1. 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.

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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%)

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

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

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

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

19. 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)

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

21. 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?

22. 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

23. 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

24. 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

25. Thank you! Questions? Leigh.brosof@louisville.edu