3. Cognitive biases in SAD

the underestimation of their own social skills [38]. It is suggested that the experience of viewing video recordings of their own social performances would enable socially anxious individuals to correct their underestimation of their social abilities. This, in turn, is expected to lead to reduced symptoms of anxiety when anticipating in future social events [39–41]. Moreover, objective information about the self is expected to result in changes in the negative self-image and lead to confidence about social performance. (See Figure 1 for an illustration of

Warnock-Parkes et al. [42] suggested five broad categories of interference that results from video feedback [43]: (a) reexperiencing feelings when watching the video, (b) selectively searching for behaviors that could be interpreted negatively, (c) discounting the accuracy of the video image, (d) mistaking safety behaviors for social deficits, and (e) reactivating habitual patterns of self-criticism. Warnock-Parkes et al. [42] suggested that patients with social anxiety disorder have these processing biases that would make it difficult for them to see the videos differently from their habitual negative self-perception. It is important to reduce processing

Several studies have reported that video feedback techniques improve distorted selfperceptions when used as a psychological intervention for social anxiety [9, 11, 39]. Rapee and Hayman showed that high and low socially anxious individuals improved their distorted self-perceptions after video feedback [9]. Harvey et al. demonstrated that 7 min of cognitive preparation before video feedback enhanced the effect of video feedback on distorted selfperceptions [39]. Rodebaugh also reported that cognitive preparation enhanced selfperceptions about speech performance [11]. On the other hand, Smits et al. failed to find any difference between exposure and exposure with video feedback [40]. They suggested that their technique might have targeted probability bias by providing performance feedback, which

Orr and Moscovitch summarized previous VF studies [37]. They described that experimental research on social anxiety and VF has typically examined the efficacy of VF on its own (i.e., with neither a pre-VF preparation phase nor a post-VF review phase) [37, 41] or only with the

> Viewing Their own social performance

> > Clinician

Cogni�ve prepara�on And restructuring

an actual video feedback session).

68 Cognitive Behavioral Therapy and Clinical Applications

biases to identify the effects of video feedback.

interferes with the necessary reappraisal of cost bias.

Trying social task (speech, conversation, etc)

> Receive objec�ve informa�on

Figure 1. Image of the state of actual video feedback.

Participant

It has been suggested that the negative interpretation bias in social situations and social information might interfere with the effectiveness of video feedback in SAD. Certain studies have reported the effects of negative interpretations on social anxiety symptoms. Foa et al. found that individuals with social phobia rated negative social events as more probable and costly than nonclinical anxious controls [45]. Stopa and Clark showed that patients with generalized social phobia were more likely to interpret ambiguous social events negatively and to catastrophize in response to unambiguous, mildly negative events relative to other anxiety disorder groups or a nonpatient control group [46]. Constans et al. reported that socially anxious individuals showed a less positive interpretation of ambiguous interpersonal events [47]. In summary, the interpretation bias regarding social situations seen in individuals with social anxiety is characterized by more negative and less positive cognitions.

It is possible that socially anxious individuals negatively evaluate their appearance on video. This negative interpretation could interfere with the effectiveness of video feedback. In addition, SAD patients may also lack positive interpretations about their appearance on video. Therefore, it is possible that SAD patients and high socially anxious individuals interpret their video as more negative and less positive. However, the relationship between negative and positive interpretations of their appearance on video and social anxiety symptoms has not been investigated to date.

Based on the above considerations, Shirotsuki et al. examined differences in efficacy between video only (VW) and video with cognitive interventions (VW + CI) [44]. They divided participants into a video only group (VW group) and a video with cognitive intervention group (VW + CI group). Only VW + CI group was instructed to watch a video of their speech objectively after the speech tasks. The results showed that there was a significant interaction (group times) on self-perception. In addition, the VW + CI group showed significantly higher ratings for self-perception than the VW group after watching the video. These findings suggest that cognitive intervention before video feedback is an important factor in enhancing the effects of video feedback. Moreover, just watching videos has only a limited effect on improving self-perceptions about speech tasks.

involvement with other people increased. The patient was afraid that he might be acting strangely or making the audience unpleasant before VF during the CBGT program. After watching his own video, he was able to see that he was not as unpleasant as he had thought. On the other hand, he mentioned a sense of burden when watching videos of himself. Although he knew that he could see himself objectively, he was somewhat afraid that he might look strange, and this sense of anxiety increased before VF. Therefore, a discussion was held before watching the video to reduce his anxiety. However, the anxiety was not completely

Video Feedback Techniques Used in Social Anxiety Disorders

http://dx.doi.org/10.5772/intechopen.71278

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As a result of the CBGT program, the client's anxiety, avoidance, and cost bias in social situations had been decreased. In addition, negative self-perception improved as a result of speech and conversation exposure. Along with the improvement in SAD symptoms, the client gradually began the process of reinstatement. These findings indicate the effectiveness of CBGT program and the process of reinstatement of SAD patients. These case examples suggest the reality of video feedback sessions. In most cases, the clients reported benefits as well as difficulties in viewing the video. Although VF sessions are highly effective, participants simultaneously feel a heavy burden. Clinicians need to recognize both these aspects of VF and take

Firstly, it is important to clarify the influence of factors interfering with VF. Certain studies have reported the effect of negative self-images and interpretations. Individuals with SAD and highly socially anxious people often provoke negative self-images before conducting video feedback. These cognitions might interrupt the shift in their thoughts to an objective and balanced view. Shirotsuki suggested that highly socially anxious people might have negative and positive interpretations about their appearance on video, which might interfere with the efficacy of VF sessions [50]. In addition, high social anxiety results in negative interpretation about social information. When conducting video feedback, activated negative interpretation biases interrupt receiving neutral information from video images. Certain studies have suggested that estimated social cost was activated by watching video images. Therefore, the relationship between these cognitions and SAD symptoms needs to be examined in the future. Secondly, conducting VF with individuals having SAD would burden the participants because they feel uneasy and strange about themselves. In clinical settings, it is often said, "It is very hard to watch myself." They feel uncomfortableness about viewing their video because some people watch only negative information on the videos and remember a negative image. It is necessary to reduce this burden to improve the effectiveness of VF. Future studies need to

identify effective interventions for reducing the psychological burden of VF.

In Figure 2, the psychological process during VF sessions is described. After conducting social tasks, highly socially anxious individuals and individuals with SAD have negative self-images. These images lead to focusing on negative information during video watching. Therefore, they become unable to change their negative self-perceptions and as a result continue to maintain

alleviated by the discussion.

5. Future direction

steps in advance to reduce the feeling of resistance.
