Socio-cognitive processes associated with paruresis and parcopresis symptoms: A proposed bivalent model

Abstract

Paruresis has been recognized as a subtype of Social Anxiety Disorder (SAD). A well-established model of SAD is the extended bivalent fear of evaluation model (extended BFOE) which include socio-cognitive processes such as fear of negative and positive evaluation (FNE and FPE), concerns of social reprisal (CSR), and disqualification of positive social outcomes (DPSO). In addition to the extended BFOE, dysfunctional attitudes (DAs) have also been recognized to contribute towards social anxiety symptoms and distress. The aim of this study was to examine whether an extended BFOE model for SAD could be used to explain paruresis and parcopresis symptoms. Three-hundred-and-sixteen undergraduate students (76.6% female; mean age = 31.25 years) completed a cross-sectional online study. A structural equation model (SEM) indicated the data supported the proposed model very well (χ2p value = .345, CMIN/df = 1.064, CFI = 1.00, TLI = .999, RMSEA = .014, SRMR = .0107) with significant direct relationships being found between DAs and FNE (p = .002), DAs and FPE (p = .002), FNE and CSR (p = .001), FPE and CSR (p = .001), CSR and paruresis score (p = .045), CSR and DAs (p = .006), FPE and paruresis score (p = .001), FPE and parcopresis score (p = .004), FNE and paruresis score (p = .004), and FNE and parcopresis score (p = .002). Although this research should be replicated, the current study provides evidence that DAs, FNE, FPE and CSR are important contributory factors in paruresis and parcopresis symptoms.

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References

  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington D.C.

  2. Barrett, P. (2007). Structural equation modelling: Adjudging model fit. Personality and Individual Differences, 42(5), 815–824. https://doi.org/10.1016/j.paid.2006.09.018.

    Article  Google Scholar 

  3. Beevers, C. G., Strong, D. R., Meyer, B., Pilkonis, P. A., & Miller, I. W. (2007). Efficiently assessing negative cognition in depression: An item response theory analysis of the dysfunctional attitude scale. Psychological Assessment, 19(2), 199–209.

    Article  PubMed  Google Scholar 

  4. Bentler, P. M. (1990). Fit indexes, Lagrange multipliers, constraint changes and incomplete data in structural models. Multivariate Behavioral Research, 25(2), 163–172.

    Article  PubMed  Google Scholar 

  5. Boschen, M. J. (2008). Paruresis (psychogenic inhibition of micturition): Cognitive behavioral formulation and treatment. Depression and Anxiety, 25(11), 903–912. https://doi.org/10.1002/da.20367.

    Article  PubMed  Google Scholar 

  6. Byrne, M. B. (2009). Structural equation modelling with AMOS: Basic concepts, applications and programming (2nd ed.) Routledge.

  7. Carleton, R. N., Collimore, K. C., & Asmundson, G. J. (2007). Social anxiety and fear of negative evaluation: Construct validity of the BFNE-II. Journal of Anxiety Disorders, 21(1), 131–141. https://doi.org/10.1016/j.janxdis.2006.03.010.

    Article  PubMed  Google Scholar 

  8. 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: Diagnosis, assessment, and treatment (pp. 63–93). New York: Guilford Press.

    Google Scholar 

  9. Cook, S. I., Meyer, D., & Knowles, S. R. (2018). Relationships between psychoevolutionary fear of evaluation, cognitive distortions, and social anxiety symptoms: A preliminary structural equation model. Australian Journal of Psychology., 71, 92–99. https://doi.org/10.1111/ajpy.12215.

    Article  Google Scholar 

  10. Field, A. (2014). Discovering statistics using IBM SPSS statistics (t. Edition Ed.). London: Sage Publications.

    Google Scholar 

  11. Gilbert, N., & Meyer, C. (2005). Fear of negative evaluation and eating attitudes: A replication and extension study. The International Journal of Eating Disorders, 37(4), 360–363. https://doi.org/10.1002/eat.20103.

    Article  PubMed  Google Scholar 

  12. Hammelstein, P., & Soifer, S. (2006). Is "shy bladder syndrome" (paruresis) correctly classified as social phobia? Journal of Anxiety Disorders, 20(3), 296–311. https://doi.org/10.1016/j.janxdis.2005.02.008.

    Article  PubMed  Google Scholar 

  13. Heimberg, R. G., & Becker, R. E. (2002). Cognitive-behavioral group therapy for social phobia: Basic mechanisms and clinical strategies. New York: Guilford Press.

