social anxiety case study analysis

Social Anxiety Disorder: A Comprehensive Case Study Analysis

Hearts racing and minds reeling, millions navigate a world where everyday interactions feel like walking through a minefield of judgment and scrutiny. This pervasive experience is the hallmark of social anxiety disorder, a condition that affects countless individuals worldwide, impacting their daily lives and overall well-being. To truly understand the complexities of this disorder and develop effective treatment strategies, researchers and clinicians often turn to case studies, which provide invaluable insights into the lived experiences of those grappling with social anxiety.

Understanding Social Anxiety Disorder

Social anxiety disorder, also known as social phobia, is characterized by an intense and persistent fear of social situations. Individuals with this condition experience overwhelming anxiety and self-consciousness in everyday social interactions, often fearing negative judgment or embarrassment. The impact of social anxiety extends far beyond mere shyness, significantly interfering with personal relationships, professional opportunities, and overall quality of life.

The prevalence of social anxiety disorder is staggering, affecting an estimated 7% of the global population. This translates to millions of individuals worldwide who struggle with the debilitating effects of this condition. From avoiding social gatherings to experiencing panic attacks in public spaces, the manifestations of social anxiety can be both diverse and profound.

To truly grasp the nuances of social anxiety disorder and develop effective treatment approaches, clinicians and researchers rely heavily on case studies. These in-depth analyses of individual experiences provide a wealth of information that cannot be captured by statistical data alone. By examining specific cases, professionals can identify patterns, explore unique manifestations, and refine treatment strategies to better serve those affected by social anxiety.

Case Study Background: Meet Sarah

In this comprehensive case study analysis, we’ll delve into the experience of Sarah, a 28-year-old marketing professional who has been grappling with social anxiety disorder for over a decade. Sarah’s journey offers valuable insights into the onset, progression, and treatment of this challenging condition.

Sarah grew up in a small town in the Midwest, describing herself as a shy and introverted child. While she had a close-knit group of friends throughout her school years, she often felt uncomfortable in large social gatherings or when required to speak in front of her class. However, it wasn’t until her college years that her anxiety began to escalate significantly.

The onset of Sarah’s more severe social anxiety symptoms coincided with her move to a large university in a bustling city. Suddenly thrust into an environment where she knew no one, Sarah found herself overwhelmed by the constant social interactions required in her new setting. She began experiencing intense physical symptoms, including rapid heartbeat, sweating, and trembling, whenever she had to participate in class discussions or attend social events.

As her symptoms worsened, Sarah sought help from the university’s counseling center. After a thorough assessment process, including interviews, questionnaires, and comprehensive social anxiety disorder tests , Sarah was diagnosed with social anxiety disorder. This diagnosis marked the beginning of her journey towards understanding and managing her condition.

Symptoms and Manifestations

Sarah’s experience with social anxiety disorder manifested in a variety of physical, cognitive, and behavioral symptoms. Physically, she reported experiencing:

1. Rapid heartbeat and palpitations 2. Excessive sweating, particularly on her palms and forehead 3. Trembling or shaking, especially in her hands 4. Nausea and stomach discomfort 5. Difficulty breathing or a sensation of choking

These physical symptoms often intensified in situations where Sarah felt she was being observed or evaluated, such as during presentations at work or when meeting new people.

Cognitively, Sarah’s social anxiety was characterized by persistent negative thought patterns and beliefs. She frequently experienced:

1. Intense fear of judgment or criticism from others 2. Excessive self-consciousness and hyper-awareness of her actions 3. Negative self-talk and self-criticism 4. Catastrophic thinking about potential social failures 5. Difficulty concentrating in social situations due to racing thoughts

These cognitive patterns significantly impacted Sarah’s ability to engage in social interactions and professional activities, often leading to a cycle of avoidance and increased anxiety.

Behaviorally, Sarah developed various avoidance strategies to cope with her anxiety. These included:

1. Declining invitations to social events or gatherings 2. Avoiding eye contact or speaking up in meetings at work 3. Using alcohol as a social lubricant to ease her anxiety 4. Overpreparation for presentations or social interactions to minimize potential mistakes 5. Relying heavily on digital communication to avoid face-to-face interactions

While these avoidance strategies provided temporary relief, they ultimately reinforced Sarah’s anxiety and limited her personal and professional growth.

Treatment Approach

Upon receiving her diagnosis, Sarah began a comprehensive treatment plan that incorporated both psychotherapy and medication management. The primary therapeutic approach used was Cognitive-Behavioral Therapy (CBT), a well-established and effective treatment for social anxiety disorder.

CBT sessions focused on helping Sarah identify and challenge her negative thought patterns and beliefs about social situations. Her therapist employed various techniques, including:

1. Cognitive restructuring to help Sarah recognize and reframe irrational thoughts 2. Mindfulness exercises to increase awareness of her anxiety symptoms and reduce their intensity 3. Role-playing exercises to practice social skills and build confidence 4. Gradual exposure to anxiety-provoking situations in a controlled environment

In addition to CBT, Sarah’s treatment plan included group therapy sessions specifically designed for individuals with social anxiety . These sessions provided a supportive environment where Sarah could practice social interactions and learn from others facing similar challenges.

To address the physical symptoms of her anxiety, Sarah’s psychiatrist prescribed a selective serotonin reuptake inhibitor (SSRI), which helped reduce the intensity of her anxiety symptoms and improved her overall mood.

