J Psychopathol Behav Assess (2011) 33:6978 DOI 10.

1007/s10862-010-9199-0

Emotional Intelligence in Social Phobia and Other Anxiety Disorders

Laura J. Summerfeldt & Patricia H. Kloosterman & Martin M. Antony & Randi E. McCabe & James D. A. Parker

Published online: 3 August 2010 # Springer Science+Business Media, LLC 2010

Abstract This study examined the associations between clinical anxiety, domains of emotional intelligence (EI), and three clinician-rated indices of maladjustment. Of key interest was whether social phobia (SP) is unique among anxiety disorders in being characterized by lower levels of Interpersonal and, particularly, Intrapersonal EI, and whether these differentially predict maladjustment. Individuals with SP (n=169) obsessive-compulsive disorder (n=65) and panic disorder (n=64), and nonclinical controls (n=169) completed the short form self-report Emotional Quotient Inventory (EQ-i: S). All anxiety disorder groups showed lower total EI than controls, and differed among themselves with the SP group displaying the lowest levels of total EI and lower scores on two EQ-i:S subscales (Interpersonal and, more robustly, Intrapersonal). The Intrapersonal dimension alone predicted all indices of greater maladjustment in

the SP group. These findings indicate a negative relationship between anxiety disorders and EI, and reaffirm the foremost link between Intrapersonal EI and SP and its functional outcomes. Keywords Emotional intelligence . Anxiety disorder . Social phobia . Adjustment . Comorbidity Emotional intelligence (EI) can be conceptualized as a set of abilities and traits related to efficaciously perceiving, expressing, understanding, utilizing, and managing emotions in oneself and others (Austin et al. 2008; Mayer et al. 2008). Discussions of the EI construct often allude to its potential clinical utility. However, these commonly cite findings from research on constructs having conceptual overlap with EI as surprisingly little empirical literature exists on EI in adult clinical populations (Parker 2005). Clearly the topic warrants additional research, and this may be particularly true for certain conditions. One of these is social phobia (SP), also known as social anxiety disorder. SP is characterized by clinically significant anxiety provoked by exposure to certain types of social or performance situations, often leading to avoidance behavior (American Psychiatric Association 2000, p. 393). A defining theme is therefore ones ability to manage the behavioral and emotional aspects of interacting with others. The EI construct embodies the interpersonal and intrapersonal (i.e., emotional self-regulatory) competencies essential to this ability. Difficulties with interpersonal competencies, for example, are evidenced by the self and other-ratings of impairment in social skills often found to be correlated with high levels of social anxiety (e.g., Creed and Funder 1998; Fydrich et al. 1998; Stangier et al. 2006; see also Vertue 2003). Whether self-reports reflect actual deficits or biased misperceptions thereof is a matter of

L. J. Summerfeldt (*) : P. H. Kloosterman : J. D. A. Parker Department of Psychology, Trent University, Peterborough, Ontario, Canada K9J 7B8 e-mail: lsummerfeldt@trentu.ca L. J. Summerfeldt : M. M. Antony : R. E. McCabe Anxiety Treatment and Research Centre, St. Josephs Healthcare & Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada P. H. Kloosterman Department of Psychology, Queens University, Kingston, Ontario, Canada M. M. Antony Department of Psychology, Ryerson University, Toronto, Ontario, Canada

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debate. Cognitive approaches to SP maintain that they arise from problematic beliefs about otherwise intact social skills, with distorted appraisals leading to inaccurate judgements of ones own and others social behaviors (see Beck et al. 2005; Cartwright-Hatton et al. 2005; Clark and Wells 1995; Hofmann and Scepkowski 2006; Rapee and Heimberg 1997). Though differing in their basis in fact, actual versus self-perceived deficits may have comparable impacts on functioning. Both may ultimately lead to disruptive levels of situational distress, poor processing of social cues, the appearance of social ineptness, and negative evaluation by others (Turk et al. 2008). Intrapersonal competencies, the other key component of EI, represent the facility with which the individual manages and utilizes his or her own emotional states. Such self-regulatory failures as excessive self-focus, anxiety over ones anticipated emotional responses, and inaccurate appraisals of ones displays of emotion figure prominently in cognitive appraisal models of social anxiety (Clark and Wells 1995; Rapee and Heimberg 1997; Stopa and Clark 1993; see also Hofmann 2000). In the words of Creed and Funder (1998), social anxiety is a trait with negative inter and intrapersonal consequences (p. 31). As such, the EI construct may be potentially useful in research on social anxiety, and may aid with theory knitting (see Kalmar and Sternberg 1988) by uniting attributes and processes often captured in diverse ways by different researchers and theorists. As an individual differences variable conceptualized as non-specific to situational context (i.e., how one behaves typically) and emotional valence (i.e., not just regarding negative or pathological emotions), it also offers opportunities for understanding continuities and discontinuities across clinical and nonclinical populations. In one of only two existing published studies of the associations among EI, social anxiety and adjustment, our group found that EI, as measured by the short version of the self-report Emotional Quotient Inventory (EQ-i:S; Bar-On 1997), was strongly negatively related to social interaction anxiety in a nonclinical sample (Summerfeldt et al. 2006). EI was the foremost predictor of interpersonal adjustment, accounting for most of its association with social interaction anxiety. This was chiefly due to the strong correlations between social interaction anxiety and the interpersonal and, particularly, intrapersonal domains of EI. In the EQ-i: S, the latter comprises emotional self-awareness and expression, as well as the ability to use emotions in thought. Partly consistent results were found in a subsequent study of EI and clinical social anxiety, which ascertained EI using a performance measure rather than self-report. Jacobs et al. (2008), used the Mayor-SaloveyCaruso Emotional Intelligence Test (MSCEIT; Mayer et al. 2001) to compare individuals with social phobia (n=28) to

