Behavioural Psychotherapy, 1988, 16, 15-22

The Three Systems Model of Fear and

Anxiety: Implications for Assessment of
Social Anxiety

Anne R. Douglas Gartnavel Royal Hospital,

Glasgow
William R. Lindsay Royal Dundee Liff Hospital
Dundee
and D . Neil Brooks Department of Psychological Medicine,
University of Glasgow, Glasgow
It has been argued that verbal reports and questionnaire data may be
constrained by cultural and social demands to the extent that they are
unlikely to show concordance with more direct measures of behavioural
and physiological anxiety. The present report investigates this hypothesis
with reference to social anxiety. It was found that physiological and
cognitive questionnaites were good predictors of physiological anxiety
and cognitions in a social interaction test. A behavioural questionnaire,
however, was a poor predictor of actual behaviour. In the social interac-
tion test, which was designed to produce anxiety, there was a high degree
of concordance on all the measures except non-verbal behaviour and heart
rate. Because behaviour ratings showed least concordance and the poorest
predictive validity, it was suggested that a behavioural assessment alone
may give an erroneous picture of a person's overall social anxiety.

Several authors have argued that assessment and treatment of anxiety and
phobic states should take account of the three systems model of fear and
emotion (Lang, 1968; Rachman, 1977). The theory has been quickly incor-
porated into clinical practice and it has been proposed that treatment should fit
the patient's response patterns in the context of the cognitive-verbal system,
the behavioural system and the physiological system of anxiety (Lang et al.,
1972; Hodgson and Rachman, 1974; Rachman and Hodgson, 1974; Ost et
al., 1981). One problem from an assessment point of view is that it has been

Reprint requests should be addressed to Dr W . R. Lindsay, Psychology Department, Royal

Dundee Liff Hospital, Dundee DD2 5NF, Scotland.

0141-3473/88/010015 + 08 $03.00/0 © 1988 British Association for Behavioural Psychotherapy

16 A. R. Douglas et al.

shown that the thtee systems do not cotrelate in any simple relationship. It
may be that under conditions of high arousal there is greater concordance, but
often the systems seem not to correlate at all (Lang, 1971; Lang and Lazovik,
1963; Lang et al., 1972; Hodgson and Rachman, 1974; Rachman and
Hodgson, 1974).
Of the three systems, the cognitive/verbal component has been the most
difficult to define. Generally, a questionnaire or verbal report has been used to
measure this anxiety system. However, questionnaires have also been used as
an indirect measure of behavioural and physiological systems. In an examin-
ation of the theory, Hugdahl (1981) questions the extent to which a verbal
report is an accurate perception of the behavioural and physiological system, or
is mediated by cultural and situational factors. Certainly Lang (1978) feels that
language as measured by questionnaire data is heavily constrained by cultural
and social demands, and for this reason questionnaire data are unlikely to show
concordance with more direct measures of the behavioural and physiological
systems. Hugdahl writes that we do not know whether "the increased
subjective intensity was caused by a perception of an increased heart rate, or if
it constituted a dimension of its own, dissociated from the autonomic
component".
Despite the problems of lack of concordance, desynchrony and cultural
constraints in the three systems of anxiety, as clinicians we continue to use
questionnaires to gather data about the feelings experienced by clients in the
components of anxiety. Indeed, Lick and Katkin (1977) have recommended
that fear questionnaires should be deliberately constructed to measure all three
anxiety response systems.
Clearly, there may be a serious clinical problem of validity. In effect, data
from questionnaires designed to test behavioural or physiological components
of anxiety may be culturally and socially mediated to the extent that they all
reflect simply the cognitive component of anxiety rather than those com-
ponents which they purport to measure. This lack of validity would be further
compounded by desynchrony and discordance between the cognitive com-
ponent and the other two systems.
The present study is designed to investigate these problems with reference
to social anxiety. Subjects completed questionnaires to assess their responses
on the three anxiety systems. These data were then compared to their actual
performance under conditions designed to produce high social anxiety. It was
hypothesized that (1) the self-report questionnaires, taken as indirect measures
of the three systems, would not predict social anxiety in the actual situation
(following Hugdahl, 1981 and Lang, 1978), and (2) that under conditions of
high anxiety in vivo, there would be considerable concordance among the three
systems (following Rachman and Hodgson, 1974).
 Three systems model of fear 17

Method

Subjects
All subjects had to meet the following inclusion criteria:
(1) Have anxiety in a wide range of social situations as the major presenting
complaint.
(2) No other psychiatric problem in immediate need of treatment.
(3) No psychotic or organic symptoms.
(4) No concurrent drug or drink problem.
Twenty-eight subjects were included in the present experiment. There
were 18 females and 10 males, with a mean age of 33 years (18—64).
The fear survey schedule (Wolpe and Lang, 1974) was used at an initial
screening device to select only subjects who scored at least one standard
deviation above the mean on the social items (computed according to
Richardson and Tasto, 1976).