A crucial component of Sarah’s treatment was exposure therapy, which involved gradually facing feared social situations in a structured and supported manner. This approach helped Sarah build confidence and develop more adaptive coping strategies. Some exposure exercises included:

1. Initiating conversations with strangers in low-pressure settings 2. Participating in social events without using alcohol as a crutch 3. Volunteering to lead presentations at work 4. Attending networking events in her industry

Throughout her treatment, Sarah also engaged in social skills training to improve her ability to navigate various social situations with greater ease and confidence.

Progress and Outcomes

As Sarah progressed through her treatment, she began to experience significant improvements in her social functioning and overall quality of life. In the short term, she reported:

1. Reduced physical symptoms of anxiety in social situations 2. Increased willingness to engage in social activities 3. Improved performance and confidence at work 4. Better ability to challenge and reframe negative thoughts

Over the long term, Sarah developed more effective strategies for managing her symptoms and maintaining her progress. She continued to practice the skills learned in therapy and gradually expanded her social circle. While she still experienced occasional anxiety in certain situations, she felt better equipped to handle these challenges without resorting to avoidance behaviors.

From Sarah’s perspective, the combination of CBT, medication, and exposure therapy was instrumental in her recovery. She particularly valued the practical skills she gained through therapy, which allowed her to approach social situations with greater confidence and self-compassion.

Analysis and Insights

Sarah’s case study offers valuable insights into the treatment of social anxiety disorder and highlights several key factors contributing to her success:

1. Comprehensive approach: The combination of psychotherapy, medication, and exposure techniques addressed multiple aspects of Sarah’s anxiety.

2. Personalized treatment plan: Sarah’s therapy was tailored to her specific needs and experiences, focusing on the situations that caused her the most distress.

3. Gradual exposure: The step-by-step approach to facing feared situations allowed Sarah to build confidence incrementally.

4. Skill development: Learning practical social skills and cognitive techniques provided Sarah with tools to manage her anxiety in real-world situations.

5. Supportive environment: Group therapy sessions offered a safe space for Sarah to practice social interactions and gain support from peers.

Despite the overall success of Sarah’s treatment, there were challenges encountered along the way. These included:

1. Initial resistance to exposure exercises due to fear of discomfort 2. Difficulty in consistently applying cognitive techniques during high-stress situations 3. Occasional setbacks or temporary increases in anxiety symptoms

Addressing these challenges required patience, persistence, and ongoing support from Sarah’s treatment team.

The insights gained from Sarah’s case have important implications for future social anxiety disorder case studies and treatment approaches. They highlight the need for:

1. Individualized treatment plans that address the unique manifestations of social anxiety in each patient 2. A focus on long-term skill development and coping strategies, rather than just symptom reduction 3. Integration of various therapeutic modalities to address different aspects of the disorder 4. Ongoing support and follow-up to maintain progress and prevent relapse

Sarah’s journey with social anxiety disorder illustrates the complex nature of this condition and the potential for significant improvement with appropriate treatment. Her case underscores the importance of a comprehensive, individualized approach that combines evidence-based therapies, medication when necessary, and ongoing support.

As research in the field of social anxiety continues to evolve, case studies like Sarah’s provide invaluable insights that inform future treatment strategies. They remind us that while social anxiety disorder can be a challenging condition, it is also highly treatable. With the right support and interventions, individuals like Sarah can learn to manage their symptoms effectively and lead fulfilling lives.

Looking ahead, the field of social anxiety research and treatment continues to advance. Emerging areas of focus include:

1. The role of virtual reality in exposure therapy for social anxiety 2. The potential of mindfulness-based interventions in managing anxiety symptoms 3. Exploration of the relationship between social anxiety and related conditions like OCD 4. Investigation into the potential benefits of social anxiety in certain contexts

As our understanding of social anxiety disorder deepens, so too does our ability to provide effective, compassionate care to those affected by this condition. Sarah’s story serves as a testament to the power of perseverance, evidence-based treatment, and the human capacity for growth and change in the face of significant challenges.

For individuals struggling with social anxiety, it’s important to remember that help is available. Whether you’re experiencing high-functioning social anxiety or more severe symptoms, seeking professional support can be a crucial first step towards managing your condition and improving your quality of life. With the right tools and support, it’s possible to navigate the complexities of social anxiety and build a life filled with meaningful connections and personal growth.

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“I Don’t Want to Bother You” – A Case Study in Social Anxiety Disorder

• First Online: 29 March 2023

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• Katharine E. Daniel 3 &
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Gi, a 34-year-old second-generation Korean American man, presented to treatment with pronounced and longstanding anxiety in many social situations, which significantly impaired his functioning (e.g., his perceived ability to run errands in crowded stores and care for his ill father). Gi engaged in cognitive behavior therapy (CBT) via telehealth during the COVID-19 pandemic. Key cognitions and biased cognitive processes that were maintaining his anxiety included a judgment that others frequently reject him, an assumption that if he expressed his own needs, then he would be unreasonably burdening others, and a core belief that he was incompetent, along with a pervasive tendency to make negative interpretations about his abilities in most social situations. He experienced marked functional improvements and reduced anxiety throughout his 17-session course of treatment. Gi’s case and treatment are detailed throughout this chapter to illustrate how individual CBT for social anxiety disorder can be implemented. Special discussion of how the clinician continuously and collaboratively modified her case conceptualization and intervention approaches with reference to aspects of Gi’s identities and in response to her own missteps are offered throughout.

