Body dissatisfaction moderates the relationship between social anxiety and exercise frequency: An ecological momentary assessment study Leigh C. Brosof, B.A., Margaret Sala, M.A., Katya Fernandez, Ph.D., & Cheri A. Levinson, Ph.D.

The Impact of Exercise on Anxiety Symptoms Exercise has positive effects on anxiety Why? Exposure to feared bodily sensations Behavioral activation Positive and negative affect Improved sleep Increase feelings of mastery and self-efficacy Overall, it is not well understood why exercise decreases anxiety Asmundson et al., 2013; Petruzzello et al., 1991; Strohle, 2009

Social Anxiety and Exercise Particularly relevant to Social Anxiety Disorder (SAD) Exercise is social in nature Less likely to engage in exercise because of social fears Aerobic exercise as treatment for SAD efficacious as Mindfulness-Based Stress Reduction Jazaieri et al., 2012; Levinson et al., 2013

Facets of social anxiety Fear of negative evaluation I am afraid that others will not approve of me Social appearance anxiety I am concerned people would not like me because of the way I look Social interaction anxiety I have difficulty talking with other people Hart et al., 2008; Mattick & Clarke, 1989

Body dissatisfaction as a moderator Body dissatisfaction affects exercise in an inverted U-shaped curve May be prompted to exercise more OR avoid according to body dissatisfaction Body-specific anxiety versus general anxiety Exercise Body Dissatisfaction Lowedyk & Sullivan, 2015; Neumark-Sztainer et al., 2006

Using ecological momentary assessment: The current study Using ecological momentary assessment: a) Test how these facets of social anxiety impact exercise frequency and vice versa Hypotheses: 1) More frequent exercise predict lower levels of all facets of social anxiety 2) Greater levels of all facets of social anxiety predict later less frequent exercise

The current study b) Test if body dissatisfaction moderates these relationships Hypotheses: 3) Body dissatisfaction would moderate later exercise and: social interaction anxiety fear of negative evaluation 4) No moderation with social appearance anxiety

methods Participants 129 female undergraduates Undergraduate study pool Compensated with class credit Aged 17 to 23 years old (M = 19.19, SD = 1.40) European American (n = 66, 51.2%)

Eating Disorder Inventory-2 I think that my stomach is too big methods Measures Body Dissatisfaction Eating Disorder Inventory-2 I think that my stomach is too big EMA Exercise How long did you exercise since your last check in? EMA Social Interaction Anxiety I have felt uncomfortable in a social situation since my last check in.  Garner, Olmstead, & Polivy, 1983; Mattick & Clarke, 1989

EMA Fear of Negative Evaluation Methods Measures EMA Fear of Negative Evaluation Six questions from Brief Fear of Negative Evaluation I am worried about what other people will think of me EMA Social Appearance Anxiety Six questions from Social Appearance Anxiety Scale I am worrying about flaws in my appearance Hart et al., 2008; Leary, 1983

Automated telephone system, TelEMA Four times per day for seven days METHODS Procedure Automated telephone system, TelEMA Four times per day for seven days 12-hour block was divided into four blocks Administered randomly within each of these blocks Fernandez, Johnson, & Rodebaugh, 2013

Data Analysis Plan methods Multilevel modeling (MLM); Generalized Linear Mixed Model (GLMM) One-assessment lag to test for temporal precedence Exercise at time t was predicted by social anxiety at t-1 Cross-day predictions were not included Exercise distribution was skewed - zero minutes at almost half of (46.3%) assessments Atkins & Gallop, 2007; Bolger & Laurenceau, 2013; Curran & Bauer, 2011; Hamaker, 2015

Data Analysis Plan (Continued) methods Data Analysis Plan (Continued) Time varying predictors (TVPs) disaggregated: TVPmean; the between-person component TVPdeviation; the within-person component TVPdev = TVPraw – TVPmean All findings reflect exclusively TVPdev effects

Hypothesis 1: Greater exercise would predict less social anxiety results Hypothesis 1: Greater exercise would predict less social anxiety Exercise as a predictor of social anxiety b SE p FNE -0.03 .01 .003** SAA -0.02 -.02 .058 SIA -0.01 .02 .500 FNE = Fear of Negative Evaluation; SAA = Social Appearance Anxiety; SIA = Social Interaction Anxiety

Hypothesis 2: More social anxiety would predict less exercise results Hypothesis 2: More social anxiety would predict less exercise Social anxiety as a predictor of exercise b SE p FNE 0.03 .86 .860 SAA 0.04 .18 .820 SIA 0.14 .11 .180 FNE = Fear of Negative Evaluation; SAA = Social Appearance Anxiety; SIA = Social Interaction Anxiety

results Hypothesis 3: Body dissatisfaction would moderate later exercise and: a) social interaction anxiety b) fear of negative evaluation

results  Body dissatisfaction moderated social interaction anxiety and later exercise (p = .050)

results Body dissatisfaction moderated fear of negative evaluation and later exercise (p = .005)

results Hypothesis 4: Body dissatisfaction would not moderate social appearance anxiety and later exercise Body dissatisfaction did not moderate social appearance anxiety and later exercise behavior (p = .15)

discussion Exercise predicted lower fear of negative evaluation social interaction anxiety + body dissatisfaction = exercise fear of negative evaluation + body dissatisfaction = exercise

Discussion Fear of Negative Evaluation: Individuals who are high in fear of negative evaluation AND body dissatisfaction may avoid exercise Individuals exercise MOST when high in body dissatisfaction and low in fear of negative evaluation Low body dissatisfaction not as affected by fear of negative evaluation Not appearance specific?

discussion Social interaction anxiety: Individuals high in body dissatisfaction may avoid exercise when also high in social interaction anxiety Individuals low in body dissatisfaction may exercise MORE when high in social interaction anxiety Negative affect relief strategy? Interestingly, not lowering social interaction anxiety

discussion Social appearance anxiety Exercise leading to less later SAA? SAA does not predict later exercise No moderation Appearance-specific Exercise may be beneficial as intervention

implications Exercise beneficial for lowering fears of negative evaluation (general and appearance-related) Targeting individuals with high body dissatisfaction may be important in using exercise as an intervention Using exercise as an addition to treatment for social interaction anxiety may help relieve some negative affect Exposure therapy for social interactions still necessary

Thank you! Questions? Leigh.brosof@louisville.edu http://www.louisvilleeatlab.com