nonclinical controls. Though the two groups did not differ on any EI domains, a strong negative correlation was found between severity of social anxiety and Experiential EI, or basic-level emotional processing involving the abilities to perceive ones own and others emotions and to use emotions in communication and thought. The two studies findings are somewhat difficult to compare, as ones operationalization differentiates the locus of EI (i.e., Interpersonal versus Intrapersonal) and the others emphasizes levels of processing across loci. Nonetheless both studies findings are in line with cognitive models of social anxiety that include the perpetuating roles played by problematic appraisals of ones own emotional state (Clark and Wells 1995; Rapee and Heimberg 1997; Wells 1997). The study by Summerfeldt et al. (2006) pointed to the potential utility of the EI construct in research on social anxiety and suggested hypotheses for further study, but had some notable limitations. Firstly, the research was done with a nonclinical sample. It is unclear to what extent these findings generalize to the clinical population, and if so, whether the relationships between social anxiety and the interpersonal and intrapersonal facets of EI have specificity or are true of anxiety conditions in general. To date there has been no research published on the topic of EI across the anxiety disorders. However, research with conceptually similar constructs, such as emotional self-awareness (Novick-Kline et al. 2005), and alexithymia (e.g., Cox et al. 1995; Fukunishi et al. 1997; Turk et al. 2005) suggests that difficulties with monitoring, identifying, and using emotional information may characterize anxiety disorders other than SP. An additional and more fundamental limitation of our previous study was its exclusive reliance on self-report data. The study had several methodological strengths: it used data from a large multi-cohort sample, permitting approximation of population values, and operationalized the constructs as latent variables, thus optimizing the reliability of the findings. Nonetheless, all variables used in the analyses were assessed by Likert-style questionnaires, completed at a single session by a sole informant. The possibility cannot therefore be ruled out that some results may have reflected the influence of measurement variance or systematic response bias, whereby individuals answering in a negative or positive direction on one measure did so on others for reasons other than the valid correlation of the constructs being measured. These often influence responses to personality questionnaires, and can be accentuated when psychopathology variables are included (see Furnham 1986). Multiple factors may contribute, including response sets, impressionistic global responding, or the systematic influence at the time of reporting of such fluctuating variables as state affect or current stress (Paulhus 1991; Podsakoff et al. 2003). Whatever the source, the

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absence of (a) a mixed method of data collection (e.g., interview and self-report questionnaire); (b) a buffering time interval between ascertainment of key variables; or (c) an objective source of information about, for example, functional outcomes or symptoms of social anxiety, limited the conclusions that could be drawn from the empirical relationships observed by Summerfeldt et al. (2006). The present study sought to further examine the relationship between social anxiety, EI, and functional outcomes while addressing these limitations. In order to determine the generalizability of our previously reported findings and their specificity to social anxiety, data were collected with samples of individuals with one of three clinical anxiety disorders: SP, obsessive-compulsive disorder, and panic disorder, as well as with a community sampled nonclinical control group. To minimize the influence of measurement variance and response biases, only EI was assessed using self-report questionnaire; all other variables were ascertained by carefully conducted diagnostic interview, with interview and questionnaire completed at different times. The metrics employed for the two key variables were also different: EI scores were measured continuously whereas social anxiety was operationalized as a categorical diagnostic variable. Finally, the indices of maladjustment used for comparisons among the clinical groupsDSM-IVTR Axis V Global Assessment of Functioning scores, and number of current and lifetime co-occurring disorderswere objective and interviewer rated. Based on findings reported in Summerfeldt et al. (2006), we hypothesized that interpersonal and intrapersonal EI scores would differentiate the clinical and control groups, with the greatest contrast seen for the SP group, as well as predict maladjustment in the SP group.

