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What If I Appear Boring, Anxious, or Unattractive? Validation and Treatment Sensitivity of the Negative Self Portrayal Scale in Clinical Samples

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Abstract

A recently developed self-report questionnaire, the Negative Self Portrayal Scale (NSPS; Moscovitch and Huyder in Behav Ther 42:183–196. doi:10.1016/j.beth.2010.04.007, 2011) assesses concerns about appearing socially incompetent, physically unattractive, and/or visibly anxious to evaluative others. Initial validation studies of the NSPS yielded promising results but were conducted exclusively on samples of undergraduate students. Here, we aimed to replicate and extend those initial studies by examining the factor structure, construct validity, and treatment sensitivity of the NSPS in samples of community-based participants with a principal diagnosis of social anxiety disorder (SAD), a principal anxiety disorder diagnosis other than SAD, or no history of psychological problems. Results provided support for the construct validity of the NSPS within clinical samples and suggested that the types of concerns assessed by the NSPS and its subscales may be useful for predicting individual differences in emotional and behavioral symptoms of social anxiety (SA) and for conceptualizing change processes during cognitive behavioral therapy for SAD. Confirmatory factor analyses indicated that while the hypothesized three-factor model fit significantly better than an alternative one-factor model, the fit indices associated with the three-factor model were below satisfactory cutoffs, thus tempering conclusions that the best fitting structure was found and highlighting the need for additional research. Implications of these findings are discussed vis-à-vis Moscovitch’s (Cogn Behav Pract 16:123–134. doi:10.1016/j.cbpra.2008.04.002, 2009) theoretical model of SA and the potential utility of the NSPS for both clinical research and practice.

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Notes

  1. The disorder-specific treatment manuals used for the present study consisted of evidence-based CBT interventions adapted from several published CBT manuals and the scientific literature. More information about the specific treatment manuals is available upon request from the second author.

  2. For the purposes of examining the factor structure of the NSPS, sample size constraints prohibited us from conducting a multiple group CFA. Prior to conducting the CFA on the pooled data, preliminary tests revealed that NSPS scores were not significantly associated with any of the demographic variables which may have differed across the subgroups. For example, the zero-order correlation between participant age and NSPS total scores was nonsignificant, r = .10, p = .19. Univariate ANOVAs further demonstrated that neither marital status, F(5,163) = .97, p = .44, nor ethnicity, F(5,167) = 1.0, p = .42, were predictive of NSPS total scores.

  3. Equivalent results were found when the two CFA models were compared using only clinical participants (i.e., excluding the healthy controls).

  4. Given that CBT for SA is geared toward addressing the types of concerns most typical of SA (and that this is not the focus of treatment for CBT for other AC conditions), it is reasonable to expect the Time × Treatment Focus interaction to be in only one direction (and not the opposite direction). Therefore, a one-tailed test of significance was used.

  5. Examining each of the NSPS subscales separately in 2 (Time) × 2 (Treatment Focus) mixed ANOVAs revealed, interestingly, that there was a significant interaction for signs of anxiety, F(1,89) = 6.0, p = .01, η 2p  = .07 (SA group: Pretreatment Mean = 22.5; SD = 7.8; Posttreatment Mean = 17.2; SD = 7.4; AC group: Pretreatment Mean = 15.9; SD = 6.0; Posttreatment Mean = 13.5; SD = 5.6), but not for social competence [F(1,89) = 1.7, p = .19, η 2p  = .02], or for physical appearance [F(1,89) = 1.6, p = .20, η 2p  = .02]. However, the pattern of differences between group means over time for each of these subscales was consistent with expectations, such that patients who received CBT for SAD reported greater changes in NSPS concerns about social competence (SA group: Pretreatment Mean = 35.5; SD = 11.1; Posttreatment Mean = 29.9; SD = 12.8; AC group: Pretreatment Mean = 22.3; SD = 9.6; Posttreatment Mean = 19.1; SD = 9.6) and physical appearance (SA group: Pretreatment Mean = 25.0; SD = 8.8; Posttreatment Mean = 21.8; SD = 8.9; AC group: Pretreatment Mean = 16.1; SD = 7.5; Posttreatment Mean = 14.4; SD = 7.7) from pre- to post-treatment than those who received CBT for other anxiety disorders.

  6. For this reason, the items that comprise the physical appearance subscale of the NSPS were worded specifically to capture these more general SAD-relevant physical appearance concerns rather than the more focused concerns about particular physical body parts, attributes, or weight and shape, which might be more applicable to BDD and the eating disorders.

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Acknowledgments

This research was undertaken thanks to funding from the Canada Research Chairs Program and the Social Sciences and Humanities Research Council of Canada. We are grateful to Lisa Young, Maria Ierullo, and Brenda Chiang for collecting and compiling data, and to staff and patients at the Anxiety Treatment and Research Centre, whose cooperation and help were invaluable.

Conflict of Interest

David A. Moscovitch, Karen Rowa, Jeffrey R. Paulitzki, Martin M. Antony, and Randi E. McCabe declare that there have no conflicts of interest.

Informed Consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (national and institutional). Informed consent was obtained from all individual subjects participating in the study. If any identifying information is contained in the paper the following statement is also necessary. Additional informed consent was obtained from any subjects for whom identifying information appears in this paper.

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No animal studies were carried out by the authors for this article.

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Authors and Affiliations

  1. Department of Psychology and Centre for Mental Health Research, University of Waterloo, 200 University Ave. West, Waterloo, ON, N2L 3G1, Canada

    David A. Moscovitch & Jeffrey R. Paulitzki

  2. Anxiety Treatment and Research Clinic, St. Joseph’s Healthcare Hamilton, Hamilton, Canada

    Karen Rowa & Randi E. McCabe

  3. Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada

    Karen Rowa & Randi E. McCabe

  4. Department of Psychology, Ryerson University, Toronto, Canada

    Martin M. Antony

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  1. David A. Moscovitch
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Correspondence to David A. Moscovitch.

Appendix: Negative Self-Portrayal Scale (NSPS)

Appendix: Negative Self-Portrayal Scale (NSPS)

According to the scale provided below, please write the number in the blank space beside each item to indicate the degree to which you are concerned about the following aspects of yourself when you are in anxiety - provoking social situations (e.g., talking to someone who is a stranger; giving a speech in front of an audience; answering a question in class; etc.).

NSPS social competence subscale score = sum of items 3, 10, 12, 14, 17, 18, 19, 20, 21, 23, 24; NSPS signs of anxiety subscale score = sum of items 1, 4, 6, 7, 8, 15, 16, 25; NSPS physical appearance subscale score = sum of items 2, 5, 9, 11, 13, 22, 26, 27; NSPS total score = sum of all items.

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Moscovitch, D.A., Rowa, K., Paulitzki, J.R. et al. What If I Appear Boring, Anxious, or Unattractive? Validation and Treatment Sensitivity of the Negative Self Portrayal Scale in Clinical Samples. Cogn Ther Res 39, 178–192 (2015). https://doi.org/10.1007/s10608-014-9645-5

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