Social Phobia as a Consequence of Inadequate Social Skills

One possibility is that social phobic individuals are deficient in or lackaltogether the social skills necessary in order to function proficientlyCurran, 1979, p.. Subsequently, as psych

Inadequate Social Skills

On first encounter social phobic individuals stand out as remote andself-involved Although on duty (e.g about to present) or in attendance(e.g Christmas party), they hardly participate in the ongoing socialactivity (e.g introducing themselves to others, exchanging pleasantries,dancing), being apart
sometimes literally When engaged by others,they remain passive, reply tersely and appear distracted, liable to lapseinto embarrassing silences or become overtalkative Physically, they keep

a distance and look away, stiff rigidity alternating with noticeable tion (tremors, perspiration, blushing, faltering voice)

agita-Extended in time and ranging over numerous social occasions,the social phobic pattern of conduct is strongly characterized byself-protective evasion of challenging encounters, flight for safety andavoidance
if possible
of situations in which one might be carefullyscrutinized and found wanting or altogether undesirable As a manner ofspeaking, social phobia might be typified by what such individuals fail

to do (e.g take a stand, initiate, take charge) and achieve socially(e.g associates, friends, spouses)

Many activities essential to normal life (e.g presenting, negotiating,courting) are struggled with tentatively or given up in despair
withserious consequences Possibilities of promotion, forging partnerships,and making new friends are often forgone In the limited number ofencounters they participate in, such individuals say little, hardly expres-sing feelings or opinions Their very suffering is usually kept hidden; thestate of apprehension they usually experience is typically dissembled.What might account for this unusual pattern of reticence?

One possibility is that social phobic individuals are deficient in or lackaltogether the social skills necessary in order to function proficiently(Curran, 1979, p 319, Stravynski & Greenberg, 1989, p 208, Marks,

1985, p 615) Their anxious distress might be considered from such

a perspective as arising from the inability to act effectively, while ing
realistically
its social consequences

forsee-225

Aim and Method

My main goal in this chapter is to consider the evidence having a bearing

on the ‘‘skill-deficits’’ account of social phobia Before doing that, ever, several intermediate steps need to be taken

how-I will first inquire into the notion of ‘‘social skills’’ generally and itsapplication to social phobia specifically Subsequently, as psychologicalconcepts cannot exist independently from the methods of their measure-ment, I will look into the validity of the corresponding tools devised toidentify and to quantify social skills deficits generally and their value insocial phobia in particular

If validity is acceptable, more important questions may be dealt with,namely whether the socially phobic differ in their social skills fromnormal individuals and/or other contrast populations The demonstra-tion of such differences is a necessary (but not sufficient) condition forthe ultimate query: do skills deficits play a causal role in the socialphobic pattern of behavior?

Finally, I shall examine the value of the construct of ‘‘skillsdeficits’’ indirectly, by considering the effects of a therapy designed toremedy them

What are Social Skills and their Deficits?

The hypothesis of skills deficits is obviously reliant on the notion ofsocial skills The hypothetical construct of social skills arises fromattempts to provide an explanatory framework for normal social behav-ior A possible way of studying social behavior is to construe it as ana-logous to a motor skill (e.g using chopsticks, swimming) It involvesacting according to pre-established rules in pursuit of certain goals(Argyle & Kendon, 1967) This underlines the tightly conventional(i.e rule-bound) aspect of social behavior (e.g first meeting someone)

as well as its dynamism (i.e constantly undergoing revisions in light ofsignals originating in the social environment) A failure to perform profi-ciently is by analogy accounted for in terms of lack of requisite skills(Trower, Bryant, & Argyle, 1978)

‘‘Deficient social skills’’ provide a concept accounting for the vation that certain individuals are socially inept either because they tend

obser-to bungle common social encounters, shirk them or fail obser-to realize normalachievements (e.g finding a mate)

As all psychopathologies unfold on the backdrop of social relations,this explanatory hypothesis has had a wide influence Among others, ithas been applied to: schizophrenia (Wallace & Lieberman, 1985),

depression (Lewinsohn, 1974), sexual dysfunctions in men (Lobitz &LoPiccolo, 1972), and social phobia (Stravynski & Greenberg, 1989).Such an account hypothetically associates certain social skills deficitswith membership in various diagnostic categories (Hersen, 1979) Thebreadth of application, however, raises the question of whether the con-struct of ‘‘social skills deficits’’ has any precise meaning.