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Daniel, K.E., Teachman, B.A. (2023). “I Don’t Want to Bother You” – A Case Study in Social Anxiety Disorder. In: Woud, M.L. (eds) Interpretational Processing Biases in Emotional Psychopathology . CBT: Science Into Practice. Springer, Cham. https://doi.org/10.1007/978-3-031-23650-1_16

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8 Treatment of Social Anxiety Disorder: A Case Complicated by Panic Disorder

• Published: February 2013
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Chapter 8 covers the treatment of Social Anxiety Disorder (SAD), and includes information about the condition, epidemiological considerations, the case study, assessment strategy and case formulation, intervention model and course of treatment, strategies for handling homework non-compliance, handling poor attendance and relapse, relapse prevention, post-treatment assessment, basic science for this case/condition, alternative strategies to consider, ethical consideration, cultural factors, clinical implications, and avoiding common mistakes during treatment.

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• Test for Panic Disorder
• Online Therapy for Panic and Anxiety
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• Social Phobia/Anxiety Case Study: Jim

Jim was a nice looking man in his mid-30’s.  He could trace his shyness to boyhood and his social anxiety to his teenage years.  He had married a girl he knew well from high school and had almost no other dating history.  He and his wife, Lesley, had three children, two girls and a boy.

At our first meeting, Jim was very shy and averted his eyes from me, but he did shake hands, respond, and smile a genuine smile.  A few minutes into our session and Jim was noticeably more relaxed.  "I’ve suffered with this anxiety for as long as I can remember", he said.  "Even in school, I was backward and didn’t know what to say.  After I got married, my wife started taking over all of the daily, family responsibilities and I was more than glad to let her."

If there was an appointment to be made, Lesley made it.  If there was a parent-teacher conference to go to, Lesley went to it.  If Jim had something coming up, Lesley would make all the social arrangements.  Even when the family ordered takeout food, it was Lesley who made the call.  Jim was simply too afraid and shy.

Indeed, because of his wife, Jim was able to avoid almost all social responsibility -- except at his job.  It was his job and its responsibilities that brought Jim into treatment.

Years earlier, Jim had worked at a small, locally-owned record and tape store, where he knew the owner and felt a part of the family.  The business was slow and manageable and he never found himself on display in front of lines of people.  Several years previously, however, the owner had sold his business to a national record chain, and Jim found himself a lower mid-range manager in a national corporation, a position he did not enjoy.

"When I have to call people up to tell them that their order is in," he said, "I know my voice is going to be weak and break, and I will be unable to get my words out.  I’ll stumble around and choke up....then I’ll blurt out the rest of my message so fast I’m afraid they won’t understand me.  Sometimes I have to repeat myself and that is excruciatingly embarrassing........"

Jim felt great humiliation and embarrassment about this afterwards: he couldn’t even make a telephone call to a stranger without getting extremely anxious and giving himself away.  That was pretty bad!  Then he would beat himself up.  What was wrong with him?  Why was he so timid and scared?  No one else seemed to be like he was.  He simply must be crazy!  After a day full of this pressure, anxiety and negative thinking, Jim would leave work feeling fatigued, tired, and defeated.

Meanwhile, his wife, being naturally sociable and vocal, continually enabled Jim not to have to deal with any social situations.  In restaurants, his wife always ordered.  At home, she answered the telephone and made all the calls out.  He would tell her things that needed to be done and she would do them.

He had no friends of his own, except for the couples his wife knew from her work.  At times when he felt he simply had to go to these social events, Jim was very ill-at-ease, never knew what to say, and felt the silences that occurred in conversation were his fault for being so backward.  He knew he made everyone else uncomfortable and ill-at-ease.

Of course, the worst part of all was the anticipatory anxiety Jim felt ahead of time – when he knew he had to perform, do something in public, or even make phone calls from work.  The more time he had to worry and stew about these situations, the more anxious, fearful and uncomfortable he felt.

REMARKS: Jim presented a very typical case of generalized social phobia/social anxiety.  His strong anticipation and belief that he wouldn’t do well at social interactions and in social events became a self-fulfilling prophecy, and his belief came true: he didn’t do well.  The more nervous and anxious he got over a situation, and the more attention he paid to it, the more he could not perform well.  This was a very negative paradox or "vicious cycle" that all people with social anxiety get stuck in.  If your beliefs are strong that you will NOT do well, then it is likely you will not do well.  Therefore, thoughts, beliefs, and emotions need to be changed.

The depression (technically "dysthymia") that comes about after the anxious event continued to fuel the fire.  "I’ll never be able to deal with this," Jim would tell himself, thus constantly reinforcing the fact that he saw himself as a failure and a loser.

Unusual in this situation is that Jim’s wife remained loyal to him, understood his problem to some extent, and even seemed to enjoy her role as the family’s "social director".  The more and more she did for Jim, the more and more he could avoid.  It got so bad that Jim, who loved to listen to new albums and read new books -- could not even go to stores or to the library.  He would tell his wife what to buy and she would buy it.  She even kept track of when the library books were due and made sure she took them back on time.

