A Multi-Informant Approach to Assessing Safety Behaviors among Adolescents: Psychometric Properties of the Subtle Avoidance Frequency Examination
Safety behaviors are subtle avoidance strategies for minimizing distress within social situations (e.g., avoidance of eye contact). These behaviors factor prominently in the development and maintenance of social anxiety concerns, and when patients use these behaviors within psychosocial treatments for social anxiety, this may impede treatment response. Prior work supports the need to include measures of safety behaviors within evidence-based assessments of social anxiety. Along these lines, researchers developed the Subtle Avoidance Frequency Examination (SAFE) to assess safety behaviors among adults. However, we know relatively little about the SAFE’s psychometric properties when administered to adolescents. We tested the SAFE’s psychometric properties using adolescent self-reports and parallel parent reports in a mixed-clinical/community sample of 96 14 to 15 year-old adolescents and their parents (33 clinic-referred; 63 community control; 59.4% African American). Adolescent and parent SAFE reports displayed moderate correspondence with each other. Both adolescent and parent SAFE reports related positively to well-established measures of adolescent social anxiety and depressive symptoms. Both reports distinguished adolescents on referral status as well as cut scores on well-established measures of adolescent social anxiety. Further, both adolescent and parent SAFE reports displayed incremental validity in relation to survey reports of adolescent social anxiety, over-and-above survey reports of adolescent depressive symptoms, which commonly co-occur with social anxiety. However, adolescent (but not parent) SAFE reports predicted adolescents’ social anxiety and state arousal as displayed within social interactions with unfamiliar peer confederates. These findings have important implications for leveraging multi-informant approaches to assessing safety behaviors among adolescents.
KeywordsAdolescents Multiple informants Safety behaviors Social anxiety Subtle Avoidance Frequency Examination
This work was supported, in part, by an internal grant from the University of Maryland at College Park (College of Behavioral and Social Sciences Dean’s Research Initiative) awarded to the last author.
N.Q.: assisted in executing the study, assisted with data analyses, and wrote the paper. B.A.M.: assisted with data analyses and collaborated in editing the paper. T.M.A. and M.F.L.: collaborated with the design of the study, executed the study, and collaborated in editing the paper. D.E.D., J.N.K., and L.M.K.: assisted in executing the study and collaborated in editing the paper. M.L.T. and S.J.R.: collaborated in editing the paper. A.D.L.R.: designed the study, assisted with data analyses, and wrote the paper.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the University of Maryland at College Park’s Institutional Review Board and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- American Psychiatric Association (2013). Social anxiety disorder (social phobia). In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.Google Scholar
- Clark, D. M. (2005). A cognitive perspective on social phobia. In W. R. Crozier, & L. E. Alden (Eds.), The essential handbook of social anxiety for clinicians (pp. 193–218). England: John Wiley & Sons.Google Scholar
- Clark, D. M. & Wells, A. (1995). A cognitive model of social phobia. In R. G. Heimberg, M. R. Liebowitz, D. A. Hope, & F. R. Schneier (Eds.), Social phobia (pp. 69–93). New York: The Guilford Press.Google Scholar
- Cohen, J. (1988). Statistical power analysis for the behavioral sciences. 2nd ed. Mahwah, NJ: Erlbaum.Google Scholar
- Cuming, S., Rapee, R. M., Kemp, N., Abbott, M. J., Peters, L., & Gaston, J. E. (2009). A self-report measure of subtle avoidance and safety behaviors relevant to social anxiety: development and psychometric properties. Journal of Anxiety Disorders, 23(7), 879–883. https://doi.org/10.1016/j.janxdis.2009.05.002.CrossRefPubMedGoogle Scholar