as a principal diagnosis (i.e., of equal severity), and (b) for those in the PD and OCD groups, having a current or lifetime additional diagnosis of SP. Diagnostic Interviews were conducted by psychologists, postdoctoral fellows, and senior graduate students, all of whom received extensive training and supervision in the SCID-IV. To ensure that diagnostic criteria were being applied consistently, the results of each interview for this study were presented at a weekly team meeting chaired by a psychologist with more than 10 years of experience in training others to administer the SCID-IV. At the meeting, diagnostic questions and responses were reviewed, and a consensus diagnosis was reached. When multiple disorders were present, a diagnosis was considered principal if it caused the most distress and/or impairment. Clinical participants completed the EQ-i:S as part of their initial assessment along with other questionnaires not relevant to the present study, and consented to the use of assessment data for research purposes. Questionnaires were completed approximately 1 week prior to a scheduled diagnostic interview. The nonclinical control group consisted of a convenience sample of 169 community sampled volunteers (50% female, mean age = 34.4111.44), case-matched by age and gender to those in the SP group. These participants were recruited by advertisements posted in the community seeking participants for research on emotions and personality. They received no monetary compensation, and completed the EQi:S in their own homes under the supervision of one of several research assistants. Community sample participants were not screened for current or past mental disorder diagnoses. Measures

Method Participants Clinical participants were 298 individuals sequentially presenting for assessment at an outpatient anxiety clinic, whose principal diagnosis met criteria for one of three categories of anxiety disorder: obsessive-compulsive disorder (OCD; n=65, 77% female, mean age = 34.6912.34), panic disorder with or without agoraphobia (PD; n=64, 75% female, mean age = 37.3111.22), or SP (n=169, 50% female, mean age = 34.4111.44) in accordance with the fourth edition of the Diagnostic and Statistical Manual (DSM-IV-TR; American Psychiatric Association 2000) and assessed using the Structured Clinical Interview for DSMIV (SCID; First et al. 1996). Exclusion criteria included the following: (a) having more than one of the target disorders

Structured Clinical Interview for DSM-IV (SCID-IV) The SCID-IV (Research Version with Psychotic Screen; First et al. 1996) was used for all diagnoses with clinical participants. This semi-structured interview provides comprehensive coverage of DSM-IV-TR Axis I disorders, with the exception of psychotic disorders for which screening questions are provided. The SCID-IV was also used to assess clinical participants scores on DSM-IVTR Axis V, the Global Assessment of Functioning Scale (GAF), which provides a global score of 1100 representing the individuals overall psychological, social, and occupational adjustment. The SCID-IV has strong psychometric qualities and is the most widely used diagnostic interview in North American research (Summerfeldt and Antony 2002). Earlier versions of the SCID have been found to have good inter-rater reliability for all diagnoses (kappa range: .691.0; Zanarini and Frankenburg 2001).

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Bar-On Emotional Quotient Inventory: Short (EQ-i:S) The EQ-i:S (Bar-On 2002) is a 51-item self-report measure derived from the 133-item Bar-On Emotional Quotient Inventory (EQ-i; Bar-On 1997) to assess the core features of EI. It has four composite scales. The Intrapersonal subscale measures how well one understands, recognizes, and expresses ones own emotions (e.g., Its hard for me to describe my feelings). Items on the Interpersonal subscale tap the ability to relate to, empathize with, and identify the emotions of, other people (e.g., Im good at understanding the way other people feel). The Adaptability subscale measures ones ability to adapt to changing demands and use emotions to facilitate problem solving (e.g., My approach in overcoming difficulties is to move step by step). The final subscale, Stress Management, assesses the ability to regulate strong negative emotions and control impulses (e.g., I believe that I can stay on top of tough situations). The scales on this short form correlate highly with their corresponding scales on the long form (EQ-i), ranging from 0.73 to 0.96 for men and from 0.75 to 0.97 for women (Bar-On 2002). Respondents are asked to rate how a statement describes them using a five-point Likert rating scale (1 = very seldom true of me; 5 = very often true of me). The EQ-i:S subscales and total scale possess good reliability (e.g., five-month total test-retests between .58 and .70; subscale alphas between .76 and .84), and display strong factorial and discriminant (Bar-On 2002), predictive (Parker et al. 2004), convergent (Parker et al. 2001) and divergent (Wood et al. 2009) validities.

