Emotional and interpersonal mechanisms in community SSRI treatment of social anxiety disorder

Emotional and interpersonal mechanisms in community SSRI treatment of social anxiety disorder

J Psychiatry Neurosci 2021;46(1):E56-E64 | PDF | Appendix

Lance M. Rappaport, PhD; Michael D. Hunter, PhD; Jennifer J. Russell, PhD; Gilbert Pinard, MD; Pierre Bleau, MD; D.S. Moskowitz, PhD

Background: Affective and interpersonal behavioural patterns characteristic of social anxiety disorder show improvement during treatment with serotonin agonists (e.g., selective serotonin reuptake inhibitors), commonly used in the treatment of social anxiety disorder. The present study sought to establish whether, during community psychopharmacological treatment of social anxiety disorder, changes in positive or negative affect and agreeable or quarrelsome behaviour mediate improvement in social anxiety symptom severity or follow from it.

Methods: Adults diagnosed with social anxiety disorder (n = 48) recorded their interpersonal behaviour and affect naturalistically in an event-contingent recording procedure for 1-week periods before and during the first 4 months of treatment with paroxetine. Participants and treating psychiatrists assessed the severity of social anxiety symptoms monthly. A multivariate latent change score framework examined temporally lagged associations of change in affect and interpersonal behaviour with change in social anxiety symptom severity.

Results: Elevated agreeable behaviour and positive affect predicted greater subsequent reduction in social anxiety symptom severity over the following month of treatment. Elevated negative affect, but not quarrelsome behaviour, predicted less subsequent reduction in symptom severity.

Limitations: Limitations included limited assessment of extreme behaviour (e.g., violence) that may have precluded examining the efficacy of paroxetine because of the lack of a placebo control group.

Conclusion: The present study suggests that interpersonal behaviour and affect may be putative mechanisms of action for serotonergic treatment of social anxiety disorder. Prosocial behaviour and positive affect increase during serotonergic treatment of social anxiety disorder. Specifically, modulating agreeable behaviour, positive affect and negative affect in individuals’ daily lives may partially explain and refine clinical intervention.


Submitted Sep. 30, 2019; Revised Apr. 4, 2020; Accepted Apr. 6, 2020; Early-released Oct. 7, 2020

Affiliations: From the Department of Psychology, University of Windsor, Windsor, Ont., Canada (Rappaport); the Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA (Rappaport); the Department of Psychology, McGill University, Montreal, Que., Canada (Rappaport, Russell, Moskowitz); the School of Psychology, Georgia Institute of Technology, Atlanta, GA, USA (Hunter); and the Department of Psychiatry, McGill University, Montreal, Que., Canada (Russell, Pinard, Bleau).

Funding: The research was partially supported by a grant from the National Institute of Mental Health (T32MH020030) and a grant from GlaxoSmithKline, who was not authorized to review the findings or manuscript, or to comment on publication as per the policy of McGill University.

Data sharing: The data that support the findings of this study are available from the corresponding author upon reasonable request.

Competing interests: None declared.

Contributors: J. Russell, G. Pinard, P. Bleau and D. Moskowitz initially designed the study and acquired the data. L. Rappaport designed the present study as a secondary analysis of previously collected data and conducted planned analyses with M. Hunter. L. Rappaport, M. Hunter and D. Moskowitz wrote the article, which all authors reviewed. All authors approved the final version to be published and can certify that no other individuals not listed as authors have made substantial contributions to the paper.

Content licence: This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4.0) licence, which permits use, distribution and reproduction in any medium, provided that the original publication is properly cited, the use is non-commercial (i.e. research or educational use), and no modifications or adaptations are made. See: https://creativecommons.org/licenses/by-nc-nd/4.0/

DOI: 10.1503/jpn.190164

Correspondence to: L. Rappaport, Department of Psychology, University of Windsor, 401 Sunset Ave., Windsor, ON, N9B 3P4; lance.rappaport@uwindsor.ca