Lei Jiedi, Mason Charlotte, Russell Ailsa, Hollocks Matthew J, Leigh Eleanor
Department of Psychiatry, University of Oxford, Oxford, UK.
Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
Clin Child Fam Psychol Rev. 2024 Dec;27(4):966-1030. doi: 10.1007/s10567-024-00509-z. Epub 2024 Nov 19.
Given the high co-occurrence of social anxiety in autism, no reviews to date have explored how cognitive and behavioural mechanisms identified to maintain social anxiety in non-autistic individuals may operate in autistic individuals. This systematic review evaluated: (1) empirical evidence underlying the Clark and Wells (1995) Cognitive Model of Social Anxiety in autistic individuals; (2) how vulnerability factors identified from autism literature (beyond core autistic traits) may be associated with social anxiety beyond the cognitive model. Published peer-reviewed English articles until 27th November 2023 were retrieved from PubMed, EMBASE, Ovid MEDLINE and PsycINFO. Quality appraisal and risk of bias were assessed using The Standard Quality Assessment Criteria for Evaluating Primary Research papers from a Variety of Fields tool. 47 articles met full inclusion criteria and included autistic individuals (with clinical diagnosis), a measure of social anxiety, and a mechanism outlined by either (or both) research questions. The majority of the 3340 participants across studies were male without intellectual disability, White/Caucasian, with 7 studies reporting an average age above 30 years old. Most studies used only self-report measures that may have inflated associations observed between social anxiety and mechanisms. All studies employed cross-sectional design, and no causality inferences could be drawn. Methodological issues around potential construct overlaps between social anxiety and autistic traits are highlighted. Overall, there is evidence in support of the as reported by Clark and Well (in: Heimberg (eds), A cognitive model of social phobia, The Guilford Press, 1995) model, as greater fear of negative evaluation from others, use of safety behaviours and somatic symptoms, and peer victimisation were associated with greater social anxiety. The review contributes evidence in support of autism specific contextual, predisposing/antecedent and maintenance factors of social anxiety beyond the original Clark and Well (in: Heimberg (eds), A cognitive model of social phobia, The Guilford Press, 1995) model. Given the potential for considerable heterogeneity for each highlighted process at an individual level across autistic individuals, clinicians can broaden formulation conversations with autistic clients to understand how autism related factors may influence the development and maintenance of social anxiety symptoms when applying and adapting the Clark and Well (in: Heimberg (eds), A cognitive model of social phobia, The Guilford Press, 1995) model.
鉴于社交焦虑在自闭症中高度共现，迄今为止尚无综述探讨已确定的维持非自闭症个体社交焦虑的认知和行为机制在自闭症个体中如何起作用。本系统综述评估了：（1）克拉克和韦尔斯（1995年）自闭症个体社交焦虑认知模型背后的实证证据；（2）从自闭症文献中确定的易损因素（超出核心自闭症特征）如何可能与认知模型之外的社交焦虑相关。从PubMed、EMBASE、Ovid MEDLINE和PsycINFO中检索了截至2023年11月27日发表的同行评审英文文章。使用《评估来自各种领域的初级研究论文的标准质量评估标准》工具评估质量评估和偏倚风险。47篇文章符合完全纳入标准，包括自闭症个体（有临床诊断）、社交焦虑测量以及由一个（或两个）研究问题概述的机制。各研究中的3340名参与者大多数为男性，无智力残疾，为白人/高加索人，7项研究报告平均年龄超过30岁。大多数研究仅使用自我报告测量方法，这可能夸大了社交焦虑与机制之间观察到的关联。所有研究均采用横断面设计，无法得出因果推断。强调了社交焦虑与自闭症特征之间潜在结构重叠的方法学问题。总体而言，有证据支持克拉克和韦尔斯（载于：海姆伯格（编），《社交恐惧症的认知模型》，吉尔福德出版社，1995年）所报告的模型，因为对他人负面评价的更大恐惧、安全行为和躯体症状的使用以及同伴受害与更大的社交焦虑相关。该综述提供了证据，支持超出最初克拉克和韦尔斯（载于：海姆伯格（编），《社交恐惧症的认知模型》，吉尔福德出版社，1995年）模型的社交焦虑的自闭症特定背景、易感/先行和维持因素。鉴于在自闭症个体中，每个突出过程在个体层面可能存在相当大的异质性，临床医生在应用和调整克拉克和韦尔斯（载于：海姆伯格（编），《社交恐惧症的认知模型》，吉尔福德出版社，1995年）模型时，可以拓宽与自闭症患者的问诊范围，以了解与自闭症相关的因素如何可能影响社交焦虑症状的发展和维持。