This family situation is unusual because most people with social anxiety/social phobia have an extremely difficult time making and continuing personal relationships -- because of self-consciousness and the need for more privacy than most other people.  In fact, social phobia ranks among one of the highest psychological disorders when it comes to failed relationships, divorce, and living alone.

TREATMENT for Jim consisted of the normal course of cognitive strategies so that he would relearn and rethink what he was doing to himself.  He was cooperative from the beginning, and progressed nicely doing therapy.  He took each of the practice handouts and spent time each day practicing.  He made a "special time" for himself that his family respected and he used this place and time to practice the cognitive strategies his mind had to learn.

His biggest real-life fear, speaking to another person in public, was not really a speaking problem; it was an anxiety problem.  There was nothing wrong with Jim’s voice, his reading ability, or his speaking ability.  Jim was a bright man who had associated great anxiety around these social events in public situations.

The course of treatment here is NOT to practice!  In fact, practicing would just draw attention to what Jim perceived was the problem: his voice, his awkwardness, his perceived inability to speak to others.  Thus, it would reinforce the very behaviors we do not want to reinforce.

Instead, Jim worked on paradoxes.  We deliberately goofed-up.  We tried to make as many mistakes as possible.  We injected humor into the situation and found that when he exaggerated his fears, he thought this was funny.  Although more is involved than just this, the concept here is to de-stress the situation and enable the person to see it for what it is: NO BIG DEAL!  If you make a mistake, SO WHAT?  Everyone else does too!

Over the weeks, before group therapy began, Jim did a number of interesting things in public that began proving to him that he was NOT the center of attention, and it just didn’t matter if he made a mistake or two.  After all, he was human just like everyone else.  It’s this idea of perfectionism, of always having to "do your best" that must be broken down.  Jim was human; humans make mistakes; so what?  It was certainly nothing to get upset about.  In fact, as time went by, it become even more funny and humorous, rather than humiliating or embarrassing.

After completion of the behavioral group therapy, Jim had an opportunity for advancement in his company, which he now felt comfortable to take.  The promotion entailed holding weekly meetings in which he was in charge.  He would have to do some public speaking and respond to his employees’ questions.  By this time, Jim was feeling much more comfortable and much less anxious about the whole situation.  "I think I’ll deliberately goof up," he joked to me before the start of his new job.  "It would be interesting to see how everyone else responds."

To say that Jim did not have any anticipatory anxiety before taking this position or before making his weekly presentations would be inaccurate.  The difference was now they were manageable.  They were simply minor roadblocks that could be overcome.  Jim’s thinking about social events and activities had changed a great deal since the first day I saw him in therapy.

I talked to Jim a few months ago and everything was going well.  His responsibilities at work had increased slightly, but Jim now had the ability and beliefs to deal with them.  He was much more confident and had a feeling of being in control.  He was doing more around the house and his wife was a little surprised at his metamorphosis.  Luckily, this did not change the marriage dynamics adversely, and the last time I talked with him, Jim had become a father again: another little boy.

"He’s the last," Jim said, laughing over the phone, "I can’t get too distracted.  I’ve got too many speeches to give now."

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Social Anxiety

• A New Test for Social Anxiety Disorder
• Why We Prefer "Social Anxiety" to "Social Phobia"
• Visiting The Social Anxiety Therapy Group
• Thinking Problems: Correcting Our Misperceptions
• What is Social Anxiety/Social Phobia?
• Personal Statements for Social Anxiety
• The Scorpion's Sting: An Anxiety Parable
• Social Anxiety Questions and Answers
• Social Anxiety and Misdiagnosis
• Social Anxiety Disorder and Medication
• The Least Understood Anxiety Disorder
• What are "The Phobias"?
• Social Anxiety: Past and Present
• What is the Difference Between Panic Disorder and Social Anxiety Disorder?
• Ask Dr. Richards About Anxiety Disorders

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The Anxiety Network began in 1995 due to growing demand from people around the world wanting help in understanding and overcoming their anxiety disorder.  The Anxiety Clinic of Arizona and its website, The Anxiety Network, received so much traffic and requests for help that we found ourselves spending much of our time in international communication and outreach.  Our in-person anxiety clinic has grown tremendously, and our principal internet tool, The Anxiety Network, has been re-written and re-designed with focus on the three major anxiety disorders: panic, social anxiety, and generalized anxiety disorder.  

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In 1997, The Social Anxiety Association , a non-profit organization, was formed and now has its own website.

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Open Access

Peer-reviewed

Research Article

Social anxiety in young people: A prevalence study in seven countries

Roles Conceptualization, Formal analysis, Methodology, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

Affiliation Resilience Research Centre, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada

Roles Conceptualization, Methodology, Writing – review & editing

• Philip Jefferies, 
• Michael Ungar

• Published: September 17, 2020
• https://doi.org/10.1371/journal.pone.0239133
• Peer Review
• Reader Comments

Social anxiety is a fast-growing phenomenon which is thought to disproportionately affect young people. In this study, we explore the prevalence of social anxiety around the world using a self-report survey of 6,825 individuals (male = 3,342, female = 3,428, other = 55), aged 16–29 years (M = 22.84, SD = 3.97), from seven countries selected for their cultural and economic diversity: Brazil, China, Indonesia, Russia, Thailand, US, and Vietnam. The respondents completed the Social Interaction Anxiety Scale (SIAS). The global prevalence of social anxiety was found to be significantly higher than previously reported, with more than 1 in 3 (36%) respondents meeting the threshold criteria for having Social Anxiety Disorder (SAD). Prevalence and severity of social anxiety symptoms did not differ between sexes but varied as a function of age, country, work status, level of education, and whether an individual lived in an urban or rural location. Additionally, 1 in 6 (18%) perceived themselves as not having social anxiety, yet still met or exceeded the threshold for SAD. The data indicate that social anxiety is a concern for young adults around the world, many of whom do not recognise the difficulties they may experience. A large number of young people may be experiencing substantial disruptions in functioning and well-being which may be ameliorable with appropriate education and intervention.