- Curran, J. P. (1982). A procedure for the assessment of social skills: the Simulated Social Interaction Test. In J. P. Curran, P. M. Monti (Eds.), Social skills training: a practical handbook for assessment and treatment (pp. 348–373). New York, NY: Guilford.Google Scholar
- De Los Reyes, A., Alfano, C. A., & Beidel, D. C. (2010). The relations among measurements of informant discrepancies within a multisite trial of treatments for childhood social phobia. Journal of Abnormal Child Psychology, 38(3), 395–404. https://doi.org/10.1007/s10802-009-9373-6.CrossRefPubMedGoogle Scholar
- De Los Reyes, A., Aldao, A., Thomas, S. A., Daruwala, S., Swan, A. J., & Van Wie, M., et al. (2012). Adolescent self-reports of social anxiety: can they disagree with objective psychophysiological measures and still be valid? Journal of Psychopathology and Behavioral Assessment, 34(3), 308–322. https://doi.org/10.1007/s10862-012-9289-2.CrossRefGoogle Scholar
- De Los Reyes, A., Augenstein, T. M., Wang, M., Thomas, S. A., Drabick, D. A., Burgers, D. E., & Rabinowitz, J. (2015). The validity of the multi-informant approach to assessing child and adolescent mental health. Psychological Bulletin, 141(4), 858–900. https://doi.org/10.1037/a0038498.CrossRefPubMedPubMedCentralGoogle Scholar
- De Los Reyes, A., Bunnell, B. E., & Beidel, D. C. (2013a). Informant discrepancies in adult social anxiety disorder assessments: links with contextual variations in observed behavior. Journal of Abnormal Psychology, 122(2), 376–386. https://doi.org/10.1037/a0031150.CrossRefPubMedPubMedCentralGoogle Scholar
- De Los Reyes, A., Henry, D. B., Tolan, P. H., & Wakschlag, L. S. (2009). Linking informant discrepancies to observed variations in young children’s disruptive behavior. Journal of Abnormal Child Psychology, 37(5), 637–652. https://doi.org/10.1007/s10802-009-9307-3.CrossRefPubMedPubMedCentralGoogle Scholar
- De Los Reyes, A., Thomas, S. A., Goodman, K. L., & Kundey, S. M. (2013b). Principles underlying the use of multiple informants’ reports. Annual Review of Clinical Psychology, 9, 123–149. https://doi.org/10.1146/annurev-clinpsy-050212-185617.CrossRefPubMedGoogle Scholar
- Deros, D. E., Racz, S. J., Lipton, M. F., Augenstein, T. M., Karp, J. N. & Keeley, L. M. et al (2018). Multi-informant assessments of adolescent social anxiety: adding clarity by leveraging reports from unfamiliar peer confederates. Behavior Therapy, 49(1), 84–89. https://doi.org/10.1016/j.beth.2017.05.001.CrossRefPubMedGoogle Scholar
- Grant, B. F., Hasin, D. S., Blanco, C., Stinson, F. S., Chou, S. P., & Goldstein, R. B., et al. (2005). The epidemiology of social anxiety disorder in the United States: results from the National Epidemiologic Survey on alcohol and related conditions. Journal of Clinical Psychiatry, 66(11), 1351–1361. https://doi.org/10.4088/JCP.v66n1102.CrossRefPubMedGoogle Scholar
- Heimberg, R. M. & Juster, H. R. (1995). Cognitive behavioral treatments: literature review. In R. G. Heimberg, M. R. Liebowitz, D. A. Hope, F. R. Schneier (Eds.), Social phobia: diagnosis, assessment, and treatment (pp. 41–66). New York: The Guilford Press.Google Scholar
- Karp, J. N., Makol, B. A., Keeley, L. M., Qasmieh, N., Deros, D. E., & Weeks, J. W. et al. (2018). Convergent, incremental, and criterion-related validity of multi-informant assessments of adolescents’ fears of negative and positive evaluation. Clinical Psychology and Psychotherapy. https://doi.org/10.1002/cpp.2156.
- Keeley, L. M., Makol, B. A., Qasmieh, N., Deros, D. E., Karp, J. N., Lipton, M. F. et al. (2018). Validity of adolescent and parent reports on the six-item ADHD Self-Report Scale (ASRS-6) in clinical assessments of adolescent social anxiety. Journal of Child and Family Studies, 27. https://doi.org/10.1007/s10826-017-0950-y.
- Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Waters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 593–602. https://doi.org/10.1001/archpsyc.62.6.593.CrossRefPubMedGoogle Scholar
- Kley, H., Tuschen-Caffier, B. & Heinrichs, N. (2012). Safety behaviors, self-focused attention and negative thinking in children with social anxiety disorder, socially anxious and non-anxious children. Journal of Behavior Therapy and Experimental Psychiatry, 43(1), 548–555. https://doi.org/10.1016/j.jbtep.2011.07.008.CrossRefPubMedGoogle Scholar
- Kraemer, H. C., Measelle, J. R., Ablow, J. C., Essex, M. J., Boyce, W. T. & Kupfer, D. J. (2003). A new approach to integrating data from multiple informants in psychiatric assessment and research: mixing and matching contexts and perspectives. American Journal of Psychiatry, 160(9), 1566–1577. https://doi.org/10.1176/appi.ajp.160.9.1566.CrossRefPubMedGoogle Scholar
- Lang, P. J. (1980). Behavioral treatment and bio-behavioral assessment: computer applications. In J. B. Sidowski, J. H. Johnson, T. A. Williams (Eds.), Technology in mental health care delivery systems (pp. 119–137). Norwood, NJ: Ablex.Google Scholar
- Lerner, M. D., De Los Reyes, A., Drabick, D. A. G., Gerber, A. H., & Gadow, K. D. (2017). Informant discrepancy defines discrete, clinically useful autism spectrum disorder subgroups. Journal of Child Psychology and Psychiatry, 58(7), 829–839. https://doi.org/10.1111/jcpp.12730.CrossRefPubMedGoogle Scholar
- McManus, F., Sacadura, C., & Clark, D. M. (2008). Why social anxiety persists: an experimental investigation of the role of safety behaviors as a maintaining factor. Journal of Behavior Therapy and Experimental Psychiatry, 39(2), 147–161. https://doi.org/10.1016/j.jbtep.2006.12.002.CrossRefPubMedGoogle Scholar
- Morrison, A. S. & Heimberg, R. G. (2013). Social anxiety and social anxiety disorder. Annual Review of Clinical Psychology, 9, 249–274. https://doi.org/10.1146/annurev-clinpsy-050212-185631.CrossRefPubMedGoogle Scholar
- Porges, S. W. (1997). Emotion: an evolutionary by‐product of the neural regulation of the autonomic nervous system. Annals of the New York Academy of Sciences, 807(1), 62–77. https://doi.org/10.1111/j.1749-6632.1997.tb51913.x.CrossRefPubMedGoogle Scholar
- Rapee, R. M. (1995). Descriptive psychopathology of social phobia. In R. G. Heimberg, M. R. Liebowitz, D. A. Hope, F. R. Schneier (Eds.), Social phobia: diagnosis, assessment, and treatment (pp. 41–66). New York: The Guilford Press.Google Scholar
- Rausch, E., Racz, S. J., Augenstein, T. M., Keeley, L., Lipton, M. F., & Szollos, S., et al. (2017). A multi-informant approach to measuring depressive symptoms in clinical assessments of adolescent social anxiety using the Beck Depression Inventory-II: convergent, incremental, and criterion-related validity. Child and Youth Care Forum, 46(5), 661–683. https://doi.org/10.1007/s10566-017-9403-4.CrossRefGoogle Scholar
- Rowa, K., Paulitzki, J. R., Ierullo, M. D., Chiang, B., Antony, M. M., McCabe, R. E., & Moscovitch, D. A. (2015). A false sense of security: safety behaviors erode objective speech performance in individuals with social anxiety disorder. Behaviour Therapy, 46(3), 304–314. https://doi.org/10.1016/j.beth.2014.11.004.CrossRefGoogle Scholar
- Storch, E. A., Masia-Warner, C., Dent, H. C., Roberti, J. W., & Fisher, P. H. (2004). Psychometric evaluation of the Social Anxiety Scale for Adolescents and the Social Phobia and Anxiety Inventory for Children: construct validity and normative data. Journal of Anxiety Disorders, 18(5), 665–679. https://doi.org/10.1016/j.janxdis.2003.09.002.CrossRefPubMedGoogle Scholar
- Thomas, S. A., Weeks, J. W., Dougherty, L. R., Lipton, M. F., Daruwala, S. E., Kline, K. & De Los Reyes, A. (2015). Allelic variation of risk for anxiety symptoms moderates the relation between adolescent safety behaviors and social anxiety symptoms. Journal of Psychopathology and Behavioral Assessment, 37(4), 597–610. https://doi.org/10.1007/s10862-015-9488-8.CrossRefPubMedPubMedCentralGoogle Scholar
- Thwaites, R. & Freeston, M. (2005). Safety-seeking behaviours: fact or function? How can we clinically differentiate between safety behaviours and adaptive coping strategies across anxiety disorders?. Behavioural and Cognitive Psychotherapy, 33(2), 177–188. https://doi.org/10.1017/S1352465804001985.CrossRefGoogle Scholar