July 24, 2020

Dear Colleagues,

The National Social Anxiety Center (NSAC) provides information about relevant and current research in service of disseminating and promoting evidence-based treatment. This month’s summary, by Dr. Andrew Rosen, focuses on a specific aspect of avoidance in socially anxious people. The article addresses visual avoidance of others’ faces.

Although visual avoidance of faces is a considered a central aspect of Social Anxiety Disorder (SAD), empirical support is equivocal. This review attempted to clarify under which conditions socially anxious individuals display visual avoidance of faces. Through a systematic search in Web of Science and PubMed up to March 2019, the authors identified 61 publications that met the inclusion criteria. They discussed the influence of three factors on the extent to which socially anxious individuals avoid looking at faces: (a) severity of social anxiety symptoms (diagnosed SAD versus High Social Anxiety levels in community samples [HSA] or related characteristics [Shyness, Fear of Negative Evaluation]), (b) three types of social situations (computer facial-viewing tasks, speaking tasks, social interactions), and (c) development (age-group).

Adults with SAD exhibited visual avoidance across all three types of social situations, whereas adults with HSA exhibit visual avoidance in speaking and interaction tasks but not in facial-viewing tasks. The relatively few studies with children and adolescents suggested that visual avoidance emerges during adolescence. The findings were discussed in the context of cognitive-behavioral and skills-deficit models. Suggestions for future research included the need for developmental studies and more fine-grained analyses of specific areas of the face.

How can clinicians who treat social anxiety assess the presence and degree of facial avoidance? What are ways to integrate facial avoidance into exposures or the overall treatment plan?

Jiemiao Chen, Esther van den Bos, P. Michiel Westenberg. A systematic review of visual avoidance of faces in socially anxious individuals: Influence of severity, type of social situation, and development, Journal of Anxiety Disorders, March, 2020.

Andrew Rosen, Ph.D., ABPP, FAACP

NSAC South Florida
(The Center for Treatment of Anxiety and Mood Disorders)