Citation: Jefferies P, Ungar M (2020) Social anxiety in young people: A prevalence study in seven countries. PLoS ONE 15(9): e0239133. https://doi.org/10.1371/journal.pone.0239133

Editor: Sarah Hope Lincoln, Harvard University, UNITED STATES

Received: March 11, 2020; Accepted: August 31, 2020; Published: September 17, 2020

Copyright: © 2020 Jefferies, Ungar. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All data files are available from the Open Science Framework repository (DOI: 10.17605/OSF.IO/VCNF7 ).

Funding: The author(s) received no specific funding for this work.

Competing interests: I have read the journal's policy and the authors of this manuscript have the following competing interests: Unilever funds the lead author's research fellowship at Dalhousie University's Resilience Research Centre, though in no way have they directed this research, its analysis or the reporting or results.

Introduction

Social anxiety occurs when individuals fear social situations in which they anticipate negative evaluations by others or perceive that their presence will make others feel uncomfortable [ 1 ]. From an evolutionary perspective, at appropriate levels social anxiety is adaptive, prompting greater attention to our presentation and reflection on our behaviours. This sensitivity ensures we adjust to those around us to maintain or improve social desirability and avoid ostracism [ 2 ]. However, when out of proportion to threats posed by a normative social situation (e.g., interactions with a peer group at school or in the workplace) and when impairing functioning to a significant degree, it may be classified as a disorder (SAD; formerly ‘social phobia’; [ 3 ]). The hallmark of social anxiety in western contexts is an extreme and persistent fear of embarrassment and humiliation [ 1 , 4 , 5 ]. Elsewhere, notably in Asian cultures, social anxiety may also manifest as embarrassment of others, such as Taijin kyofusho in Japan and Korea [ 6 ]. Common concerns involved in social anxiety include fears of shaking, blushing, sweating, appearing anxious, boring, or incompetent [ 7 ]. Individuals experiencing social anxiety visibly struggle with social situations. They show fewer facial expressions, avert their gaze more often, and express greater difficulty initiating and maintaining conversations, compared to individuals without social anxiety [ 8 ]. Recognising difficulties can lead to dread of everyday activities such as meeting new people or speaking on the phone. In turn, this can lead to individuals reducing their interactions or shying away from engaging with others altogether.

The impact of social anxiety is widespread, affecting functioning in various domains of life and lowering general mood and wellbeing [ 9 ]. For instance, individuals experiencing social anxiety are more likely to be victims of bullying [ 10 , 11 ] and are at greater risk of leaving school early and with poorer qualifications [ 11 , 12 ]. They also tend to have fewer friends [ 13 ], are less likely to marry, more likely to divorce, and less likely to have children [ 14 ]. In the workplace, they report more days absent from work and poorer performance [ 15 ].

A lifetime prevalence of SAD of up to 12% has been reported in the US [ 16 ], and 12-month prevalence rates of .8% have been reported across Europe [ 17 ] and .2% in China [ 18 ]. However, there is an increasing trend to consider a spectrum of social anxiety which takes account of those experiencing subthreshold or subclinical social anxiety, as those experiencing more moderate levels of social anxiety also experience significant impairment across different domains of functioning [ 19 – 21 ]. Therefore, the proportion of individuals significantly affected by social anxiety, which include a substantial proportion of individuals with undiagnosed SAD [ 8 ], may be higher than current estimates suggest.

Studies also indicate younger individuals are disproportionately affected by social anxiety, with prevalence rates at around 10% by the end of adolescence [ 22 – 24 ], with 90% of cases occurring by age 23 [ 16 ]. Higher rates of social anxiety have also been observed in females and are associated with being unemployed [ 25 , 26 ], having lower educational status [ 27 ], and living in rural areas [ 28 , 29 ]. Leigh and Clark [ 30 ] have explored the higher incidence of social anxiety in younger individuals, suggesting that moving from a reliance on the family unit to peer interactions and the development of neurocognitive abilities including public self-consciousness may present a period of greater vulnerability to social anxiety. While most going through this developmentally sensitive period are expected to experience a brief increase in social fears [ 31 ], Leigh and Clark suggest that some who may be more behaviourally inhibited by temperament are at greater risk of developing and maintaining social anxiety.

Recent accounts suggest that levels of social anxiety may be rising. Studies have indicated that greater social media usage, increased digital connectivity and visibility, and more options for non-face-to-face communication are associated with higher levels of social anxiety [ 32 – 35 ]. The mechanism underpinning these associations remains unclear, though studies have suggested individuals with social anxiety favour the relative ‘safety’ of online interactions [ 32 , 36 ]. However, some have suggested that such distanced interactions such as via social media may displace some face to face relationships, as individuals experience greater control and enjoyment online, in turn disrupting social cohesion and leading to social isolation [ 37 , 38 ]. For young people, at a time when the development of social relations is critical, the perceived safety of social interactions that take place at a distance may lead some to a spiral of withdrawal, where the prospect of normal social interactions becomes ever more challenging.