    Google Scholar 

  14. Khan, S. R., & Naqvi, I. (2016). Self-criticism and fear of negative evaluation among university students with and without obesity. Pakistan Journal of Psychological Research, 31(2), 509–530.

    Google Scholar 

  15. Knowles, S. R., & Skues, J. (2016). Development and validation of the shy bladder and bowel scale (SBBS). Cognitive Behaviour Therapy, 45(4), 324–338. https://doi.org/10.1080/16506073.2016.1178800.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Kocijan, L., & Harris, L. M. (2016). Fear of positive evaluation and social anxiety. Behaviour Change, 33(01), 15–26. https://doi.org/10.1017/bec.2015.17.

    Article  Google Scholar 

  17. Kuoch, K. L. J., Meyer, D., Austin, D. W., & Knowles, S. R. (2017). A systematic review of paruresis: Clinical implications and future directions. Journal of Psychosomatic Research, 98, 122–129. https://doi.org/10.1016/j.jpsychores.2017.05.015.

    Article  PubMed  Google Scholar 

  18. Kuoch, K. L. J., Austin, D. W., & Knowles, S. R. (2019a). Latest thinking on paruresis and parcopresis: A new distinct diagnostic entity? The Australian Journal of General Practice, 48(4).

  19. Kuoch, K. L. J., Cook, S., Meyer, D., Austin, D. W., & Knowles, S. R. (2019b). Exploration of the socio-cognitive processes underlying paruresis and parcopresis. Current Psychology. https://doi.org/10.1007/s12144-019-0125-7.

  20. Lipton, M. F., Weeks, J. W., & De Los Reyes, A. (2016). Individual differences in fears of negative versus positive evaluation: Frequencies and clinical correlates. Personality and Individual Differences, 98, 193–198. https://doi.org/10.1016/j.paid.2016.03.072.

    Article  Google Scholar 

  21. Maia Barros, R. E. (2011). Paruresis and parcopresis in social phobia: A case report. Revista Brasileira de Psiquiatria, 33, 416–417.

    Article  Google Scholar 

  22. Malouff, J. M., & Lanyon, R. I. (1985). Avoidant paruresis: An exploratory study. Behavior Modification, 9(2), 225–234. https://doi.org/10.1177/01454455850092006.

    Article  PubMed  Google Scholar 

  23. Marsh, H. W., & Hocevar, D. (1985). Application of confirmatory factor analysis to the study of self-concept: First- and higher order factor models and their invariance across groups. Psychological Bulletin, 97(3), 562–582.

    Article  Google Scholar 

  24. Rapee, R. M., & Heimberg, R. G. (1997). A cognitive behavioral model of anxiety in social phobia. Behaviour Research and Therapy, 35(8), 741–756. https://doi.org/10.1016/S0005-7967(97)00022-3.

    Article  PubMed  Google Scholar 

  25. Seres, G., Kovacs, Z., Kovacs, A., Kerekgyarto, O., Sardi, K., Demeter, P., et al. (2008). Different associations of health related quality of life with pain, psychological distress and coping strategies in patients with irritable bowel syndrome and inflammatory bowel disorder. Journal of Clinical Psychology in Medical Settings, 15(4), 287–295. https://doi.org/10.1007/s10880-008-9132-9.

    Article  PubMed  Google Scholar 

  26. Soifer, S. (2012). Shy bladder syndrome (paruresis): An update: International Paruresis association Inc.

    Google Scholar 

  27. Soifer, S., Zgourides, G. D., Himle, J., & Pickering, N. L. (2001). Shy bladder syndrome: Your step-by-step guide to overcoming paruresis: New Harbinger Publications.

  28. Soifer, S., Himle, J., & Walsh, K. (2010). Paruresis (shy bladder syndrome): A cognitive-behavioral treatment approach. Social Work in Health Care, 49(5), 494–507. https://doi.org/10.1080/00981381003684898.

    Article  PubMed  Google Scholar 

  29. Steiger, J. H. (1990). Structural model evaluation and modification an interval estimation approach. Multivariate Behavioral Research, 25(2), 173–180.

    Article  PubMed  Google Scholar 

  30. Streiner, D. L. (2003). Starting at the beginning: An introduction to coefficient alpha. Journal of Personality Assessment, 80(1), 99–103.

