HealthEven facial expressions can cause anxiety

Even facial expressions can cause anxiety

It is well established that people suffering from social anxiety fear being negatively evaluated by others. More recently, however, researchers have shown that even positive recognition can set off triggers for those who suffer from social anxiety. In our recent paper, we looked into how different facial expressions affect social anxiety and found some insight on the mechanisms behind the act of avoidance.

Social anxiety disorder is a debilitating psychological condition. People with this disorder suffer from persistent and excessive fears of one or more social or performance situations, where there is potential for evaluation by others. Those who suffer from social anxiety also exhibit something we call ‘attentional bias,’ which includes behaviors such as avoidance. Attentional bias can happen when someone is faced with social situations that increase their anxiety.

Because of these fears and consequential behaviors, the disorder can be severely incapacitating causing significant impairment in daily functioning and is one of the most prevalent lifetime disorders. Given the nature of the disorder concerning fear and avoidance of social situations, most sufferers fail to seek treatment unless they develop an additional disorder, which is associated with further impairment. That’s why identifying the causes and maintenance of social anxiety is so important.

What Responses to Facial Expressions Can Teach Us about Social Anxiety

Considering that the fear of being evaluated and judged by others is often at the core of social anxiety disorder, we were interested in finding out if this core fear could explain the relationship between social anxiety and attentional biases, such as avoidance. In our recent study, we simulated an anxiety-provoking social situation and used a computer task in order to assess how attention is distributed to differing facial expressions (e.g., angry, happy and neutral facial expressions).

We found that higher levels of social anxiety symptoms were associated with a greater avoidance of angry facial expressions. Furthermore, the relationship between social anxiety and an avoidance of angry faces was explained by increased levels of fear of positive evaluation.

Currently, the most common and effective therapy for social anxiety disorder is Cognitive Behavior Therapy (CBT). Present CBT interventions, which emphasize fear of negative evaluation, cognitive restructuring, and exposure work, typically do so with regards to situations involving apprehension of negative appraisal. As a result, fear of positive evaluation may not be specifically addressed during treatment. The information we collected from our study on facial expressions, attentional biases, and social anxiety can help change these limitations in treatment.

Is the Fear of Positive Evaluation the Missing Link in Social Anxiety Treatment?

By expanding upon current diagnostic and therapy techniques that identify and address not only the social anxiety fears that involve negative attention from others, but also incorporating strategies that address fears of being positively evaluated by others, our findings are exceptionally useful for clinicians who work with people suffering from social anxiety.

This fear of positive judgement may be one potential explanation as to why such individuals tend to use avoidance strategies in social situations. As such, treatment strategies for individuals with social anxiety disorder that are more disorder specific may prove more successful for improving cognitive-behavioral symptoms associated with this debilitating disorder.

Given that research on fear of positive evaluation is still in its infancy, future research is warranted to assess the inclusion of fear of positive evaluation in CBT in order to examine whether this does indeed diminish attentional avoidance often seen in those with social anxiety disorder.


Sluis, R. A., & Boschen, M. J. (2014). Fear of evaluation in social anxiety: Mediation of attentional bias to human faces. Journal of Behavior Therapy and Experimental Psychiatry,45, 475-483. doi: 10.1016/j.jbtep.2014.06.007

Ph.D. Candidate at Griffith University at Griffith University

Rachel Sluis holds a Bachelor of Psychology (Hons) from Griffith University, Australia, and is pursuing a Ph.D. in psychology there. Her research centers on social anxiety disorder, focusing on specific features that contribute to its development and persistence. A member of various psychological organizations, she aims to develop innovative interventions, particularly related to cognitive attentional control, to enhance existing therapy practices like CBT.

Clinical Psychologist and Senior Lecturer at University of Queensland

Mark Boschen, Ph.D., is a Clinical Psychologist who completed his clinical training at The University of Queensland in 1996. Since this time, Dr. Boschen has worked across public and private sector clinical roles. Dr. Boschen completed his Ph.D. at The University of Queensland in 2005, and has since worked primarily in clinical research and teaching, specializing in the assessment and treatment of obsessive-compulsive disorder, and other anxiety disorders in adults.


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