diagnostic group (three anxiety disorder groups and nonclinical controls) as the independent variable.2 The omnibus effect was significant, F (3,463)=71.43, p<.001, 2 =.32. Post hoc Newman-Keuls tests showed that all three diagnostic groups scored significantly (p<.05) lower than the nonclinical control group on total EQ-I:S. The only differences observed among the clinical groups were for the SP group, which displayed a significantly lower mean total score than did both the PD and OCD groups (see Table 1). In order to examine group effects at the subscale level, four univariate ANOVAs were conducted, with a Bonferroni adjustment of =.013. There were significant effects of group for all subscales: Interpersonal, F (3, 463)= 21.31, 2 =.12, Intrapersonal, F (3, 463)=68.78, 2 =.31, Adaptability, F (3, 463)=19.84, 2 =.11, and Stress, F (3, 463)=38.63, 2 =.20, p<.00001 in all cases. As shown in Table 1, Post-hoc Newman-Keuls comparisons showed that all three diagnostic groups scored significantly lower than the nonclinical control group on the EQ-I:S Intrapersonal, Adaptability, and Stress subscales. Only the SP group scored significantly lower than the nonclinical control group on the Interpersonal subscale. The SP group scored significantly lower than the PD and the OCD groups on both the Interpersonal and Intrapersonal subscales, but not on the Adaptability and Stress subscales. No differences were found between the PD and OCD groups.3 Predicting Impairment: Past Year Functioning We sought to determine whether the EQ-I:S Intrapersonal and Interpersonal subscalesfound to distinguish the SP group from the other clinical groupsalso contributed to any differences among these groups in highest level of overall functioning in the past year. In order to increase power, the PD and OCD group data were combined into a
2 Levenes test showed homogeneity of variances across the four groups for the EQ-i:S total score and all subscales. 3 To rule out the possibility that differences between the SP group and the other two clinical groups Intrapersonal and Interpersonal EQ-I:S scores were due to state negative affect at time of self-report, analyses were conducted with data from a majority subset (74%, n=218) of clinical participants that had completed the short Depression Anxiety and Stress Scale (DASS-21; Lovibond and Lovibond 1995) at the same time as the EQ-I:S. The DASS21 is a measure of current (last week) state affect, and its Depression and Anxiety subscales display sound psychometric properties in clinical anxiety samples (Antony et al. 1998a). We compared the three clinical groups scores on the two EQ-I:S subscales, with DASS Anxiety and Depression subscale scores entered simultaneously as covariates. With the state affect variables controlled for, differences between the groups remained significant for both Interpersonal, F (2, 213)=6.20, p < .01 [DASS Depression =.41, t (213)=4.94, p<.0001, Anxiety =.10, t (213)=1.22, n.s.] and Intrapersonal EQ-I:S scores F (2, 213)=9.43, p<.0001 [DASS Depression =.42, t (213)=5.46, p<.0001, Anxiety =.06, t (213)=.82, n.s.].

Results Group means and standard deviations for the EQ-i:S total and four subscales are shown in Table 1. All EQ-i:S subscales showed satisfactory internal reliability, with Cronbachs alphas for clinical participant data ranging from .81 for the Intrapersonal subscale to .85 for the Adaptability subscale. Similar values were observed for the nonclinical control group, with the exception of the Adaptability subscale, with an alpha of .71.1 Group Comparisons An initial analysis of variance (ANOVA) was performed, with EQ-i:S total score as the dependent variable and
1 This is consistent with community sample psychometric data reported in the EQ-i:S manual, wherein alpha coefficients for the Adaptability subscale are the lowest for each age group for men, and tie for lowest for most age-groups in women.

J Psychopathol Behav Assess (2011) 33:6978 Table 1 Means and standard deviations for emotional quotient inventory: short (EQ-i:S) scores across diagnostic group PD panic disorder with or without agoraphobia, SP social phobia, OCD obsessive-compulsive disorder, NC nonclinical. Means in the same row sharing superscripts do not differ at p<.05 in the Neuman-Keuls comparison EQ-i:S scale Group PD (n=64) Total Interpersonal Intrapersonal Adaptability Stress 130.3920.21a 41.085.11a 32.838.45a 24.365.94a 32.137.91a SP (n=169) 116.7919.72 37.017.10 26.678.00 23.596.17a 29.528.07a OCD (n=65) 127.8818.99a 40.435.83a 32.188.39a 23.955.20a 31.317.44a

