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Please make 2 powerpoint slides with full scirpts provided, use google powerpoint I have to work on my social psychology project, but i have to idea on the topic provided. You have to read the provi
Original Article The Type D Construct Is Social Inhibition More Than Social Fear? Gesine Grande, 1 Matthias Romppel, 1 Matthias Michal, 2 and Elmar Brähler 3 1Faculty of Applied Sciences, Leipzig University of Applied Sciences, Germany, 2Department of Psychosomatic Medicine and Psychotheraphy, University Medical Center, Mainz, Germany,3Department of Medical Psychology and Sociology, University Medical Center, Leipzig, Germany Abstract.The interaction of negative affectivity (NA) and social inhibition (SI), known as the Type D personality, is associated with a worse prognosis in cardiac patients. Until now, causal models have been speculative, and this is partly due to a lack of clarity related to the validity of SI, its role in emotion regulation, and the postulated independence of social and emotional functioning. To examine the construct validity of the Type D personality, we analyzed associations of NA and SI with different measures of affectivity, social anxiety, and social competencies in a German population-based representative sample (n= 2,495). Both NA and SI were associated with all other measures of social functioning and negative affect (allrs > .30) and showed considerable cross-loadings (NA:a 1= .39,a 2= .63; SI:a 1= .73 anda 2= .34) in a two-factor solution with the factors labeled as Social Functioning and Negative Affectivity. The SI subscale did not properly differentiate between social fears and social competencies, which emerged as rather different aspects of social functioning. Further studies should examine the effect of broader dimensions of social orientation and competencies and their interaction with NA on cardiac prognosis. Keywords:negative affectivity, social inhibition, distressed personality, Type D personality The concept of the‘‘distressed personality’’(Type D) was introduced in 1995 by Denollet (Denollet, Sys, & Brutsaert, 1995). For cardiac patients with a combination of high lev- els of negative affectivity (NA) and social inhibition (SI), higher morbidity and higher mortality have been demon- strated in a series of studies, even though the effects appeared to weaken over time (Grande, Romppel, & Barth, 2012), and recently, some large studies have failed to rep- licate this association (Coyne et al., 2011; Damen et al., 2013; Grande et al., 2011). It has been supposed that the interaction of NA and SI would affect cardiac prognosis beyond the known effects of negative affect and depression (Denollet et al., 2006). In the ongoing discussion related to the concept of the Type D personality, more empirical support for the unique synergis- tic interaction is required as well as a more systematic and conceptually guided research approach (e.g., Smith, 2011). Actually, the first ideas about the Type D personality were not derived from a theoretical model, but rather emerged from empirical analyses that were originally intended to demonstrate the negative effects of repressive coping (Denollet et al., 1995). Until now, there has not been a com- prehensive theoretical model of the pathogenic mechanisms that operate through the interaction of NA and SI. Two cru- cial open questions in this context are related to the con- struct validity of SI and the independence of SI and NA. Validity of SI Denollet himself defined social inhibition on a behavioral level as the (intentional) inhibition of emotional expressionin social situations and on an intrapsychic level as the moti- vation to avoid disapproval by others (Denollet, 2005). He assumed that socially inhibited persons feel insecure among other people, lack assertiveness, and tend to adopt self-enhancing strategies such as withdrawal (Denollet, 2005). Withdrawal and avoidance are often motivated by the fear of unsatisfactory social evaluation by others (Asendorpf, 1989). Thus, withdrawal and the inhibition of emotional expression could serve as emotional regulation strategies in people with high levels of socially related fears. High correlations of SI and shyness support this assumption (Grande et al., 2004). Recently, an interpreta- tion bias among Type D persons toward threat was reported. Type D persons rated written descriptions of ambiguous or neutral social situations as more distressing and perceived a higher level of threat related to these sce- narios (Grynberg, Gidron, Denollet, & Luminet, 2012). On the other hand, associations between SI and intro- version have been repeatedly demonstrated (for a summary, see Grande, Glaesmer, & Roth, 2010). But in contrast to the intrapsychic regulation described above, the missing social involvement of introverts has been attributed to