    Article  PubMed  Google Scholar 

  31. Tierney, A. J. (1998). Nursing models: Extant or extinct? Journal of Advanced Nursing, 28(1), 77–85.

    Article  PubMed  Google Scholar 

  32. Vythilingum, B., Stein, D. J., & Soifer, S. (2002). Is "shy bladder syndrome" a subtype of social anxiety disorder? A survey of people with paruresis. Depression and Anxiety, 16(2), 84–87. https://doi.org/10.1002/da.10061.

    Article  PubMed  Google Scholar 

  33. Weeks, J. W. (2010). The disqualification of positive social outcomes scale: A novel assessment of a long-recognized cognitive tendency in social anxiety disorder. Journal of Anxiety Disorders, 24(8), 856–865. https://doi.org/10.1016/j.janxdis.2010.06.008.

    Article  PubMed  Google Scholar 

  34. Weeks, J. W., & Howell, A. N. (2012). The bivalent fear of evaluation model of social anxiety: Further integrating findings on fears of positive and negative evaluation. Cognitive Behaviour Therapy, 41(2), 83–95. https://doi.org/10.1080/16506073.2012.661452.

    Article  PubMed  Google Scholar 

  35. Weeks, J. W., & Howell, A. N. (2014). Fear of positive evaluation: The neglected fear domain in social anxiety. Chichester: John Wiley & Sons, Ltd..

    Google Scholar 

  36. Weeks, J. W., Heimberg, R. G., Fresco, D. M., Hart, T. A., Turk, C. L., Schneier, F. R., & Liebowitz, M. R. (2005). Empirical validation and psychometric evaluation of the brief fear of negative evaluation scale in patients with social anxiety disorder. Psychological Assessment, 17(2), 179–190. https://doi.org/10.1037/1040-3590.17.2.179.

    Article  PubMed  Google Scholar 

  37. Weeks, J. W., Heimberg, R. G., & Rodebaugh, T. L. (2008a). The fear of positive evaluation scale: Assessing a proposed cognitive component of social anxiety. Journal of Anxiety Disorders, 22(1), 44–55. https://doi.org/10.1016/j.janxdis.2007.08.002.

    Article  PubMed  Google Scholar 

  38. Weeks, J. W., Heimberg, R. G., Rodebaugh, T. L., & Norton, P. J. (2008b). Exploring the relationship between fear of positive evaluation and social anxiety. Journal of Anxiety Disorders, 22(3), 386–400. https://doi.org/10.1016/j.janxdis.2007.04.009.

    Article  PubMed  Google Scholar 

  39. Weeks, J. W., Menatti, A. R., & Howell, A. N. (2015). Psychometric evaluation of the concerns of social reprisal scale: Further explicating the roots of fear of positive evaluation. Journal of Anxiety Disorders, 36, 33–43. https://doi.org/10.1016/j.janxdis.2015.06.008.

    Article  PubMed  Google Scholar 

  40. Werner, K. H., Jazaieri, H., Goldin, P. R., Ziv, M., Heimberg, R. G., & Gross, J. J. (2012). Self-compassion and social anxiety disorder. Anxiety, Stress, and Coping, 25(5), 543–558. https://doi.org/10.1080/10615806.2011.608842.

    Article  PubMed  Google Scholar 

  41. Wong, S. S. (2008). The relations of cognitive tirad, dysfunctional attitudes, automatic thoughts, and irrational beliefs with test anxiety. Current Psychology, 27, 177–191.

    Article  Google Scholar 

  42. Yap, K., Gibbs, A. L., Francis, A. J., & Schuster, S. E. (2016). Testing the bivalent fear of evaluation model of social anxiety: The relationship between fear of positive evaluation, social anxiety, and perfectionism. Cognitive Behaviour Therapy, 45(2), 136–149. https://doi.org/10.1080/16506073.2015.1125941.

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors would like to thank all the individuals who participated in our research.

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This research was conducted through the support of the Australian Government Research Training Program Scholarship.

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Correspondence to Simon R. Knowles.

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Kuoch, K.L.J., Meyer, D., Austin, D.W. et al. Socio-cognitive processes associated with paruresis and parcopresis symptoms: A proposed bivalent model. Curr Psychol (2019). https://doi.org/10.1007/s12144-019-00376-w

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Keywords

  • Paruresis
  • Parcopresis
  • Socio-cognitive
  • Psychosomatic
  • Extended bivalent fear of evaluation model