .05; ** p \ .001

494 Cogn Ther Res (2017) 41:489–497

123

With regard to the second research question, we did not

find evidence for a social skill deficit; we only found a non-

mediated relationship of trait social anxiety with an

underestimation of social skills. We found that children

generally tended to underestimate their social skills com-

pared to observers, and this underestimation increased with

a higher trait social anxiety. These findings are consistent

with cognitive theories of social anxiety, which assume that

socially anxious people have the tendency to underestimate

their skills, and overestimate risk of rejection (Clark 2001;

Hofmann 2007).

Some limitations of the current study should be men-

tioned. First, we exposed the children to a video camera

and an experimenter, which is not representative of usual

social situations. To increase the ecological validity of

these findings, it may be better to test the children in a more

realistic setting, such as in a classroom or during interac-

tion with peers (Spence et al. 1999), even though it should

be noted that there might be more interfering factors in a

realistic setting that cannot be easily measured and con-

trolled. Second, we only measured social threat thoughts

after the social speech task. It would be useful to measure

these thoughts at more time points. Third, we only included

children with varying levels of social anxiety, and the

results might differ for children with a diagnosed social

anxiety disorder. It is possible that children with a social

anxiety disorder are even more vigilant for threat and

therefore their social threat thoughts might be triggered by

milder threats (Mogg and Bradley 1998). Future studies

should include a clinically anxious group, before firm

conclusions can be drawn. Furthermore, our study focussed

on social anxiety only and it would be worthwhile to

investigate if social treat thoughts are specific to social

anxiety or if they arise in a variety of anxiety disorders.

Finally, to gain more insight in the relationship between

social threat thoughts and the maintenance of social anxi-

ety, it would be relevant to measure the relation between

social threat thoughts and behaviour. For instance, does the

presence of social threat thoughts predict automatic

approach–avoidance behaviour (Heuer et al. 2007). If so,

this would be in line with cognitive theories of social

anxiety that state that social threat interpretations lead to

avoidance behaviour (Hofmann 2007). Some evidence for

this hypothesis has been found in adults by Rachman et al.

(2000), who reported that post-event rumination was rela-

ted to anxiety during a social situation and avoidance of

comparable situations in the future.

Clinical Relevance

This study showed that an increase in anxiety during social

situations could be partly explained by the presence of

cognitions about being rejected by others. Challenging

these social threat thoughts in children might be an

important component in treatment, as evidence suggests

that change of threat expectancies regarding the likelihood

of aversive events could be the working mechanism in

anxiety treatments, as opposed to habituation (Craske et al.

2014). Thus, exposure to social situations without taking

the social threat expectancies in account might even be

counter productive. Anxious children will continue to feel

rejected, even though there is no objective evidence that

they are performing worse than other children. Since there

are already treatment protocols for adults that focus on

these expectancies and include (video) feedback to change

these social threat thoughts (Hofmann and Otto, 2008), it is

very relevant to study if this approach would also be

beneficial for children.

Compliance with Ethical Standards

Conflict of Interest Rianne E. van Niekerk, Anke M. Klein, Esther Allart-van Dam, Jennifer L. Hudson, Mike Rinck, Giel J.

M. Hutschemaekers and Eni S. Becker declare they have no conflict

of interest.

Ethical Approval All procedures performed in studies involving human participants were in accordance with the ethical standards of

the institutional and/or national research committee and with the 1964

Helsinki declaration and its later amendments or comparable ethical

standards.

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