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NC controls (n=169) 146.3116.64 42.065.11a 38.626.61 27.784.20 37.856.22

single other anxiety disorder group (n=129), which was then compared with the SP group.4 An ANOVA with diagnostic group as the independent variable and past-year GAF score as the outcome variable was significant, F (1,207)=4.54, p<.05, 2 =.02, reflecting the lower mean GAF score for the SP group (54.887.65) than for the other anxiety disorders groups (57.228.10). In order to determine whether either the Intrapersonal or Interpersonal EI variables contributed to this difference, the analysis was conducted a second time with these two EQ-I:S subscales entered simultaneously as covariates.5 The two variables were correlated at r=.40 (p<.0001). When they were controlled for, the difference between groups in past-year GAF score was no longer significant, F (1,205)=.13; n.s. Results for the covariates showed a significant effect for the Intrapersonal variable, =.31, t (205)=4.49, p<.00001, but not the interpersonal variable, =.10, t (205)=1.47, n.s. Thus, the significantly lower level of past year functioning observed in the SP group compared to the other anxiety disorders group was entirely accounted for by differences in Intrapersonal EQ-I:S scores, with the Intrapersonal variable acting as a positive predictor of past year GAF score. Predicting Impairment: Current and Lifetime Comorbidity In order to determine whether the Intrapersonal and Interpersonal subscales contributed to any group differences in either current or lifetime comorbidity rates, two sets of
4 Current (past month) GAF rating is conventionally used at our site, but for the present studys purposes it was considered less meaningful than a rating of the individuals highest level of functioning in the past yearan indicator of impairment conceivably less influenced by week-to-week fluctuations in symptoms and life events. However, past year GAF ratings were not assigned for the full duration of the data collection, thus sample sizes were reduced for analyses with the GAF (SP group n=121; other anxiety group n=88). As there was no difference between the PD (n=39) and OCD (n=49) groups in pastyear GAF rating [t (86)=.33, p=n.s.], and there were no research questions about differences among SP and these specific diagnoses, their merger into a composite other anxiety disorders group seemed sensible for this and subsequent analyses. The control group was not included in these analyses as they were not administered the SCID-IV. 5 Tests of parallelism showed homogeneity of regression to be achieved across diagnostic groups for intrapersonal and Interpersonal subscale scores for all outcome variables analyzed with ANCOVA.

analyses using ANOVA were conducted again comparing the SP group to the composite other anxiety disorder group. The first analysis, with number of current additional diagnoses (i.e., other than the principal diagnosis) as the outcome variable, was significant, F (1,296)=19.31, p <.00001, 2 =.06, reflecting the greater mean number of additional diagnoses in the SP group (2.051.59) than in the other anxiety disorders group (1.291.36).6 To determine whether Intrapersonal or interpersonal EI contributed to this difference, the analysis was conducted a second time as an analysis of covariance (ANCOVA), with these EQ-I:S subscales entered simultaneously as covariates. With the two variables controlled for, the difference between groups in current comorbidity rates was diminished but remained significant, F (1, 294)=9.11, p<.005, 2 =.03. Results for the covariates showed a significant effect for the Intrapersonal variable, =.24, t (294)=3.93, p<.0001, but not the interpersonal variable, =.05, t (294)=.76, n.s.. The second analysis, with number of lifetime additional diagnoses as the outcome variable, also showed a significant difference between the two groups, F (1,296)=15.74, p<.0001, 2 =.05, with a greater number seen in the SP group (2.421.64) than in the other anxiety disorders group (1.681.52). When this analysis was conducted a second time with the Intrapersonal and Interpersonal subscales entered simultaneously as covariates the difference between groups was diminished but remained significant, F (1, 294)=7.49, p<.01, 2 =.02. Results for the covariates showed a significant effect for the Intrapersonal variable, =.22, t (294)=3.72, p<.0005, but not the interpersonal variable, =.06, t (294)=.97, p=n.s.. Thus, the significantly greater numbers of both current and lifetime comorbid disorders observed in the SP group compared to the other anxiety disorders group were partly accounted for by
Current and lifetime comorbidity counts are ordinal data, and the distributions for both were positively skewed for both groups. Given the large sample sizes and the fact that the skew and spread was comparable across groups, both ANOVA and ANCOVA can be expected to be robust to violations of the assumptions of normality and homogeneity of variance (Tabachnick and Fidell 1996). As a further check, Levenes tests confirmed homogeneity of variance across groups for both comorbidity outcomes, and nonparametric Kruskal-Wallis ANOVAs confirmed the ANOVA results.
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differences in Intrapersonal EQ-I:S scores, with lower scores associated with higher rates of both types of comorbidity. A final analysis was performed in order to determine to what extent the difference observed between the SP and other anxiety disorder group in level of past year functioning was accounted for by differences in current (i.e., past year) comorbidity rates, and whether the Intrapersonal EI variable contributed to the difference above-and-beyond the effect of comorbidity. This issue was investigated with a single ANCOVA, with past-year GAF score as the outcome variable, diagnostic group (SP, other anxiety disorder group) as the independent variable, and number of current additional diagnoses and the Intrapersonal EQ-i:S subscale score as covariates. When these two variables were controlled for, the difference between groups was not significant, F (1,205)=.39, p=n.s. Results for the covariates showed significant effects for both the current additional diagnoses variable, =.19, t (205)=2.85, p<.005, and the intrapersonal variable, =.31, t (205)=4.69, p<.00001. Thus, Intrapersonal EI remained a significant predictor of the lower past year functioning observed in the SP group compared to the other anxiety disorders group, even when group differences in current comorbidity rates were taken into account.