This compels us to clarify the concept of skill The term itself, despitefrequent use and wide-ranging application, has proved to be exceedinglydifficult to define (see Adams, 1987)

Libet & Lewinsohn (1973) provided one of the first and oft-quoteddefinitions of social skills being ‘‘the complex ability to maximize therate of positive reinforcement and to minimize the strength of punish-ment from others’’ (p 311) This functional definition, does not pin-point specific behaviors, but considers any social success to benecessarily the result of skill This definition is problematic First,desired social outcomes may result from circumstances rather thanskill Second, this definition also includes conduct considered inappro-priate (e.g temper tantrums), or even morally repugnant (e.g shiftingthe blame) Finally, it does not provide the unskilled performer with anyguidance as to what he or she could do to improve their lot

Another functional definition stresses control over others: ‘‘a personcan be regarded socially inadequate if he [sic] is unable to affect thebehavior and feelings of others in the way he intends and societyaccepts’’ (Trower, Bryant, & Argyle, 1978, p 2) The same critique asabove applies here

A different kind of definition altogether seeks to provide details of theessential elements of skillful performance Eye contact, appropriate con-tent of speech, and reciprocity, among others, are mentioned (seeCurran, 1979 and McFall, 1982 for overviews) Lists of elements, how-ever concrete or comprehensive, cannot be taken for a definition Nor is

it clear why the listed elements have been singled out while potentialothers have been left out

Other definitions still (e.g Bellack, 1979, p 98), argue for the ration of cognitive factors (e.g social perception) to the behavioralelements of social skills Such splitting of constituting elements maypose a risk of diluting the construct of social skills through its expansion

integ-to the extent of encompassing almost all behavior

As may be gathered from this brief survey, no satisfactory definition ofsocial skills, and by implication their absence or inadequacy, is availabletoday Nevertheless, the term has wide currency perhaps because itseems endowed with a certain concrete obviousness in the eyes of itsusers Bolstering this face validity seems to be the sense that ‘‘deficient

social skills’’ are a set of behaviors or characteristics and therefore, pably recognizable.

pal-In Wlazlo, Schroeder-Hartig, Hand, Kaiser, & Mu¨ nchau (1990), forexample, clinicians had little trouble separating skill-deficient patientsfrom others on the basis of information from their clinical notes.Similarly, Juster, Heimberg, & Holt (1996a) maintain: ‘‘in our clinicmost social phobic persons are found to possess adequate social skillsbut are inhibited when it comes to applying their skills in social situa-tions’’ (p 84) What is the conceptual and empirical basis for both sets

of observations? Does the term ‘‘skill’’ denote similar psychologicalqualities in both cases?

In conclusion, Curran’s (1979, p 321) remark that ‘‘everyone seems

to know what good and poor social skills are’’ but ‘‘no one can definethem adequately’’ still holds today Putting the frustrating quest fordefinitions aside, I shall now consider how the construct of socialskills has been assessed in research

Assessment of Social Skills of Social Phobic Individuals

As the assessment of social skills had to be fashioned out of the tual imprecision of the fundamental notion of ‘‘social skills,’’ two basicorientations have evolved

concep-The first might be termed, an intra-personal approach Within this,social skills are most commonly treated as a hypothetical mental con-struct denoting certain mental processes assumed to predispose a person

to act in a particular way Being ‘‘socially unskilled’’ in the intra-personalsense is not an observable performance Rather, it is an underlying qual-ity that manifests itself in or may be inferred from, actual behavior.Trower (1995, p 55) for example distinguishes between the components

of social skills, (i.e behaviors or repertoires of actions) and social skill(i.e the process of generating skilled behavior) The mental construct(or process) is the driving force within that gives rise to the action with-out As a trait, social skills are attributes of persons, not somethingthey do

Such a construal brushes against the risk of tautology Inadequatesocial skills are inferred from an inept performance Yet the very samelackluster performance will be put down to deficient skills

For a hypothetical mental structure to be endowed with explanatorypower, it must be shown to be valid in a series of independent studies(i.e that it makes a difference and that it has a myriad of predictableconsequences) Such independent demonstrations are scarce

The advantage that the trait approach brings to the study of socialskills is that it does not require a specific definition of such skills; such adefinition is after all unavailable As it is an abstraction, it is sufficientthat such a construct meets certain psychometric criteria to be consid-ered useful The drawback is that as with all trait conceptions, socialskills are assumed to be stable in time and across situations and thereforecan be summed up in a score; this is very doubtful Self-rating scalesillustrate the intra-personal approach to assessment.