Therefore, in this study, we sought to determine the current prevalence of social anxiety in young people from different countries around the world, in order to clarify whether rates of social anxiety are increasing. Specifically, we used self-report measures (rather than medical records) to discover both the frequency of the disorder, severity of symptoms, and to examine whether differences exist between sexes and other demographic factors associated with differences in social anxiety.

Materials and methods

This study is a secondary analysis of a dataset that was created by Edelman Intelligence for a market research campaign exploring lifestyles and the use of hair care products that was commissioned by Clear and Unilever. The original project to collect the data took place in November 2019, where participants were invited to complete a 20-minute online questionnaire containing measures of social anxiety, resilience, social media usage, and questions related to functioning across various life domains. Participants were randomly recruited through the market research companies Dynata, Online Market Intelligence (OMI), and GMO Research, who hold nationally representative research panels. All three companies are affiliated with market research bodies that set standards for ethical practice. Dynata adheres to the Market Research Society code of conduct; OMI and GMO adhere to the ESOMAR market research code of conduct. The secondary analyses of the dataset were approved by Dalhousie University’s Research Ethics Board.

Participants

There were 6,825 participants involved in the study (male = 3,342, female = 3,428, other = 55), aged 16–29 years (M = 22.84, SD = 3.97), from seven countries selected for their social and economic diversity (Brazil, China, Indonesia, Russia, Thailand, US, and Vietnam) (see Table 1 for full sample characteristics). Participant ages were collected in years, but some individuals aged 16–17 were recruited through their parents and their exact age was not given. They were assigned an age of 16.5 years in order to derive the mean age and standard deviation for the full sample.

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https://doi.org/10.1371/journal.pone.0239133.t001

Email invitations to participate were sent to 23,346 young people aged 16–29, of whom 76% (n = 17,817) were recruited to take the survey. These were panel members who had previously registered and given their consent to participate in surveys. Sixty-five percent of respondents were ineligible, with 10,816 excluded because they or their close friends worked in advertising, market research, public relations, journalism or the media, or for a manufacturer or retailer of haircare products. A further 176 respondents were excluded for straight-lining (selecting the same response to every item of the social anxiety measure, indicating they were not properly engaged with the survey; [ 39 ]). The final sample comprised 6,825 participants and matched quotas for sex, region, and age, to achieve a sample with demographics representative of each country.

Participants were compensated for their time using a points-based incentive system, where points earned at the end of the survey could be redeemed for gift cards, vouchers, donations to charities, and other products or services.

The survey included the 20-item self-report Social Interaction Anxiety Scale (SIAS; [ 40 ]). Based on the DSM, the SIAS was originally developed in conjunction with the Social Phobia Scale to determine individuals’ levels of social anxiety and how those with SAD respond to treatment. Both the SIAS and Social Phobia Scale correlate strongly with each other [ 40 – 43 ], but while the latter was developed to assess fears of being observed or scrutinised by others, the SIAS was developed more specifically to assess fears and anxiety related to social interactions with others (e.g., meeting with others, initiating and maintaining conversations). The SIAS discriminates between clinical and non-clinical populations [ 40 , 44 , 45 ] and has also been found to differentiate between those with social anxiety and those with general anxiety [ 46 ], making it a useful clinical screening tool. Although originally developed in Australia, it has been tested and found to work well in diverse cultures worldwide [ 47 – 50 ], and has strong psychometric properties in clinical and non-clinical samples [ 40 , 42 , 43 , 45 – 47 ].

For the current study, all 20 items of the SIAS were included in the survey, though we omitted the three positively-worded items from analyses, as studies have demonstrated that including them results in weaker than expected relationships between the SIAS and other measures, that they hamper the psychometric properties of the measure, and that the SIAS performs better without them [e.g., 51 – 53 ] (the omitted items were ‘I find it easy to make friends my own age’ , ‘I am at ease meeting people at parties , etc’ , and ‘I find it easy to think of things to talk about’ .). One item of the SIAS was also modified prior to use: ‘ I have difficulty talking to attractive persons of the opposite sex’ was altered to ‘ I have difficulty talking to people I am attracted to’ , to make it more applicable to individuals who do not identify as heterosexual, given that the original item was meant to measure difficulty talking to an attractive potential partner [ 54 ].

The questionnaire also included measures of resilience, in addition to other questions concerning functioning in daily life. These were included as part of a corporate social responsibility strategy to investigate the rates of social anxiety and resilience in each target market. A translation agency (Language Connect) translated the full survey into the national languages of the participants.

We analysed social anxiety scores for the overall sample, as well as by country, sex, and age (for sex, given the limited number and heterogeneity of individuals grouped into the ‘other’ category, we only compared males and females). As social anxiety is linked to work status [ 25 ], we also examined differences in SIAS scores between those working and those who were unemployed. Urban/rural differences were also investigated as previous research has suggested anxiety disorders may differ depending on where an individual lives [ 28 ]. Education level [ 27 ], too, was included using completion of secondary education (ISCED level 3) in a subgroup of participants aged 20 years and above to ensure all were above mandatory ages for completing high school. Descriptive statistics are reported for each group with significant differences explored using ANOVA (with Tukey post-hoc tests) or t-tests.

