1.0 IntroductionIndividuals with social anxiety disorder (SAD) encounter stress and anxiety, that interferes with engagement with social situations and fear of negative evaluation (Kent, Keohane, 2001). This particular situation is likely to associate with with maladaptive functioning of anxiety disorders (Dugas, Gosselin & Ladouceur, 2001). Studies show that even with people who experience severe levels of anxiety, understanding and functioning of anxiety hinder and treatment of SAD remain relatively low (Olfson, et. al., 2000). Anxiety disorders shows strong connection with stress and rumination that are dependent on external factors (Yook, Keunyoung, et al., 2010). Occurance of stress and rumination leads development of coping strategies. These coping strategies subsequently for anxiety disorder, occupy the treatment options because of anxiety reducing elements of coping strategies (Hoffman, 2007). Given the persistence and interference with functioning of disorder, it is detrimental to know the implying factors on anxiety in demonstration and prohibition of anxiety.Uncertainty intolerance (UI), which described as inability to face with ambiguous situations determined by fear of worry and distress. It is thought to be one of the main reason of neuroticism (negative evaluation of self) that is constant in anxiety related and mood disorders(Carleton, 2012; 2016). In subject of social anxiety uncertainty intolerance, possess the role of sensitivity towards possible anxious outcome that later on implies neuroticism to individual (Boelen, Reijnjtes, 2009). Research findings suggests that, intolerance sensitivity for the individual who experience cognitive bias, are relatively higher compared to others(Taylor ,Koch & McNally, 1995; Taylor, Cox, 1998; Olatunji, Taylor, 2009). Risk factor of catastrophic outcome and neuroticism, functions as determination pattern in anxious situations, in fact, findings suggest continuity of disorder base on same perception towards outcome and experience of neuroticism (Buhr, Dugas, 2006). Latest studies states, the experience of anxiety for individuals with intolerance of uncertainty, results with avoidant behavior, in other term safety behavior (Reuman et. al., 2015). Recent studies on anxiety disorders have shown increasing rates of external focused anxiety among college students(Mahmoud, J. S. R., Staten, R. T., Hall, L. A., & Lennie, T. A. 2012). Thus, it is among some of the most prevalent psychiatric disorders (Kessler, Berglund, Demler, Jin, & Walters, 2005). Therefore it is vital to understand the components of anxiety in particular. Following review will examine the etiology, epidemiology and diagnostic specifiers of anxiety. Thenceforth, conceptualization of disorder, UI social anxiety relationship, will be discussed including cognitive models that define the nature of maintenance of disorder, Although, symptomatic explanation of social anxiety disorder is one of the most common understanding in defining anxiety, current literature also debates on usefulness and validity of symptomatic consideration of disorders such as anxiety (Bogen, 2010). Due to the fact that, correspondence of disorder shares same characteristics with disorders that are unlike with anxiety disorders. 1.2 Social Anxiety DisorderSocial Anxiety Disorder (also known as social phobia) characterize as fear of public humiliation or embarrassment according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (DSM-5; American Psychiatric Association APA, 2013). Fear state subsequently occur unreasonably and can be recognized by individual (APA, 2013). Disclosure to feared situation results with experience of intense discomfort, anxiety and physiological arousal (Murray B Stein, Dan J Stein, 2008). Such social encounters can basis on fear of humiliation in conditions of interaction (e,g.,gazing another person) performance oriented (e,g., presenting a project) and observation (e,g., standing in front of everyone). Therefore, occurrence of such conditions, can result with greater fear from public humiliation and distress, consequently avoidance from uncertain situations (Reuman et. al., 2015). The experienced distress and expected outcome, in perception of individual, is greater than reality of the event (Stein, Gelernter & Smoller, 2004) That being said, external recognizability of distress and anxiety are potentially influential for individual, in fact, it is subject to repetitive thinking throughout the decrease of feeling of anxiety (Rapee & Heimberg, 1997).To satisfy requirements individual suppose to have no prior medical condition or mental disorder, since symptoms might be misleaded (Murray, Stein, 2008); moreover, although it carries unique components, differentiation with normal shyness, panic disorder, agoraphobia, major depressive disorder, and obsessive compulsive disorder can be hard to detect, due to fluency of symptoms (Murray B Stein, Dan J Stein, 2008). In the current version of DSM (DSM-5; APA, 2013) does not include generalized subtype, regarding the fact that anxiety does not occur directly linked to a social situation.1.2.1 Etiology. Development of SAD still cannot be elucidated with one factor, however, etiological models of SAD suggest that early onset can occur during childhood and can be diagnosed until age of 8 (Evren, 2010). However, according to SAD report, 75% of individual symptoms arise between ages of 8-15 (Stein, Walker & Forde, 1996). On the contrary, recent studies suggest that 50% of adults do no recognize