The second approach might be termed inter-personal Within this ception, social skills are considered a function of given situations.Moreover, ‘‘social skills are an attribute of a person’s situation-specificbehavior, not of the person per se’’ (McFall, 1982, p 7) It follows that

con-‘‘no particular behavior can be considered intrinsically skillful, dent of its context’’ (1982, p 7) While highlighting the failings inherent

indepen-in the trait approach, the indepen-interpersonal perspective is not free of comings It is not clear, for example, what are the key units of behavior

short-to consider (constituent structures of behavior) and how short-to measuretheir effects on others Nor is it obvious what makes a performancesatisfactory

The implication of this approach for assessment is that behaviors mustalways be seen in the context of situations The most radical implication,

by far, is that social skills are idiosyncratic and cannot be measured bysome general test Simulations of behavior observed by assessors illus-trate this approach to assessment of social skills However, the manner

of reporting results with scores generalized across situations ignoresthe interpersonal principles and draws close to the intra-personalconception

As carrying out a comprehensive review would not serve our purpose(McNeil, Ries, & Turk, 1995 provide one), I shall limit myself to severalinstruments with some background research to document aspects oftheir psychometric characteristics with social phobic subjects

mea-1 display of negative feelings (15 items)

2 expression of personal shortcomings (14 items)

3 display of assertion (9 items)

4 expression of positive feelings (8 items)

Distress is rated on a 5-point dimension ranging from 1 ¼ not at all to

5 ¼ extremely Performance is quantified in terms of frequency rangingfrom 1 ¼ never do to 5 ¼ always do Each domain has a score: a generalscore (separate for distress and performance) is the summation of thescores of all domains The evidence regarding the soundness of the test

is summarized in Table 8.1

In summary, the accuracy of this instrument is satisfactory However,

it is not altogether certain what it ultimately measures as its (convergent)

Table 8.1 Psychometric characteristics of the Scale for Interpersonal Behavior(SIB)1

r (SIB distr./SIB perf.) ¼
0.53 (**)

r (distress) ¼ 0.85 a (perform.) ¼ from

0.91 to 0.97 (**)

r (SIB perf./FQa)

¼ from
0.15 (ns) to

1

Based on the following studies: Arrindell & van der Ende (1985); Arrindell, Sanderman, van der Molen et al (1988); Arrindell, Sanderman, Hageman et al (1991b); Bridges, Sanderman, Breukers et al (1991); Mersch, Breukers, & Emmelkamp (1992b) (ns)¼ non significant; (*)¼ p < 0.05; (**)¼ p < 0.01.

NB: There are no p values given for test
retest correlations.

validity rests on moderate correlations with other instruments.The relationship of the SIB with the social behavior of social phobics

in their own lives remains for the time-being unknown

Role-play Tests

The construction of most role-play tests flows from the interpersonalview of social skills, namely as being situation-specific and rather indi-vidual For this reason, most role-play tests are ad-hoc creations.Additionally, most tend to widen the narrow behavioral focus on con-duct by adding ratings of subjective assessment of anxiety during it

A key issue in role-play tests is how to analyze and make sense of theperformance displayed by the participants As only theory can offerguidance, the definitions of social skills acquire a high practical impor-tance In practice, two perspectives are taken

The first, ‘‘molecular,’’ focuses on various verbal (i.e speech) contentand para-linguistic dimensions (e.g intonation, length of speech,pauses) and non-verbal (e.g gaze, posture, hand-movement) elements

of social performance These are sought across behaviors The elementsare in all likelihood chosen because they have an intuitive appeal (asseeming building blocks) and easy to ‘‘make sense’’ of as there is notheoretical grounding to this practice

The second, the ‘‘molar,’’ focuses on global behaviors in key domains(e.g assertion, courtship) deemed to be essential to social functioning.The assessors’ ratings (on Likert-type scales) reflect their intuition as towhat constitutes a skillful performance Although such practice seems toyield good reliability, ‘‘it is not clear precisely what these ratings actuallyreflect’’ (Bellack, 1979, p 168)

These two levels of assessment are not mutually exclusive and havebeen used simultaneously in some studies By way of illustration I chosethe most psychometrically elaborate and sophisticated role-play test:

The ‘‘simulated social interaction test’’ (SSIT)
Curran (1982)The SSIT provides descriptions of 8 short situations described by anarrator These are: criticism, being the focus of attention, anger, meet-ing someone of the opposite sex, expression of warmth, conflict with aclose relative, interpersonal loss, and receiving compliments Thesethemes were selected on the basis of previous factor-analytic investiga-tions aiming to identify the most common difficulties (e.g Richardson &Tasto, 1976; Goldsmith & McFall, 1975) At the end of each descrip-tion, the subject is prompted to respond The role-plays are intended

to be short but no specific duration is suggested All proceedings arevideotaped.

