Fear of positive evaluation and social affiliation in social anxiety disorder and major depression

Fear of positive evaluation (FPE) is posited as a core feature of social anxiety disorder (SAD); however, little is known about its role in interpersonal functioning. We examined relationships between FPE and responses to a standardized social affiliation paradigm designed to facilitate positive social connection with an unacquainted conversation partner (trained confederate). The sample included adults with SAD (N = 52), major depressive disorder (MDD; N = 23), comorbid SAD and MDD (N = 36), and non-psychiatric controls (N = 33). Participants completed measures assessing FPE, affect, safety behaviors, and desire for future interaction. Confederates and observers rated participant behavior and their own desire for future interaction. FPE was most elevated in the SAD and comorbid groups, followed by the MDD group, and then non-psychiatric controls. In the full sample, FPE was associated with greater self-reported anxiety and safety behavior use, lower self-reported positive affect and desire for future interaction, lower observer-rated desire for future interaction and approach behaviors, and greater observer-rated anxious behaviors. Within-group correlations revealed that associations were weaker in the SAD only and comorbid groups (cf. control and MDD only groups); however, post-hoc moderation analyses indicated that the relationships between FPE and the outcomes of interest largely held across varying levels of social anxiety and depression severity. Findings underscore the potential role of FPE as a transdiagnostic factor relevant to understanding interpersonal functioning in social anxiety and depression.