The role of social anxiety on safety-learning: Bridging the gap from the lab to the clinic

In the UK, anxiety disorders affect over eight million people and cost the economy approximately £10 billion a year (McCrone et al., 2008). Social anxiety disorder (SAD) is the most common anxiety disorder, except for specific phobia (Ruscio et al., 2008), and is characterised by excessive fear and avoidance of social or performance situations. SAD typically develops during late childhood or adolescence and therefore has a significant impact on a large number of young people, as well as adults (Beesdo et al., 2007; Detweiler et al., 2014; Stein et al., 2017). Further, some level of social anxiety is experienced by most humans at some point in their lives, for example when attending a job interview or having to give a presentation. People who suffer from social anxiety symptoms report poorer life satisfaction, physical health, mental health and have more clinical complaints and disabilities compared to people with lower social anxiety symptoms, even if they do not qualify for a diagnosis (Fehm et al., 2008). Therefore, the number of people severely affected by social anxiety may in fact be higher than current estimates of the disorder indicate (Jefferies & Ungar, 2020).

Cognitive Behavioural Therapy (CBT) is used for the treatment of SAD and includes exposure therapy as a main component. Exposure therapy for social anxiety includes face-to-face and imagined encounters with feared social situations, for example, starting a conversation or attending a social event, with the help of a Clinical Psychologist. Exposure to these social situations provide the patient with the opportunity to learn that the feared social situation will not always pose a threat. As the patient learns this information, they generate "safety" associations and social anxiety declines. However, treatment for SAD is often not successful. Many patients still experience symptoms or a return of fear after treatment. This suggests that there is room for improvement in the treatment of SAD. Laboratory-based research on safety learning, for example learning that something that was once threatening is now safe within an experimental task, can be carried out by researchers to further understanding of why fear may be maintained or return after exposure for people with social anxiety. Findings from this research can be used to inform Clinical Psychologists of potential methods of improving treatment for SAD. Therefore, there is a need to encourage collaboration between laboratory-based researchers and Clinical Psychologists to gather new ideas that might improve treatment outcome for SAD.

This fellowship aims to maximise the potential of my laboratory-based research to bridge the gap between laboratory science and clinical practice. This project is important because it may help us to design ways to adapt exposure therapy for SAD that might lead to improved outcomes of treatment. The findings of my work are relevant for clinicians using exposure-based treatments for SAD, and this fellowship will provide the opportunity to gain clinical experience and foster connections with clinicians to maximise the societal impact of my work. Further, the fellowship will enable me to develop my track record academically through the publication of two substantial review papers and an experimental piece and engage with patients and the public to ensure that future research is informed by and reflects the priorities of people affected by social anxiety. Therefore, the fellowship will enable me to develop the track record, networks and experience required to enhance the translational impact of my research from the laboratory to clinical practice. In the long term, this work has the potential to improve the quality of life of people suffering with social anxiety and decrease the substantial societal costs associated with the disorder.