A Comprehensive Review and Multi-Method Examination of the Relationship between Social Anxiety and Alcohol Use

Abstract

Epidemiological studies show that those with high social anxiety are at increased risk of having alcohol use problems. This risk appears especially high in socially anxious women. Researchers have long sought to understand this relationship, but findings are often inconsistent and point towards the need for novel methodologies to more comprehensively study how alcohol affects social anxiety. The current dissertation begins with a comprehensive review paper outlining the prominent theories in this area and reviews experimental studies examining links between alcohol intake and social anxiety. Next, for Studies 1 and 2, socially anxious participants were randomly assigned to consume alcohol or control beverages and then completed a standardized social interaction with a confederate. In Study 1, videos of the social interactions were coded for participant safety behaviors (i.e., eye contact, time speaking, latency to respond to questions, and nervous laughter). Those who consumed alcohol spent more time speaking during the interaction, and experienced a lesser increase in state social anxiety, than those who did not consume alcohol. In Study 2, participants completed measures of post-event processing (i.e., dwelling on events after they happen) a few days after completing the social interaction. Women who consumed alcohol had decreased levels of post-event processing compared to women who had not consumed alcohol, whereas men who consumed alcohol had higher levels of post-event processing than men who consumed control beverages. Finally, in Study 3, participants used palm pilots for 22 days to track their state social anxiety through the afternoon and evening, while also recording their alcohol use. Multi-level modeling showed that for every alcoholic beverage consumed, subsequent state social anxiety decreased by approximately 4%. Taken together, these findings support the idea that socially anxious individuals experience negative reinforcement from drinking as it alleviates symptoms of social anxiety and reduces the use of safety behaviors, which may maintain social anxiety. However, socially anxious women may experience additional negative reinforcement from drinking due to its effect on the social anxiety-maintaining cognitive process of post-event processing. Results have implications for improving treatment programs for those who use alcohol as a means of coping with social anxiety.