Discussion This study sought to expand upon and address limitations of existing research by examining the associations between clinical anxiety, domains of EI, and three indices of maladjustment: GAF ratings and current and lifetime comorbidities. Of particular interest was whether SP is unique among the three anxiety disorders examined in being characterized by lower levels of Interpersonal and Intrapersonal EI, and whether these variables predict differences among the anxiety groups in levels of maladjustment. Partial support was found for the hypotheses related to the Interpersonal EI domain. Although the SP group did show significantly lower Interpersonal EI scores than did both other diagnostic groups, contrary to expectation, the SP group was alone among the diagnostic groups in having lower scores than nonclinical controls. In contrast, all diagnostic groups scored lower than nonclinical controls on the Intrapersonal EI domain, with, as predicted, the greatest contrast found for the SP group. Intrapersonal EI scores also differentiated the SP group from the other diagnostic groups, and, unlike Interpersonal EI scores, were found to predict all indices of greater maladjustment in the SP group. These findings, which reaffirm earlier ones with a nonclinical sample (Summerfeldt et al. 2006), allow us to make conclusions more confidently about the importance in SP of competencies related to the understanding of

emotions in self, more so than the interpersonal ones implicit in the disorders appellation. Lower scores on two EI subscalesStress Management and Adaptabilitydistinguished all anxiety groups from the nonclinical comparison group, but not from one another. These two EI variables gauge ones ability to manage and utilize emotions in challenging contexts and of the four domains of EI examined here show the greatest overlap with traditional conceptions of emotion regulation (e.g., Frijda 1986; Gross 2002). This finding, then, is consistent with a body of literature showing such abilities to be fundamental to adjustment (Mayer et al. 2004) and mental health (Kring and Werner 2004). The SP group had a lower Interpersonal EI score than did all comparison groups. This was also the only EQ-I:S subscale that did not differentiate the other anxiety disorder groups from nonclinical controls. Though these findings are noteworthy in replicating an association found with nonclinical participants (Summerfeldt et al. 2006), they are perhaps best viewed as evidence for the validity of this EQi-S subscale. It is well demonstrated that individuals with SP self-rate their social competencies as weak, often more so than do their interaction partners (e.g., Rapee and Lim 1992; Segrin and Kinney 1995; Stopa and Clark 1993). It is also noteworthy that the other anxiety groups Interpersonal EI scores were comparable to those of nonclinical controls. Although social and relational problems often accompany anxiety disorders other than SP (see Mendlowicz and Stein 2000) these likely arise from factors other than specific interpersonal deficits, such as negative affect and phobic avoidance (see Telch et al. 1995). All the anxiety disordered groups had lower Intrapersonal EI scores than did nonclinical controls, a finding consistent with the well established link between difficulties identifying and describing emotions, and disorders that involve problems in the modulation of distressing affects (see Taylor et al. 1997). However, consistent with Summerfeldt et al. (2006), intrapersonal EI emerged as an extraordinarily salient dimension of EI for the SP group. Lower intrapersonal EI scores differentiated this group from nonclinical controls and, most notably, from the other clinical anxiety groups, with an effect size for the group differences almost three times greater than that for the interpersonal EI domain. A specific link between social anxiety and inadequate awareness and comprehension of ones emotions is suggested by research on emotion regulation. In a factor analytic study with a nonclinical sample, Mennin et al. (2007) identified poor understanding, negative reactivity, and maladaptive management of emotions as sub-factors of a higher-order emotion dysregulation factor. Poor understanding and maladaptive management both predicted levels of social anxiety, but when overlap with self-