a lower need for stimulation and the tendency to feel more comfort- able when alone; they are definitely not prone to shyness, apprehensiveness, or socially related fears (McCrae & Costa, 1999). Both introverted and socially anxious persons score high on the SI subscale of the DS14 (Grande, Glaesmer, et al., 2010), making it difficult to gain insight into possible causal mechanisms that link the interaction of SI and NA with a cardiac prognosis. Thus, when some studies demon- strate that participants classified as Type D report lower 2013 Hogrefe PublishingEuropean Journal of Psychological Assessment2014; Vol. 30(4):283–288 DOI: 10.1027/1015-5759/a000189 levels of perceived social support (Michal, Wiltink, Grande, Beutel, & Br hler, 2011; Pedersen, Spinder, Erdman, & Denollet, 2009; Polman, Borkoles, & Nicholls, 2010; Williams et al., 2008; Williams & Wingate, 2012), this could be due to their anxious withdrawal (Denollet, 2005) or to lower social needs as are assumed in introverted per- sons (Grande, Glaesmer, et al., 2010). Depending on what SI actually is assessing – introversion versus social anxiety, different patterns of associations are expected with social fears, social competencies, and social support (Table 1). With regard to suitable and effective intervention strategies, it is very important to distinguish between these opposite dynamics. Independence of SI and NA Exploratory factor analyses have consistently suggested a two-factor structure (Denollet, 2005; Grande et al., 2004; Pedersen, Yagensky, et al., 2009; Spindler, Kruse, Zwisler, & Pedersen, 2009; Straat, van der Ark, & Sijtsma, 2012). Intercorrelations between the two subscales of the DS14 – NA and SI – have been found to lie betweenr=.37 (Denollet, 2005) andr= .57 (Spindler et al., 2009) for car- diac patients, with specific findings ofr= .48 in healthy workers (Grande et al., 2004) andr=.45 in students (Pedersen, Yagensky, et al., 2009). Obviously, there is a significant overlap between the two dimensions, a finding that has rarely been discussed until now. In more general terms, the purported independence of social dysfunction and emotional distress in predicting health and the course of coronary heart disease has been recently questioned (Ketterer, 2010; Smith & MacKenzie, 2006). Objectives Thus, our study has two main goals: In a large nonclinical representative population-based sample, associations of SI with different measures of social competencies, sociallyrelated fears, and perceived social support will be analyzed and compared with the correlational pattern hypothesized for introversion versus socially related fears. The second aim is to examine the interdependency of the SI and NA subscales. Anyway, an overlap between both subscales could be due to the specific operationalization of both con- structs in the DS14 or/and due to an interaction of social traits and negative affectivity in general that can be pre- dicted by theoretical models. So, in a first step we examine the intercorrelation of both subscales. In the second step we analyze by means of a factor analysis, including all mea- sures of social functioning and negative affectivity, whether negative affectivity and social functioning turned out to be independent factors or not independent factors as some authors recently assumed. Last, by analyzing the factor loadings of the subscales of NA and SI on the (hypothe- sized) factorial dimensions of social functioning and nega- tive affectivity the construct validity will be examined. Results can contribute to a better understanding of possible pathways that link the Type D personality with cardiac prognosis and to develop suitable intervention goals and strategies. Material and Methods Participants A representative sample of the general German population was selected randomly with the assistance of a demo- graphic consulting company (USUMA, Berlin, Germany). The details of the recruiting procedure are described elsewhere (Grande, Romppel, Glaesmer, Petrowski, & Herrmann-Lingen, 2010). A total of 2,507 people between the ages of 14 and 92 years agreed to participate and com- pleted the self-rating questionnaires in November and December, 2003 (participation rate: 66.4%). Eighty-two subjects were excluded from the following analyses because they had missing values on at least one of the Table 1. Predicted associations with social inhibition for different dimensions of social functioning Theoretical predictions Empirical examination Dimensions of social functioning Introverts Socially anxious DS14 Social inhibition Need for social stimulation Low Normal n.a. Social fears Low High SCL-27 Negative correlation Positive correlation Sociophobia, mistrust Social competencies Normal Low Giessen-Test Null correlation (Independent from competencies not motivated to appear as social competent/attractive)Negative correlation (Want