shyness as a trait in their childhood (Stein, 2008). Common consequence of SAD on early onset eventually result with refusal of school and problems with peer relations (Kroenke, et. al., 2004). From another aspect, occurance of SAD in particular, might be related to family heritability according to family studies (Rapee & Spence, 2004). According to same study first degree relative sharing the same distinction with individual who suffers from SAD which suggest that predispositional influence of anxiety. However, in respect of cognitive models of anxiety temperamental trait, in other words behavioral inhibition commonly concerned as a factor (Stein, 2008: Becker, Henin et. al., 2007). This suggest that influence of inhibition during childhood might be a factor in development of psychopathology as well as vulnerability to anxiety due to predispositions.1.2.2 Epidemiology. Overall prevalence of SAD, approximately rated around 12% which makes SAD fourth prevalent disorder of psychological disorders (Kessler, 2005). SAD reports that include (Iuancu et. al., 2006). Epidemiological reports indicated that, women reported higher approximating the ratio of 3:2 (Furmark, 2002). Prevalence rates are similar across cultures and can vary due to methodological issues and cultural differences since manifestation of anxiety occurs differently across nations (APA, 2013; Rapee & Spence, 2004). Welfare of SAD individuals associate with significantly low social functioning including, academic, occupational, interpersonal impairments (Furmark, 2002). Which subsequently result with higher financial cost and reduced health quality (Stein, 2005). In consideration of chronicity of disorder, it appears as a lifelong and quality reducing if left untreated. Despite, the dysfunctional characterization and psychological distress experienced, only about half of the SAD population seek for treatment (Stein, 2008). 1.3 Uncertainty IntolarenceDugas and Robichaud (2007) described uncertainty intolarence as “a dispositional characteristic resulting from negative beliefs about uncertainty and its implications” (p. 24). High levels of uncertainty intolarence shapes on how individual perceive ambigous, uncertain situations that are usually more catastrophic in individuals perspective (Korener & Dugas, 2006). UI has been stated as cue factor to stress, worry and rumination which can create panic sensation in the individual that functions as lower order factor for higher order constructs (Dugas, Gossellin & Ladouceur, 2001). In perspective of SAD individual, distress caused by uncertainty is often account for interference with social interaction and social avoidance (Carleton, 2010). Level of distress caused by uncertainty eventually inhibits the fear of negative evaluation for individual which later on associate with sense of worry, fear and rumination (Yook, Kim & Suh, 2010). Although the effect occur based on fear of negative evaluation recent findings suggest that fear of positive evaluation is also effective in development of uncertainty intolerance (Carleton, 2010). Uncertainty intolerance divides into two dimensions according to factor structure studies; prospective UI and inhibitory UI (e.g., Bryne, Hunt, & Cheng, 2015; Carleton, Norton, & Asmundson, 2007; Hong & Lee, 2015; McEvoy & Mahoney, 2011). Prospective UI refers to fear and anxiety based on future uncertainty that is essentially reflects to cognitive aspect of UI (Carleton et al., 2012).. Whereas, inhibitory UI refers to experienced uncertainty that considered to be behavioral aspect (Carleton et al., 2012).1.3.1 Uncertainty Intolarence and Maintainance of Social Anxiety. Although, intolarence of uncertainty findings lacking in understanding the origins, its behavioral and cognitive consequences that are related with uncertainty intolarence are known. Previous studies suggested that individual held intolarence of uncertainty due to positive beliefs about handling the situation with avoidance, however recent findings of UI-SAD relationship have been shown that, it is not directly linked with just positive beliefs (Ladouceur, Blais, Freeston & Dugas, 1998; Francis, Dugas, 2003). According to Dugas and Francis (2003), acknowledgment of positive beliefs are more broader and complicated. Therefore they stated five specific positive belief(motivation, control over negative events, superstitious, problem solver, personal trait) about worry that is believed to benefit individual. 1.4 Safety BehaviorSafety behavior is the projection of uncertainty intolerance towards the situation and even though, it is the outcome of uncertainty, there is still a gap in literature. Cognitive behavioral models suggest that expectation of humiliation and embarrassment directly associate with negative outcome (Rapee, Heimberg, 1997). Such that, even presence of physiological symptoms contribute in increase of uncertainty, subsequently safety behavior (Rapee, Heimberg, 1998). Occurance of safety behavior may involve, threats for individual. Given the role of worry in UI, it is essentially linked with external stress caused by threat condition (Oglesby, Schimidt, 2017).. Such conditions consist of negative or positive traits regarding the uncertainty level of situation These threats might not be a danger for the self but pursue the neuroticism (Oglesby, Schimidt, 2017).1.4.1 Safety Behavior Social Anxiety Relationsip. Safety behavior as its directly accounted by UI, shows that safety behavior especially in high social threat serves as an