Affective dynamics and emotional reactivity in social anxiety disorder

Background Although heightened anxiety associated with social interaction or evaluation is the core diagnostic criterion for social anxiety disorder (SAD), there is growing evidence that SAD is characterized by more pervasive reactivity beyond social situations. We employed Ecological Momentary Assessment (EMA) to describe the affective dynamics and emotional reactivity to daily events in a community-based sample of adults with SAD compared with other anxiety disorders, and controls without anxiety or mood disorders. Methods A sample of 236 adults with a lifetime diagnosis of SAD (n = 53), other anxiety disorders (n = 120), and no mood or anxiety disorder (n = 63) based on comprehensive diagnostic interviews answered brief electronic interviews that assessed daily life events and mood and anxiety symptoms four times a day for two weeks. Linear mixed models were used to quantify reactivity to daily life events. Results Persons with SAD had higher average levels of sad and anxious mood than those with other anxiety disorders or controls. Irrespective of comorbid mood disorders, people with SAD also demonstrated significantly greater decreases in both sad and anxious mood following positive events, and a greater increase in anxious mood following negative, particularly non-social events. Conclusions Our findings regarding pervasive reactivity beyond the social context in people with SAD confirm the need for broader conceptualization of this disorder as well as expansion of interventions beyond the social context. This work also demonstrates the utility of EMA as a powerful tool to track individual variability and reactivity in daily life that can inform etiology, treatment and prevention.