Anxiety for both the fear and avoidance sub-scores of the GARS. Unsurprisingly, we observed the highest correlation for social anxiety, confirming the diagnostic relevance of reduced eye contact in social phobia (see Table 4). Divergent validity was confirmed by the TenapanorMedChemExpress Tenapanor negative correlation with extraversion, conscientiousness and to some extent agreeableness. However, negative correlations were much lower, suggesting that normal variants in these variables are less predictive for fear-associated reductions in eye contact. The association between the total GARS score and social anxiety (SIAS) remained significant after controlling for trait anxiety (STAI-t): GARS-total/SIAS rpart = .56. Using the situational factors for correlation analyses, we found higher correlations for situations of social threat than everyday situations. In particular, fear and avoidance of eye gaze in socially-threatening situations (Roc-A biological activity Factor 2) were the better predictors for social anxiety (r = .63 and r = .61) than fear and avoidance in everyday situations (factor 1; r = .42 and r = .43; Fisher’s Z = 3.74; p<.001).Validity--Gaze anxiety and avoidance in GSADGroup differences between GASD patients and matched healthy controls were calculated for the GARS subscales and the two situational factors (see Table 5). Overall, GSAD patients reported higher levels of gaze fear and avoidance than healthy controls (Fig 1). Effect size (Cohen's d) was 2.47, indicating an overlap of the two distributions of about 23 . As expected, the GSAD patients displayed markedly enhanced fear and avoidance in both everyday (factor 1) and social threat situations (factor 2). However, a three-way ANOVA with group (HC vs. GSAD), scale (fear vs. avoidance), and situation (everyday vs. threat) revealed a significant group x situation interaction (F[1,61] = 27.68; p<.001), indicating a stronger tendency to report high levels of fear and avoidance of eye gaze in threatening situations in GSAD, as compared to healthy controls. Calculation of effect sizes (Cohen's d) confirmed the greater difference in gaze fear and avoidance in GSAD patients in social threat situations (factor 2). Exploratory analysis of the descriptive data in the additional GARS items revealed consistently higher scores on the anxiety-associated attributions of gaze avoidance in patients with GSAD (see Table 6).Table 4. Concurrent and discriminant validity of the GARS. Correlations of the total scale (Tot), factor 1 (F1 "Everyday situations") and factor 2 (F2 "Situations with social threat") with social anxiety (SIAS), fear of negative evaluation (BFNE), trait anxiety (STAI-t), depression (CES-D), and the big five personality dimensions (n = 328). GARS-fear Scale SIAS BFNE STAI-t CES-D Neuroticism Extraversion Conscientiousness Openness Agreeableness doi:10.1371/journal.pone.0150807.t004 Tot .63 .36 .45 .37 .43 -.32 -.25 -.03 -.09 F1 .42 .20 .31 .26 .27 -.24 -.19 -.02 -.13 F2 .63 .38 .44 .36 .42 -.29 -.22 -.03 -.05 Tot .64 .34 .42 .36 .43 -.30 -.20 -.09 -.15 GARS-avoidance F1 .43 .21 .31 .30 .31 -.22 -.16 -.03 -.21 F2 .61 .34 .39 .33 .40 -.28 -.18 -.09 .PLOS ONE | DOI:10.1371/journal.pone.0150807 March 3,7 /Gaze Anxiety Rating ScaleTable 5. Fear and avoidance of eye gaze in GSAD and matched healthy controls. GSAD (n = 33) Scale GARS Fear GARS Avoidance GARS SART.S23503 Total GARS Fear Factor 1 Factor 2 GARS Avoid. Factor 1 Factor 2 Age STAI (20?0) SIAS-D (0?8) BFNE (12?0) BDI-II (0?0) Neuroticism Extraversion Conscientiousness Openness Agreeab.Anxiety for both the fear and avoidance sub-scores of the GARS. Unsurprisingly, we observed the highest correlation for social anxiety, confirming the diagnostic relevance of reduced eye contact in social phobia (see Table 4). Divergent validity was confirmed by the negative correlation with extraversion, conscientiousness and to some extent agreeableness. However, negative correlations were much lower, suggesting that normal variants in these variables are less predictive for fear-associated reductions in eye contact. The association between the total GARS score and social anxiety (SIAS) remained significant after controlling for trait anxiety (STAI-t): GARS-total/SIAS rpart = .56. Using the situational factors for correlation analyses, we found higher correlations for situations of social threat than everyday situations. In particular, fear and avoidance of eye gaze in socially-threatening situations (factor 2) were the better predictors for social anxiety (r = .63 and r = .61) than fear and avoidance in everyday situations (factor 1; r = .42 and r = .43; Fisher’s Z = 3.74; p<.001).Validity--Gaze anxiety and avoidance in GSADGroup differences between GASD patients and matched healthy controls were calculated for the GARS subscales and the two situational factors (see Table 5). Overall, GSAD patients reported higher levels of gaze fear and avoidance than healthy controls (Fig 1). Effect size (Cohen's d) was 2.47, indicating an overlap of the two distributions of about 23 . As expected, the GSAD patients displayed markedly enhanced fear and avoidance in both everyday (factor 1) and social threat situations (factor 2). However, a three-way ANOVA with group (HC vs. GSAD), scale (fear vs. avoidance), and situation (everyday vs. threat) revealed a significant group x situation interaction (F[1,61] = 27.68; p<.001), indicating a stronger tendency to report high levels of fear and avoidance of eye gaze in threatening situations in GSAD, as compared to healthy controls. Calculation of effect sizes (Cohen's d) confirmed the greater difference in gaze fear and avoidance in GSAD patients in social threat situations (factor 2). Exploratory analysis of the descriptive data in the additional GARS items revealed consistently higher scores on the anxiety-associated attributions of gaze avoidance in patients with GSAD (see Table 6).Table 4. Concurrent and discriminant validity of the GARS. Correlations of the total scale (Tot), factor 1 (F1 "Everyday situations") and factor 2 (F2 "Situations with social threat") with social anxiety (SIAS), fear of negative evaluation (BFNE), trait anxiety (STAI-t), depression (CES-D), and the big five personality dimensions (n = 328). GARS-fear Scale SIAS BFNE STAI-t CES-D Neuroticism Extraversion Conscientiousness Openness Agreeableness doi:10.1371/journal.pone.0150807.t004 Tot .63 .36 .45 .37 .43 -.32 -.25 -.03 -.09 F1 .42 .20 .31 .26 .27 -.24 -.19 -.02 -.13 F2 .63 .38 .44 .36 .42 -.29 -.22 -.03 -.05 Tot .64 .34 .42 .36 .43 -.30 -.20 -.09 -.15 GARS-avoidance F1 .43 .21 .31 .30 .31 -.22 -.16 -.03 -.21 F2 .61 .34 .39 .33 .40 -.28 -.18 -.09 .PLOS ONE | DOI:10.1371/journal.pone.0150807 March 3,7 /Gaze Anxiety Rating ScaleTable 5. Fear and avoidance of eye gaze in GSAD and matched healthy controls. GSAD (n = 33) Scale GARS Fear GARS Avoidance GARS SART.S23503 Total GARS Fear Factor 1 Factor 2 GARS Avoid. Factor 1 Factor 2 Age STAI (20?0) SIAS-D (0?8) BFNE (12?0) BDI-II (0?0) Neuroticism Extraversion Conscientiousness Openness Agreeab.