The SIAS is said to be unidimensional when using just the 17 straightforwardly-worded items [ 52 ], with item scores summed to give general social anxiety scores. Higher scores indicate greater levels of social anxiety. Heimberg and colleagues [ 42 ] have suggested a cut-off of 34 on the 20-item SIAS to denote a clinical level of social anxiety (SAD). This level has been adopted in other studies [e.g., 45 ] and found to accurately discriminate between clinical and non-clinical participants [ 53 ]. This threshold for SAD scales to 28.9 when just the 17 items are used, and this is slightly more conservative than others who have used 28 as an adjusted 17-item threshold [ 53 , 55 ]. Therefore, in addition to analyses of raw scores to gauge the severity of social anxiety (and reflect consideration of social anxiety as a spectrum), we also report the proportion of individuals meeting or exceeding this threshold for SAD (≥29) and analyse differences between groups using chi-square tests.

Additionally, despite the unidimensionality of the SIAS, the individual items can be interpreted as examples of contexts where social anxiety may be more or less acutely experienced (e.g., social situations with authority: ‘ I get nervous if I have to speak with someone in authority ’, social situations with strangers: ‘ I am nervous mixing with people I don’t know well ’). Therefore, as social anxiety may be experienced differently depending on culture [ 6 ], we also sorted the items in the measure to understand the top and least concerning contexts for each country.

Finally, we also sought to understand whether individuals perceived themselves as having social anxiety. After completing the SIAS, participants were presented with a definition of social anxiety and asked to reflect on whether they thought this was what they experienced. We contrasted responses with a SIAS threshold analysis to determine discrepancies, including assessment of the proportion of false positives (those who thought they had social anxiety but did not exceed the threshold) and false negatives (those who thought they did not have social anxiety but exceeded the threshold).

All analyses were conducted using SPSS v25 [ 56 ].

As the survey required a response for each item, there were no missing data. The internal reliability of the SIAS was found to be strong (α = .94), with the removal of any item resulting in a reduction in consistency.

Social anxiety by sex, age, and country

In the overall sample, the distribution of social anxiety scores formed an approximately normal distribution with a slightly positive skew, indicating that most respondents scored lower than the midpoint on the measure ( Fig 1 ). However, more than one in three (36%) were found to score above the threshold for SAD. There were no significant differences in social anxiety scores between male and female participants ( t (6768) = -1.37, n.s.) and the proportion of males and females scoring above the SAD threshold did not significantly differ either ( χ 2 (1,6770) = .54, n.s.).

https://doi.org/10.1371/journal.pone.0239133.g001

Social anxiety scores significantly differed between countries ( F (6,6818) = 74.85, p < .001, η p 2 = .062). Indonesia had the lowest average scores ( M = 18.94, SD = 13.21) and the US had the highest ( M = 30.35, SD = 15.44). Post-hoc tests revealed significant differences ( p s≤.001) between each of the countries, except between Brazil and Thailand, between China and Vietnam, between Russia and China, and between Russia and Indonesia (see Table 2 ). The proportion of individuals exceeding the threshold for SAD was also found to significantly differ between the seven countries (χ 2 (6,6825) = 347.57, p < .001). Like symptom severity, the US had the highest prevalence with more than half of participants surveyed exceeding the threshold (57.6%), while Indonesia had the lowest, with fewer than one in four (22.9%).

https://doi.org/10.1371/journal.pone.0239133.t002

A significant age difference was also observed ( F (2,6822) = 39.74, p < .001, η p 2 = .012), where 18-24-year-olds scored significantly higher ( M = 25.33, SD = 13.98) than both 16-17-year-olds ( M = 21.92, SD = 14.24) and 25-29-year-olds ( M = 22.44, SD = 14.22). Also, 25-29-year-olds scored significantly higher than 18-24-year-olds ( p s < .001). The proportion of individuals scoring above the threshold for SAD also significantly differed between age groups (χ 2 (2,6825) = 48.62, p < .001) ( Fig 2 ).

https://doi.org/10.1371/journal.pone.0239133.g002

A three-way ANOVA confirmed significant main effect differences in social anxiety scores between age groups ( F (2,6728) = 38.93, p < .001, η p 2 = .011) and countries ( F (6,6728) = 45.37, p < .001, η p 2 = .039), as well as the non-significant difference between males and females ( F (1,6728) = .493, n.s.). However, of the interactions between sex, age, and country, the two-way country*age interaction was significant ( F (12,6728) = 1.89, p = .031, η p 2 = .003), where 16-17-year-olds in Indonesia were found to have the lowest scores ( M = 15.70, SD = 13.46) and 25-29-year-olds in the US had the highest ( M = 30.47, SD = 16.17) ( Fig 3 ). There was also a significant country*sex interaction ( F (6,6728) = 2.25, p = .036, η p 2 = .002), where female participants in Indonesia had the lowest scores ( M = 18.07, SD = 13.18) and female participants in the US had the highest ( M = 30.37, SD = 15.11) ( Fig 4 ).

https://doi.org/10.1371/journal.pone.0239133.g003

https://doi.org/10.1371/journal.pone.0239133.g004

Work status

Social anxiety scores were also found to significantly differ in terms of work status (employed/studying/unemployed; F (2,6030) = 9.48, p < .001, η p 2 = .003), with those in employment having the lowest scores ( M = 23.28, SD = 14.32), followed by individuals who were studying ( M = 23.96, SD = 13.50). Those who were unemployed had the highest scores ( M = 26.27, SD = 14.54). Post-hoc tests indicated there were significant differences between those who were employed and unemployed ( p < .001), between those studying and unemployed ( p = .006), but not between those employed and those who were studying. The difference between those exceeding the SAD threshold between groups was also significant (χ 2 (2,6033) = 7.55, p = .023).

