Comparing Patient Assessment Tools for Social Anxiety in Systemic Sclerosis

anxiety checked off on list
anxiety checked off on list
The BFNE-S was determined to be the best self-reported tool for measuring patient social fears.

The short-form, 8-item Brief Fear of Negative Evaluation (BFNE-S) scale was found to be superior to the BFNE-II and BFNE-8 versions in the assessment of appearance-based social fears in patients with systemic sclerosis (SSc), according to study results published in Arthritis Care & Research.

Although many patients with conditions that visibly alter their appearance experience fear of negative evaluation and psychosocial distress, this phenomenon has not been extensively investigated in the SSc population. Researchers aimed to clarify which method would be the most suitable for measuring these fears and anxieties.

A total of 1010 patients (mean age, 55.5 years; 88% women) with SSc in the Scleroderma Patient-Centered Intervention Network (SPIN) Cohort were included in the study. Participants completed the 12-item BFNE-II, and the 8-item BFNE-8 and BFNE-S scores were then derived from the BFNE-II responses. The results were examined for validity and reliability via factor analysis, Cronbach’s alpha, and Pearson product-moment correlations and were compared with a variety of accepted social and behavioral assessments.

All 3 versions of the BFNE scale demonstrated acceptable fit in single-factor models, with excellent Cronbach’s alphas (BFNE-8, 0.96; BFNE-S, 0.97; BFNE-II, 0.98). All formats of the scale had similar relationships with standard anxiety and depression assessments, exhibiting good alpha scores that ranged from 0.89 to 0.96.

Structural validity was verified for all versions of the scale using one-factor structures. Convergent validity was confirmed with powerful positive correlations for social anxiety measures and divergent validity was confirmed with weak negative correlations with age. There was also high intercorrelation among the 3 versions (rs = 0.99).

Since the 12-item BFNE-II did not exhibit any improved measuring ability compared with the 8-item scales, the latter short-form versions were preferable. Of the two 8-item scales, the BFNE-S was the more extensively studied tool and had previously shown strong validity in other populations. Therefore, the researchers chose the BFNE-S as the recommended method of assessing fear of negative evaluation in patients with SSc.

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Study limitations included the administration of only the BFNE-II rather than all 3 versions, which could have influenced results due to changes in context and item order. The investigators also used a convenience sample of patients with SSc, which may not represent the larger SSc patient population.

Although all 3 versions of the scale were found to be psychometrically sound, the authors determined the BFNE-S to be the best self-reported tool for measuring patient fear of negative evaluation. Clinicians should adopt the use of the BFNE-S to accurately reflect the social fears and anxieties of patients who have undergone visible changes in appearance.


Fox RS, Kwakkenbos L, Carrier M-E, et al. Validation of the brief fear of negative evaluation scale-II in patients with systemic sclerosis: a scleroderma patient-centered intervention network cohort study [published online February 6, 2018]. Arthritis Care Res. doi:10.1002/acr.23532

This article originally appeared on Rheumatology Advisor