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reported GAD and major depression symptoms was controlled only poor understanding remained as a unique predictor of social anxiety. Poor understanding of emotions, however, may be further deconstructed accordingly to how purely intrapersonal, or private, is its expression. In a study of anxiety conditions and emotion in a large nonclinical sample, Turk et al. (2005) found that greater difficulty identifying emotions, but not describing them, distinguished social anxiety from GAD as well as controls. This is somewhat counter-intuitive: describing emotions, by definition, entails an interpersonal context that ought to be more negatively impacted by social anxiety (e.g., a sample item from the measure used by Turk et al. was It is difficult for me to find the right words for my feelings). Combined with the results of the present study, these findings suggest that poor self-awareness and comprehension and differentiation of ones emotions are a fundamental problem in social anxiety independent of interpersonal context. The importance of the Intrapersonal variable in our findings is underscored by its unique prediction of differences between the SP and other anxiety disorder group on all three indices of maladjustment. Our earlier research found Interpersonal and, particularly, Intrapersonal EI to be significant contributors to the strong negative relationship between social anxiety and adjustment, as measured by self-rated life satisfaction (Summerfeldt et al. 2006). Does this effect hold true for objective indicators of general functioning and life adjustment? Consistent with reports of high functional impairment in SP (e.g., Antony et al. 1998b; Schneier et al. 1994), the SP group exhibited poor past-year social and occupational adjustment relative to the other anxiety group, as ascertained by GAF scores. More notably, this difference in GAF ratings was completely accounted for by the SP groups lower Intrapersonal EI scores. The significance of adaptive functioning in GAF scores can be obscured by variance contributed by the presence of symptoms (Skodol et al. 1988). However our analyses showed that even when number of symptoms (i.e., comorbidity) was statistically accounted for, GAF differences among the diagnostic groups were still significantly impacted by Intrapersonal EI scores. In keeping with clinical population studies of anxiety disorders (e.g., Brown et al. 2001) the SP group had more current and lifetime comorbidities than their counterparts with PD and GAD. Again, Intrapersonal EI scores were a robust predictor of these differences, whereas Interpersonal EI was not. It seems sensible to consider range of comorbidity, particularly over the lifespan, as an index of general vulnerability to psychological maladjustment. If this reflected poor coping or regulation of strong emotions then one would expect differences among the clinical

groups in the Adaptability and Stress Management subscales of the EQ-I:S. However, there were no such group differences. This is congruent with Jacob et al.s (2008) finding that social anxiety severity was unrelated to Strategic EI (higher-level conscious emotional processing). Both sets of results implicate difficulties early in the process of emotion regulation (i.e., initial labelling and identifying of emotions) more than downstream efforts at repair and management (see Gross 2002; Rottenberg and Gross 2003). Given the self-report and cross-sectional nature of these data, our findings raise important questions. Are individuals with SP more likely to appraise their intrapersonal competencies as weak, in effect displaying a memory or attentional bias for negative information about the self? Some cognitive models posit a global tendency on the part of socially phobic individuals to appraise their own competencies in the worst possible light; perhaps as part of a negatively biased mental representation of how they appear to others (see Clark and Wells 1997; Turk et al 2008). However, presumably this negative bias would have led to comparably deflated scores on all EQ-i:S subscales. This was not the case. Alternatively, did these self-reports reflect actual deficits, with lower Intrapersonal EI potentially leading to an increased risk for the development of SP? More subtly, might such diminished self-reports arise from intact competencies, but a lesser confidence or propensity to apply them? Although this studys crosssectional data are not able to answer these questions, it seems unlikely that biases in self-report alone would be so predictive of the clinician-rated impairment variables. Nor would they account for the association between social anxiety severity and lower performance EI reported by Jacobs et al. (2008). Whether due to faulty appraisals or actual deficits, problems with Intrapersonal EI are associated with substantial, objectively discernable, life problems for this population. This studys findings have potential theoretical implications. Contemporary cognitive models of SP posit the perpetuating roles played by inaccurate appraisals of ones own emotional state (Clark and Wells 1995; Rapee and Heimberg 1997; Wells 1997), but usually reference emotion and situation-specific difficulties (i.e., perceptions of anxiety states in social situations). The finding that adults with SP endorse having poor abilities to comprehend and express their own emotionsoutside of a social interaction context and without reference to type of emotionsupports Summerfeldt et al.s (2006) suggestion that social anxiety is linked with more global self-perceived intrapersonal difficulties than are suggested by much existing research. If these findings are replicated, potential clinical implications include support for the value of early preventative measures that incorporate a focus on strengthening the accuracy and