Assessment

Self-report questionnaires
Autonomk system. The subjects assessed their physiological anxiety on the
modified somatic perception questionnaire (MSPQ) (Mandler et al., 1958;
Main and Waddel, 1982; Main, 1983). This 26-item questionnaire asks
subjects to assess various aspects of their autonomic activity.

Behavioural system. Subjects reported their social behaviour on a social

situations questionnaire (Bryant and Trower, 1974). This measure is widely
used to assess perception of social behaviour in, degree of difficulty in, and
avoidance of different social situations. The first part consists of 30 items
which deal with difficulties in social situations (SSQD) and the second part has
22 items which deal with the frequency with which subjects are in different
social settings (SSQF).

Cognitive system. The social anxiety self-statement check list (SASSC) was
designed for the present study to measure the negative self-statements of
socially anxious subjects. The questionnaire consists of 16 negative self-
statements to be rated in terms of frequency of occurrence on a scale of 0-3. A
detailed description can be obtained from the authors.

Assessment in the social situation

Physiological system. Pulse rate was recorded continuously through a
18 A. R. Douglas et al.

photoelectric plethysmograph attached to the subject's right thumb, and the

signal was displayed on a multimeter in digital form as beats per minute.
Readings were taken at 15-second intervals over a 5-minute period, and the
pulse rate used as a final measure was the average over 20 readings.
After the social interaction test, subjects were asked to give a self-report of
their perceived physiological anxiety. This was done on a simple Lickert fear
thermometer rated 0—10.

Behavioural system. The subject's behaviour was assessed in the social

interaction test (SIT) (adapted from Marzillier et al., 1976; Ost et al., 1981).
The subject participated in a short conversation with an unknown person of the
opposite sex and the conversation was videotaped for later analysis. The
subject's instructions were to initiate and maintain a conversation for at least 5
minutes with the other person. The SIT was video-recorded and the subject's
behaviour was then rated by two independent raters blind to the experimental
hypothesis.
The rating scale used was that of Ost etal. (1981) and Trower etal. (1978).
The items were as follows: volume, tone, pitch, clarity, pace of speech, speech
disturbance, proximity, orientation, facial expression, gaze, posture, gesture,
length of speech, meshing, turn-taking and question asking. After training,
the raters' interrater reliability was in excess of 70% absolute agreement.
Disagreements of more than two scale points were found in less than 8% of the
total ratings.

Cognitive system. Immediately after the SIT, subjects completed a Lickert

scale fear thermometer which asked them to rate how much difficulty they had
experienced in thinking clearly during the conversation. Again the scale was
graded from 0—10. The SASSC was again administered with instructions to
answer according to how they had felt during the SIT.

Procedure
Subjects first had an hour-long interview to determine their suitability for the
project and to fill out the screening measures. Subjects then completed the
questionnaires. Finally, they participated in the SIT and filled out the
questionnaires and fear thermometers.

Results
Hypothesis 1 stated that self-report questionnaires would not predict actual
responses in the three systems. This was tested by correlating the various
measures taken and the results are shown in Table 1. The SSQF and SSQD do
 TABLE 1. Intercorrelations between measures

Self-report questionnaires Social interaction test

Non-
SASSC1 MSPQ SSQF SSQD Fear A Fear C SASSC2 HR Verbal verbal

SASSC1 0-523** 0-075 0-215 0-427* 0-362 0-441* 0-284 0-2 0-01
Self-report MSPQ 0-059 0-358 0-624** 0-4* 0-614** 0-733** 0-415* 0-24
questionnaire SSQF 0-213 0-03 0-041 0-243 -0-035 0-148 -0-124
. SSQD 0-178 0-147 0-354 0-178 0-411* 0-013
Fear A 0-71** 0-654** 0-414* 0-371* 0-107
Social Fear C 0-738** 0-347 0-422* 0-254
SASSC2 0-356 0-725** 0-362
interaction HR 0-229 -0-15
test Verbal 0-587**
Non-verba