to appear as social competent/attractive, but can’t)Social Resonance, Open-Mindedness, Social Potency (perceived) social support Low Low F-SozU14 Negative correlation Negative correlation 284 G. Grande et al.: Validity of the Type D Construct European Journal of Psychological Assessment2014; Vol. 30(4):283–288 2013 Hogrefe Publishing scales that we used. Thus, a total of 2,425 people (1,331 women) were included in this study. The mean age was 48.6 years (SD= 17.8). Measures DS14: Type D personality was assessed with the German version of the 14-item DS14 scale (Denollet, 2005; Grande et al., 2004). The scale consists of two seven-item sub- scales: NA (e.g.,‘‘I am often irritated’’) and SI (e.g.,‘‘Ifind it hard to start a conversation’’). Each item is rated on a five-point Likert-type scale ranging from 0 (‘‘false’’)to4 (‘‘true’’). Cronbach’s alpha was .86 and .84 for the NA and SI subscales, respectively. PHQ-D: We used the depression and the stress modules of the German version of the Patient Health Questionnaire (Martin, Rief, Klaiberg, & Br hler, 2006; Spitzer, Kroenke, & Williams, 1999). The nine items of the depression mod- ule are rated on a four-point scale ranging from 0 (‘‘not at all’’)to3(‘‘nearly every day’’) and are summed to build a depression score (Cronbach’s alpha = .85). The 10 items of the stress module are rated on a three-point scale ranging from 0 (‘‘not impaired’’)and2(‘‘strongly impaired’’)and summed to build a stress score (Cronbach’sa= .76). SCL-27: The Symptom Checklist SCL-27 (Hardt & Gerbershagen, 2001), a modification of the SCL-90-R (Derogatis, 1977), is a short screening instrument for men- tal health problems. It contains six subscales of which the ‘‘sociophobic symptoms’’and‘‘symptoms of mistrust’’sub- scales with four items each were used in the analyses. Items are rated on a scale ranging from 0 (‘‘not at all’’)to4(‘‘very strong’’). Cronbach’sawas .80 for the sociophobic symp- toms subscale and .75 for the symptoms of mistrust subscale. Giessen-Test: From this questionnaire, which is based on psychodynamic concepts and social interaction models, three of six dimensions were selected to measure different aspects of social motives and behavior: Social Resonance (a person is socially resonant when he or she is perceived as attractive by others, liked, well-respected, and assertive; Cronbach’sa= .73), Open-Mindedness (open minded toward social contacts, forms close bonds, franklyexpresses romantic needs, easily gives away personal infor- mation; Cronbach’s a= .75), and Social Potency (sociable, capable of devotion, forming long-term relationships, imag- inative; Cronbach’sa= .63). Each dimension includes six items with bipolar statements (e.g.,‘‘For me, I believe it’s rather easy/difficult to enter a romantic long-term commit- ment’’) that are rated on a seven-point scale (Roth, Korner, & Herzberg, 2008). F-SozU14: The short form of the Social Support Ques- tionnaire (Fragebogen zur Sozialen Unterst tzung; F-SozU) (Fydrich, Sommer, Tydecks, & Br hler, 2009) consists of 14 items that assess different aspects of perceived support (emotional support, instrumental support, and social inte- gration). The items are rated on a five-point scale ranging from 1 (‘‘false’’)to5(‘‘true’’). Cronbach’safor the sum score was .94. Statistics To analyze the associations between the different scales, Pearson correlations were calculated. A principal compo- nents analysis with orthogonal varimax rotation and oblique oblimin rotation was performed to explore the structure of the associations. All calculations were computed with IBM SPSS Statistics version 20. Results The Pearson correlations of the DS14 subscale SI with the other scales are summarized in Table 2. All variables showed an association of at leastr= .30 with SI. For SI, negative correlations |.50| were found with the Giessen Test subscales Social Resonance, Open-Mindedness, and Social Potency. The intercorrelation of NA and SI was r=.55. The Kaiser-Meyer-Olkin measure of sampling adequacy (.88) and Bartlett’s test of sphericity (v 2= 11813,df=45, p< .001) supported the adequacy of the sample for factor analysis. The extraction of two components was suggested by both the Kaiser criterion and the scree plot (the first four Table 2. Pearson correlations between scales in a representative German sample (n= 2,425) Scales SI NA Dep Str Soc Mis Res Ope Pot Sup DS14 Social Inhibition (SI) 1 .55 .38 .31 .48 .35 .56 .60 .58 .43 DS14 Negative Affectivity (NA) 1 .53 .50 .47 .46 .39 .39 .34 .34 PHQ Depression (dep) 1 .60 .62 .57 .34 .32 .31 .31 PHQ Stress (str) 1 .48 .51 .23 .23 .18 .31 SCL-27 Sociophobic Symptoms (soc) 1 .68 .39 .36 .36 .37 SCL-27 Symptoms of Mistrust (mis) 1 .25 .30 .25 .33 GT Social Resonance (res) 1 .59 .61 .47 GT Open-Mindedness (ope)1 .70 .47 GT Social Potency (pot)1 .44 F-SoZu Social Support (sup)1 Note. All correlations