Shannon, entropy, Fisher information and disequilibrium

Although stronger evidence has been demonstrated for GAD, relatively little is known concerning causal relationships in social anxiety. To our knowledge, an unequivocal causal

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relationship between IU and social anxiety has not yet been established, although three studies have provided some initial indications that a reduction in IU are associated with a reduction in social anxiety.

First, Hewitt et al. (2009) examined the efficacy of 6 sessions of Cognitive Behavioural Therapy (CBT) specifically targeting IU for a patient who had a comorbid diagnosis of several anxiety disorders and depressive symptoms. The results demonstrated that IU and social anxiety were reduced significantly during the intervention and follow up, but not with regards to the panic disorder symptoms.

Likewise, Mahoney and McEvoy (2012) independently replicated these findings. They examined the same protocol among 32 patients diagnosed with social anxiety. They reported that this treatment was able to lead to reductions in IU, social anxiety and depression.

Interestingly, the reduction in IU was associated only with the reduction in social anxiety, and not with the reduction in depression.

More recently, based on studies suggesting IU as a transdiagnostic factor, Boswell et al.

(2013) examined the efficacy of 18 weeks treatment using a Transdiagnostic Cognitive-Behavioural Therapy. They conducted a Randomized Control Trial (RCT) design among 37 patients diagnosed with heterogeneous anxiety, including social anxiety and depression. The core treatment modules were designed to target the regulation of emotional experience. The patients were randomised into an immediate-treatment group or a delayed-treatment group.

First, it was found that this treatment effectively reduced IU and also the severity of anxiety and depression symptoms. Second, IU reduction was significantly associated with the reduction in symptom severity across diagnoses, including social anxiety.

Notwithstanding the absence of temporal precedence supporting a causal relationship between IU and social anxiety in these previous studies, the fact that both IU and social anxiety change is a step towards supporting the idea that IU may conceivably act as a causal factor for social anxiety.

Overall, the focus of this recent study is IU given it is an emerging factor that has recently been proposed as a transdiagnostic factor across anxiety emotional disorders (see Sub-Chapter 3.3. below), including being linked with social anxiety. The contribution of IU is investigated and compared only to FNE and AS, and not with other cognitive vulnerability factors, given FNE has been stamped as the principal feature of social anxiety, while AS has been identified as the amplifier of anxiety across anxiety disorders. Therefore, it is

hypothesised that these three cognitive factors may be the primary model of cognitive vulnerabilities related to social anxiety. This is the primary reason for this research studying only these three cognitive risk factors.

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This is also in accordance with the fundamental fears proposed by Carleton, Thibodeau, Osborne, Taylor and Asmundson (2014). This concept is a refinement of the previous concept proposed by Reis (1991) who suggested that AS, FNE and Injury/Illness Sensitivity (IIS) may be the fundamental fears that essentially contribute to anxiety-related psychopathologies. Furthermore, Carleton et al (2014) added IU and pain-related anxiety.

This concept proposed that each construct represents distinct reaction to common situations.

FNE is the hallmark of social anxiety, IU for worry, AS for panic disorder, IIS has been studied in the context of specific phobias, and lastly pain-related anxiety is associated with chronic pain. IU and FNE are more associated with mental and social consequences, while AS covers all physical, mental and social concerns. Conversely, both IIS and pain-related anxiety appear to specifically represent physical symptoms-related fears; fear of being injured and fear of chronic pain, respectively. Carleton et al (2014) reported from their factorial analyses that these fear-related cognitive factors are distinctive although the dimensions within constructs may overlap. Therefore, these fear-related cognitive factors could be further explored as either independent or interdependent variables. All in all, fundamental fears is an overarching framework for anxiety disorders that allows variables to be both transdiagnostic factors and disorder specific factors across anxiety disorders.

Moreover, Hong & Cheung (2014) conducted a meta-analysis and suggested that IU, FNE and AS are cognitive vulnerabilities associated with anxiety, while ruminative style, pessimistic inferential style and dysfunctional attitudes are more associated with depression.

Therefore, this makes a very neat and coherent rationale for IU, FNE and AS in anxiety disorders and social anxiety in particular. Specifically, a very neat and coherent rationale to investigate to what extent IU, which has been associated with worry, contribute to social anxiety.

Trait variables, such as neuroticism and perfectionism, are not the focus of this recent study assuming that the cognitive approach has been considered as the most influential approach (Brendan & Bradley, 1998; Butler, 1985; Emmelkamp, 1982; Morrison &

Heimberg, 2013; Ouimet et al., 2009; Rapee & Heimberg, 1997; Riskind, 1997; Stopa &

Clark, 1993). Trait variables have also been identified close to inherited characteristics and thus, may be less treatable/modifiable. Neuroticism, perhaps the best established trait variable that is relevant to anxiety, may not be of the same order with IU seeing as the relationship between neuroticism and social anxiety is mediated by cognitive variables (i.e. Hong, 2013;

McEvoy & Mahoney, 2012). Although perfectionism has been proposed by some as a cognitive transdiagnostic factor within anxiety models (e.g. Levinson et al., 2015), others

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have argued that it is fundamentally a trait variable (e.g. Hong, 2013; Hong & Cheung, 2014;

Newby et al., 2017).

Once the proposed model involving IU, FNE and AS has been supported, further investigation expanding the model is possible. This may involve either other cognitive risk factors, for instance rumination, self-esteem and self-presentation or trait variables, such as neuroticism and perfectionism would be interesting.