defense mechanism to the self. In fact, in variety of situations, safety behavior have been performed to avoid social anxiety by high uncertainty intolerant individuals (McManus, Sacadura, & Clark, 2008). Therefore, its unique contribution to comforting the individual, who sense intense distress and anxiety, is likely to be seen as positive rather negative (Freeman, Garety,1999.). The perception towards safety behavior eventually become associated with relief, therefore it plays as a key factor in maintenance of social anxiety (McManus, Sacadura, & Clark, 2008). Moreover, findings of Luhmann and colleagues (2011) indicates that individual may initiate in safety behavior to minimize spent time in uncertainty. Thus another study have been shown that, high UI people may engage in more probabilistic decision making rather than gathering more information before taking the decision (Bensi & Guisberti, 2007). 2.0 Current InvestigationCurrent study purpose is to adress effect of uncertainty intolerance on safety behavior seeking and its mediation with social anxiety among Turkish college students aged between 18-25. 2.1 HypothesesParticipants with high intolarence of uncertainty would significantly rate higher in safety behavior seeking.Inhibitory uncertainty intolerance would rate higher in social anxiety compared to prospective uncertainty intolerance.Social anxiety would mediate the relationship between uncertainty intolarence and safety behavior.MethodsParticipants Sample will consist university students aged between 18-25 who are randomly assigned and are willing to participate in this study. Following participants will complete the task through computerized surveys. ProcedureParticipants will be informed that the current study was designed to assess uncertainty intolerance and safety behavior with a brief investigation purpose. However, social anxiety component of study will not be included to informed consent, to assess the initial reaction. Upon reading and accepting the terms, participants will be redirected to self-reported measures.MaterialsMeasures will include, in following order, demographic questionnaire (e.g., gender, age, education) as well as the standardized scales: Intolerance of Uncertainty Scale-Short Form (IUS-12; Carleton, Norton, & Asmundson, 2007); Brief Fear of Negative Evaluation Scale–Straightforward Items (BFNE-S; Leary, 1983); Social Interaction Phobia Scale (SIPS; Carleton, Collimore, Asmundson, McCabe, Rowa, & Antony, 2009). Self Report Measures. Intolarence of Uncertainty Scale-Short Form (IUS-12; Carleton, Norton, & Asmundson, 2007). The IUS-12 is a form of shorter scale that contains 12 item, originally created as 27 item (Freeston, Rhéaume, Letarte, Dugas, & Ladouceur, 1994), Purpose of this scale is to assess responses to ambiguity, uncertainty and the forecast of responses (Carleton, et al., 2007). Items include 2 dimension of uncertainty; inhibitory IU, prospective IU, which are strongly correlate with original IUS-27 (rs = .94 to .96), likewise internal consistency and validity (Carleton, et al., 2007). Examples include “I should be able to organize everything in advance”, “When it’s time to act, uncertainty paralyses me”. Items are evaluated on 5-point likert scale, ranging from 1 to 5 indicating the intolerance of uncertainty in basis of acknowledgement of the characteristics. Such as; 1 “not at all characteristic of me”, 5 “entirely characteristic of me”.Brief Fear of Negative Evaluation Scale–Straightforward Items (BFNE-S; Leary, 1983). The BFNE-S is a 8-item scale, which is shorter version of Brief Fear of Negative Evaluation Scale (BFNE; Leary, 1983). Scale is intended to assess level of distress and concern of individuals by the idea of negatively evaluation of others. Such as, “I am worried people will think my behavior odd”, “I worry I’ll lose control of myself in front of other people”. Based on the analyses of Carleton and colleagues (2011), BFNE-S demonstrated high internal consistency (? > .92), which appears to be more reliable and valid for indication of fear of negative evaluation (Rodebaugh et al., 2004).Social Interaction Phobia Scale (SIPS; Carleton et al., 2009). SIPS measure consists of 14 item, that assess social anxiety symptoms in 3 dimension; fear of evaluation, fear attracting attention, and interaction anxiety. Items are designed to respond in 5-point likert scale, ranging from 0 (least) to 5 (most) with a cut-off score of 21 which indicate clinically significance of social distress (Carleton et al., 2009). SIPS showed good internal consistency (? = .94) validity and test-retest reliability (rs. ranging from .74 to .76) across samples (Carleton et al., 2009; McCabe, et. al., 2010). ResultsAccording to presented findings on intolerance of uncertainty and threat conditions, it is expected that participants who are high on uncertainty intolerance would rate higher in safety behavior. Since Social Interaction Phobia Scale indicates the clinically significant distress due to cut-off score, mediation with social anxiety will also appear as significant among participants who are high on uncertainty intolerance. In addition female participants may also show more social distress as it is discussed previously. Moreover, participants who showed significant social anxiety is also expected to correlate with specifically inhibitory intolerance rather prospective, due to suggestion that population may not be in such socially phobic state.
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