The simulation is rated for performance and anxiety on an 11-pointLikert-type scale ranging from ‘‘not at all skillful’’ (1) to ‘‘extremelyskillful’’ (11) and ‘‘extremely anxious’’ (1) to ‘‘not at all anxious’’ (11).Two key features of the test give rise to some concern First, a global(and molar) approach to the rating of social skills was adopted becausethe authors ‘‘have not yet empirically determined the components ofsocial skills for our criterion situation’’ (Curran, 1982, p 363) Thatsuch a decision was guided by nothing more meaningful than the lack

of a better option, gives pause

Second, the training of the assessors involved 6 senior cliniciansreaching agreements on ratings of performance of bogus patients.These ratings then become the criterion (i.e the proper normative)response The process of training consisted in ‘‘recalibration’’ ofthe assessors’ judgments (correlation coefficients had to reach r ¼ 0.8

at the least) to conform to those on which the senior clinicians hadagreed

Although this procedure guarantees agreement (i.e reliability) amongassessors, it may, paradoxically, through enforcing conformism, com-promise the validity of what constitutes skillful behavior The evidenceregarding the soundness of the test is summarized in Table 8.2

In summary, the strengths of this test reside in it having a tative selection of difficult situations, a high rate of inter- and intra-assessors reliability Furthermore, it distinguished psychiatric patientsfrom normal control participants

represen-Its weaknesses consist of poor accord with independent ratingsperformed in other settings and with non-trained observers (nurses,research assistants) Interestingly, assessors’ agreements varied despitethe setting of a high threshold by the experimenters The greatest short-coming of this test, however, is the absence of any evidence of its gener-alizability, namely that it provides information that may be considered asequivalent to observing what people do in actual life Being on the wardcan hardly be considered representative of routine social life The author

of the test concedes that ‘‘we are still not content with the informationyield from such ratings’’ (Curran, 1982, p 371) Overall, then, this onedevice for measuring social skills has, accuracy aside, few sound psycho-metric characteristics to recommend it

To sum up, in view of the vagueness of the construct of social skills, it

is not entirely surprising that its measurement leaves something to bedesired This is especially disappointing in the case of the role-play as itsappeal lies precisely in the promise of being an economical substitute for

observation of real social conduct in natural settings Unfortunately,

it is not (see McNamara & Blumer, 1982, p 545 and Bellack,

r (anxiety) ¼ from

0.45 to 0.68 (*)

r ¼ 0.41 for women (*)

when raters ¼ nurses ICC (skills) ¼ 0.22 SSIT anxiety/SIB

distress

psychiatric outpatients ICC (anxiety)¼ 0.73

r (skills) ¼ 0.51 (**) r ¼
0.01 for men

(ns) when raters ¼

research assistants

r ¼
0.48 for women (*)

r (skills) ¼ 0.64 (**) SSIT/behaviors on the

ward when raters ¼

interviewers

r ¼ from 0.51 to 0.94 (*)

(***)¼ p < 0.001.

that no theoretical or operational definition of social skills is available.

In practice, the analysis of performance is done in ways that generallypreclude comparisons and, paradoxically, diminish the likelihood ofidentifying elements of convergent validity

Strictly speaking, this survey ought to end at this stage for, lacking aclear theoretical vision of what social skills (and conversely their deficit

or deficiencies) are, as well as meaningful means to identify and quantifythem, how can we hope to answer the more complex question ofwhether social phobia is characterized by deficient social skills, letalone if these are its cause? Nevertheless, as there is something to besaid for pursuing the exploration as instructive in itself, I shall carry on

as if the conceptual/measurement drawbacks were not there

Are there Social Skills Deficits Characteristic of theSocially Phobic?

Direct Evidence: Laboratory Simulations

The Socially Phobic Compared to Normal Individuals nately, it is impossible to answer this question satisfactorily as neithernorms of social skills nor of their deficiencies have been established Aroundabout way of attempting to answer it is to compare the social skills

Unfortu-of the socially phobic to those Unfortu-of normal control individuals, the latterpresumed to personify skillful social conduct Although this precludesthe drawing of absolute conclusions, it casts some light on the relativestanding of social phobic individuals As usual, the large variety of oper-ational definitions of social skill used in different studies makes compar-isons inherently difficult

Rapee & Lim (1992) compared the enactment of a brief speech infront of a small audience by 28 social phobic individuals (13 generalized,

15 specific) to that of 31 control subjects The performance wasanalyzed in terms of

1 specific elements of behavior (e.g eye contact, clarity of voice) and

2 global quality of performance (e.g subject’s capacity to arouse est) and rated on 5-point Likert scales by observers and the subjectsthemselves

inter-While no differences in terms of specific behaviors were reported,differences emerged in comparisons of the amalgamated scores ofboth specific and global aspects of performance In light of the above,the meaning of the association between lesser skill and social phobiaremains obscure Subjects’ self-ratings of performance tended to