were significant atp< .001. G. Grande et al.: Validity of the Type D Construct 285 2013 Hogrefe PublishingEuropean Journal of Psychological Assessment2014; Vol. 30(4):283–288 eigenvalues were 4.86, 1.60, 0.67, and 0.64). In the princi- pal components analysis with orthogonal rotation, on the first factor, measures of social competencies, social support, and social inhibition showed the highest loadings, whereas measures of negative affectivity, social fears, and stress loaded on the second factor (Table 3). The factors were thus labeled‘‘Social Functioning’’and‘‘Negative Affectivity’’; in total, 65% of the variance was explained. NA and SI showed cross-loadings on the factors‘‘Social Functioning’’ and‘‘Negative Affectivity’’(NA:a 1=.39,a 2=.63; SI: a 1= .73 anda 2= .34). The only other variable demonstrat- ing cross-loadings greater thanr= .30 was Sociophobic symptoms (a 1=.31anda 2= .76). The results of the prin- cipal components analysis with oblique rotation demon- strated that the sizes of the cross-loadings are reduced in a factor solution with correlated factors (NA:a 1=.26, a 2= .59; SI:a 1= .71 anda 2= .17) (see Table 3, last two columns). The correlation between the two factors was r=.46. We carried out a post hoc confirmatory factor analysis using Mplus version 6.1 (Muth n & Muth n, 2010) to com- pare a model with two correlated factors (factor 1: social functioning [Social Inhibition, Social Resonance, Open- Mindedness, Social Potency, Social Support], factor 2: neg- ative affectivity [Negative Affectivity, Depression, Stress, Sociophobic Symptoms, Symptoms of Mistrust]) to the same model with cross-loadings allowed for NA and SI. The model with cross-loadings for NA and SI allowed showed a significantly better fit (v 2= 801,df= 32, com- parative fit index CFI = 0.935, root mean square error of approximation RMSEA = 0.10) than the model with no cross-loadings allowed (v 2= 1040,df= 34, CFI = 0.915, RMSEA = 0.11;Dv 2= 239,df=2,p< .001). Discussion The subdimension SI of the Type D scale was associated with all other measures of negative affectivity and socialfunctioning. With regard to its convergent validity, SI showed the strongest associations with other measures of social functioning. The correlational pattern of SI confirms the hypotheses that social inhibited persons are socially anxious, reporting low social competencies, high symptom scores of social fears, and low social support (Table 2). Thus social inhibited persons demonstrated the complex pattern of affective, cognitive-behavioral, and interactional characteristics predicted for social anxiousness. In conflict with these results, in our factor analyses, SI showed a cross-loading on the dimension Negative Affectivity, but has a stronger loading on the dimension of Social Function- ing. So social fears and sociophobic symptoms in particular rather represent the affective component and therefore belong to the dimension of Negative Affectivity. SI, as the results of the bivariate correlations already suggest, merely assesses cognitive-behavioral characteristics of social anxiousness (Grande, Glaesmer, et al., 2010) and is better represented by the social functioning dimension. Social inhibited persons may combine both characteristics and demonstrate low social competencies on a cognitive- behavioral dimension and social fears on an affective dimension as typical for the whole syndrome of social anxiousness. The second aim of our study was to contribute to the ongoing debate related to the interdependency or indepen- dency of social functioning and negative affectivity. In our study measures of social competencies and perceived social support in particular were negatively associated with measures of negative affect in the bivariate correlation anal- yses, indicating some interdependency. With regard to the DS14 NA and SI scales, an intercorrelation ofr=.55,cor- responding to a large effect size according to Cohen (1992), was found, indicating a considerable overlap between the two dimensions. The intercorrelation is near the upper limit of correlations previously reported for clinical samples (De- nollet, 2005; Grande et al., 2004; Spindler et al., 2009) and comparable in size to correlations reported for other non- clinical samples (Grande et al., 2004; Pedersen, Yagensky, et al., 2009). Results of the factor analyses support some Table 3. Results of the principal components analysis: varimax and oblimin rotated component matrix Orthogonal rotation (varimax) componentOblique rotation (oblimin) component Scale 1 2 1 2 DS14 Negative Affectivity .39 .63 .26 .59 DS14 Social Inhibition .73 .34 .71 .17 PHQ Depression .21 .81 .02 .83 PHQ Stress .08 .80 .12 .85 SCL-27 Sociophobic Symptoms .31 .76 .14 .75 SCL-27 Symptoms of Mistrust .15 .81 .05 .84 GT Social Resonance .80 .18 .82 .02 GT Open-Mindedness .84 .16 .87 .05 GT Social Potency .85 .11 .90 .11 F-SoZu Social Support .60 .29 .58 .15 % explained variance 32.9 31.7 Correlation between factors r = .46 286 G. Grande et al.: Validity of the Type D Construct European Journal of Psychological Assessment2014; Vol. 30(4):283–288 2013 Hogrefe Publishing interdependency of social functioning and negative affec- tivity. A principal component analysis, including all mea- sures of social functioning and various measures of negative affectivity, and NA and SI, delivered a two-factor structure, but various cross-loadings raise doubts on the assumed independence of both dimensions of psychological functioning. In the CFA the model fit improved consider- ably after allowing for cross-loadings of both DS14 sub- scales. In an earlier study, for a two-factor solution from a confirmatory factor analysis of the DS14, also an unsatis- factory fit was demonstrated before allowing for cross-load- ings and correlations between residuals, supporting the assumption that the two subscales are distinguishable but significantly related (Grande, Romppel, et al., 2010). So the oblique oblimin rotation as well as the post hoc confir- matory factor analyses rather support the model of some interdependency between the subscales NA and SI as well as between social functioning and emotional distress in general as recently argued by others (Ketterer, 2010; Smith & MacKenzie, 2006). Our results suggest that the Type D scale DS14 is not ideally suitable to differentiate between both dimensions – emotional and social functioning. So, previous Type-D research possibly could not deliver reliable data on the interaction of socially related traits and negative affectivity but rather deliver results on the interaction or additive effect of a more general negative affectivity and a more specific socially related anxiety. Further analysis of the interaction of social and emotional functioning and their effects on health should complement or replace the SI subscale with other established, validated, and more explicit measures of social functioning and emotion regulation (e.g., shyness: Cheek & Buss, 1981, Schmidt & Buss, 2010; sociability: Cheek & Buss, 1981; emotional suppression: Gross & John, 2003). Limitations Our study has some limitations. All data were collected from self-report measures; thus, negative affectivity as a general emotion-regulation strategy may affect the ways in which internal and external information is perceived, rated, and communicated (e.g., in a questionnaire). Stronger associations would be expected between different self- report measures than between a self-report measure and rat- ings by others or more objective measures of social func- tioning. With regard to the first aim of the study, it is a limitation that only three out of four hypothesized predic- tions were examined and only two of the measured con- structs allowed to analyze the differential validity of SI. As the study is cross-sectional, interactions between emo- tional and social functioning over time cannot be examined. Finally, there may be differences in the convergent validity and the dependency of emotional and social functioning between population-based and clinical samples. Conclusions In summary, in a large population-based sample, negative affectivity and social functioning emerge as different but interdependent aspects of psychological functioning. The DS14 SI subscale does not allow for a proper differentiation between the two dimensions. Further studies should exam- ine the effect of broader dimensions of social functioning using established and well-validated measures of shyness and suppression. References Asendorpf, J. B. (1989). 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Valida- tion and utility of a self-report version of PRIME-MD: The PHQ primary care study.JAMA, 282, 1737–1744. Straat, J. H., van der Ark, L. A., & Sijtsma, K. (2012). Multi- method analysis of the internal structure of the Type D Scale-14 (DS14).Journal of Psychosomatic Research, 72, 258–265. Williams, L., O’ Connor, R. C., Howard, S., Hughes, B. M., Johnston, D. W., Hay, J. L.,...O’Carroll, R. E. (2008). Type-D personality mechanisms of effect: The role of health-related behavior and social support.Journal of Psychosomatic Research, 64, 63–69. Williams, L., & Wingate, A. (2012). Type D personality, physical symptoms and subjective stress: The mediating effects of coping and social support.Psychology & Health, 27, 1075–1085. Date of acceptance:October 8, 2013 Published online:December 16, 2013 Matthias Romppel Faculty of Applied Social Sciences Leipzig University of Applied Sciences 04251 Leipzig Germany Tel. +49 341 3076-3217 E-mail [email protected] 288 G. Grande et al.: Validity of the Type D Construct European Journal of Psychological Assessment2014; Vol. 30(4):283–288 2013 Hogrefe Publishing

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