** = P < 0-01, * = P < 0-05, SASSC, social anxiety self-statements checklist; MSPQ, modified somatic perception questionnaire; SSQF, social situations
questionnaire (frequency); SSQD, social situations questionnaire (difficulty); Fear A, self-rating of physical anxiety; Fear C, ratings of problems with cognition;
HR, heart rate; Verbal, ratings of verbal behaviour; Non-verbal, ratings of non-verbal behaviour.
20 A. R. Doug/as et al.

not consistently predict behaviour in the SIT. The only significant correlation
is between SSQD and verbal behaviour (r = 0-411, P < 0-05). However, it
is clear that the MSPQ has correlated significantly and positively with heart
rate(r = 0-733, P < 0-01) and fear A (r = 0-624, P < 0-01), which were
the two measures of physiological anxiety in the SIT.
Interestingly, the MSPQ shows a significant postive correlation with the
cognitive measures of SASSC1 (r = 0-523, P < 0-01), fearC (r = 0-4, P <
0-05) and SASSC 2 (r = 0-614, P < 0-01). There is also a significant
relationship between the MSPQ and the behavioural measure of verbal ratings.
The SASSC 1 correlates with the SASSC2 (r = 0-441, P < 0-05), and only just
fails to correlate significantly with fear C (it falls short by 0-005).
Hypothesis 2 predicted concordance between the three systems in this
high anxiety situation. We can see that the physiological scale fear A correlates
with heart rate (r = 0-414, P < 0-05), the behavioural measure of verbal
ratings (r = 0-37 1, P < 0-05), and two cognitive indices; fear C (r = 0-71,
P < 0-01) and SASSC2 (r = 0-654, P< 0-01). These two cognitive measures
further correlate with each other (r — 0-738, P < 0-01). Verbal ratings
correlate with fear C (r = 0-422, P < 0-05) and SASSC2 (r = 0-725, P <
0-01). Heart rate fails to correlate with any measure apart from fear A (r =
0-414, P < 0-05). Non-verbal ratings do not correlate with anything other
than verbal ratings (r = 0-587, P < 0-01).

Discussion
In relation to hypothesis 1, it seems that some self-report questionnaires are
good at predicting actual responses in a real situation. The MSPQ shows a high
positive correlation with heart rate and self-perception of physical anxiety. The
SASSC correlated significantly with the cognitive measures taken during the
SIT. The SSQ, however, was not a good predictor of behavioural ratings taken
during the SIT, correlating positively on only one of four measures. Compar-
ing across anxiety systems, the MSPQ was the best predictor of anxiety in all
systems. It correlated significantly and positively with all the physiological
and cognitive measures. The behavioural measures seemed not to relate
particularly strongly to each other or the other anxiety systems.
Turning to hypothesis 2, the best predictor of all three anxiety systems was
fear A. The authors are aware that fear A is not a pure physiological measure
and has more cognitive mediation than heart rate, since it is a self-report of
physiological anxiety. Nevertheless, it does correlate with all other indices
except non-verbal behaviour. It is noteworthy that in this study merely asking
the subject how physically anxious he or she feels is a good indication of the
three systems of anxiety. Verbal behaviour also correlates significantly with
 Three systems model of fear 21

everything except heart rate. Overall, there is a high degree of concordance

between fear A, cognitive measures and verbal behaviour. The measures which
fail to relate with the others are non-verbal behaviour and heart rate.
It is worth examining the behavioural measures in this study. Apart from
verbal ratings, they show the least concordance and the worst predictive
validity. The SSQ is a widely used social skills questionnaire and non-verbal
behaviour is seen as extremely important by social psychologists and clinical
psychologists alike (Argyle, 1975). Yet here, those variables relate poorly with
other aspects of anxiety. It may be that a behavioural assessment alone gives an
erroneous picture of how a person thinks and feels in relation to their anxiety.
There are very few studies which look at the predictive validity of
psychological assessments within the context of the three systems theory of
anxiety. Given the problems of cognitive mediation and variable concordance
between the systems, it would seem important to introduce such a procedure
into the development of many assessments. Certainly in the present study, one
widely used assessment technique was shown to be a poor predictor while
others seemed more reasonable.

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(Date received: July 1986)