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confidence with which one reads then uses ones own emotional states (see Lock and Barrett 2003), and the need in therapy to address socially anxious individuals perceptions of their abilities to access, differentiate, and express their own emotional states. Accounts of functional impairment in SP usually consider interpersonal problems to be the mediator (e.g., occupational failures may occur due to difficulties relating to others; Antony et al. 1998b), but there was no evidence of this in our data. In particular, our findings do not support the social skills deficit account of SP. A criticism of classic research on social skills in SP has been of its use of molecular behaviors (e.g., gaze duration) rather than global and dynamic competencies (e.g., general sensitivity and attunement) to operationalize interpersonal skills (see Alden and Cappe 1986; Fischetti et al. 1977; Vertue 2003). The self-rated behaviors assessed by the Interpersonal EI domain are more consistent with the latter, and though they were lower in the SP group than in all other groups, their lack of association with objective indices of maladjustment suggests that they may reflect biased appraisals and low social confidence more than actual major social skills impairments (c.f., Dannahy and Stopa 2007; Rapee and Lim 1992; Stopa and Clark 2000). Even so, cognitive models of SP maintain that even inaccurate self-appraisals of social competencies can detrimentally impact functioning (e.g.,Clark and Wells 1995). Our finding that Interpersonal EI contributed no unique variance to GAF outcomes does not support this. This study has limitations, all of which suggest directions for future research. We did not include measures of conceptually overlapping constructs such as alexithymia and emotion regulation and so cannot determine whether EI offers incremental value in accounting for differences among clinical anxiety groups. Existing research shows EI and alexithymia to be correlated but independent variables, with EI the broader concept of the two (Parker et al. 2001). Less is known about the relationship between trait EI and emotion regulation. The two constructs come from different traditions. EI is widely regarded as a multidimensional traitlike individual differences variable with cross-situational stability. Emotion regulation, in contrast, is generally conceptualized and operationalized as situation and emotion-specific (see Rottenberg and Gross 2003; Sloan and Kring 2007). The degree and nature of the relationship between the two constructs warrants research attention. Secondly, our findings with the single-item GAF provide preliminary evidence of a disorder-specific link between Intrapersonal EI and functional impairment. Use of a multidimensional measure of functioning would allow inquiry into how specific domains of impairment may be differentially related to emotional competencies and possible differences in these relationships for different anxiety

conditions (see Antony et al. 1998b). In addition, the present studys analyses were limited to those anxiety disorder diagnoses most prevalent at our site. Expanding upon this to include other anxiety diagnoses, particularly generalized anxiety disorder (see Turk et al. 2005), would be informative. Replication of our findings with diagnostically-screened nonclinical controls would address the limitations posed by our use of a community sample comparison group. Finally, the present research relied on categorical DSM-IV diagnoses to characterize participants so did not analyse potential relationships between EI domains and differing levels of severity of the anxiety conditions. Continuous measures of disorder-specific symptom severity would allow a more sensitive analysis, as would inclusion in the same analysis of participants with clinical, subclinical, and nonclinical levels of symptom severity. Although we have offered interpretations of how intrapersonal competencies may contribute to the onset and perpetuation of SP, these are inferences based on crosssectional comparisons of differences between groups of individuals with existing diagnoses. An important unresolved issue is the direction of relationship between SP and low Intrapersonal EI. Do such difficulties render people more vulnerable to SP and a host of accompanying problems, or does SP make people more likely to describe themselves in this way? Might Intrapersonal EI, as a stable trait, be detrimentally shaped by the experience of having significant social anxiety (i.e., the scar hypothesis)? A substantial literature supports the idea that Intrapersonal competencies appear early in the course of development, and are relatively stable (e.g., Lane and Schwartz 1987; Saarni 2000). Nonetheless, research on anxiety disorders and alexithymia suggests that such attributes may not only develop after the onset of psychopathology, but be specific to it (e.g., Fukunishi et al. 1997). Freyberger (1977) described l this as secondary alexithymiaa reversible state reaction to intense negative affect, like clinical anxiety. This symptom-specific interpretation of the link between Intrapersonal EI and social anxiety is not supported by Summerfeldt et al.s (2006) finding of a similar relationship in a high functioning nonclinical sample. Nonetheless, better understanding of the nature of EI in SP might be gained by prospective designs with at-risk child and youth populations, or pre and post-treatment research with adults. Such designs would also permit study of how Intrapersonal EI fits into the collection of variables thought to comprise the vulnerability profile of SP. These include dispositional constructs like behavioral inhibition (see Kimbrel 2008, for a recent review), reactivity to environmental stimuli, and emotional intensity (see Gross 2002; Rottenberg and Gross 2003). A number of questions might be asked about the pattern of relationships among Interpersonal and Intrapersonal EI and these variables, and in turn

J Psychopathol Behav Assess (2011) 33:6978

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