Urban/Rural

Social anxiety scores also significantly varied depending on an individual’s place of residence ( F (4,6820) = 9.95, p < .001, η p 2 = .006). However, this was not a linear relationship from urban to rural extremes ( Fig 5 ); instead, those living in suburban areas had the highest scores ( M = 25.64, SD = 14.08) and those in central urban areas had the lowest ( M = 22.70, SD = 14.67). This pattern was reflected in the proportions of individuals exceeding the SAD threshold (χ 2 (4,6825) = 35.84, p < .001).

https://doi.org/10.1371/journal.pone.0239133.g005

Education level

In the subsample of individuals aged 20 or above, level of education also resulted in a significant differences in social anxiety scores ( t (5071) = 5.51, p < .001), with individuals who completed secondary education presenting lower scores ( M = 23.40, SD = 14.15) than those who had not completed secondary education ( M = 27.94, SD = 15.07). Those exceeding the threshold for SAD also significantly differed (χ 2 (1,5073) = 38.75, p < .001), with half of those who had not finished secondary education exceeding the cut-off (52%), compared to just over a third of those who had (35%).

Concerns by context

Table 3 illustrates the items of the SIAS sorted by severity for each country. For East-Asian countries, speaking with someone in authority was a top concern, but less so for Brazil, Russia, and the US. Patterns became less discernible between countries beyond this top concern, indicating heterogeneity in the specific situations related to social anxiety, although individuals in most countries appeared to be least challenged by mixing with co-workers and chance encounters with acquaintances.

https://doi.org/10.1371/journal.pone.0239133.t003

Self-perceptions of social anxiety

Just over a third of the sample perceived themselves to experience social anxiety (34%). Although this was similar to the proportion of individuals who exceeded the threshold for SAD (36%), perceptions significantly differed from threshold results (χ 2 (1,6825) = 468.80, p < .001). Just fewer than half of the sample (48%) perceived themselves as not being socially anxious and were also below the threshold, and a fifth (18%) perceived themselves as being socially anxious and exceeded the threshold ( Fig 6 ). However, 16% perceived themselves to be socially anxious yet did not exceed the threshold (false positives) and 18% perceived themselves not to be socially anxious yet exceeded the threshold (false negatives). This suggests a large proportion of individuals do not properly recognise their level of social anxiety (over a third of the sample), and perhaps most importantly, that more than 1 in 6 may experience SAD yet not recognise it ( Table 4 ).

https://doi.org/10.1371/journal.pone.0239133.g006

https://doi.org/10.1371/journal.pone.0239133.t004

This study provides an estimate of the prevalence of social anxiety among young people from seven countries around the world. We found that levels of social anxiety were significantly higher than those previously reported, including studies using the 17-item version of the SIAS [e.g., 55 , 57 , 58 ]. Furthermore, our findings show that over a third of participants met the threshold for SAD (23–58% across the different countries). This far exceeds the highest of figures previously reported, such as Kessler and colleague’s [ 16 ] lifetime prevalence rate of 12% in the US.

As this study specifically focuses on social anxiety in young people, it may be that the inclusion of older participants in other studies leads to lower average levels of social anxiety [ 27 , 59 ]. In contrast, our findings show significantly higher rates of SAD than anticipated, and particularly so for individuals aged 18–24. It also extends the argument of authors such as Lecrubier and colleagues [ 60 ] and Leigh and Clark [ 30 ] that developmental challenges during adolescence may provoke social anxiety, especially the crucial later period when leaving school and becoming more independent.

We also found strong variations in levels of social anxiety between countries. Previous explorations of national prevalence rates have been less equivocal, with some reporting differences [ 6 ] while others have not [ 61 ]. Our findings concur with those of Hofmann and colleagues’ [ 6 ] who note that the US has typically high rates of social anxiety, which we also found (in contrast to other countries). However, the authors suggest Russia also has a high prevalence and that Asian cultures typically show lower rates. In contrast, we found samples from Asian countries such as Thailand and Vietnam had higher rates than in the sample from Russia, and that there were significant differences between Asian countries themselves ( Table 2 ). As our study used the SIAS, which determines how socially anxious an individual is based on their ratings of difficulty in specific social situation, one way of accounting for differences may be to consider the kinds of feared social situations that are covered in the measure. For instance, our breakdown of concerns by country ( Table 3 ) indicates that in Asian countries, speaking with individuals in authority is a strongly feared situation, but this is less challenging in other cultures. For non-Asian countries, one of the strongest concerns was talking about oneself or one’s feelings. In Asian countries, where there is typically less of an emphasis on individualism, talking about oneself may be less stressful if there is less perceived pressure to demonstrate one’s uniqueness or importance. Future investigations could further explore cultural differences in social anxiety across different types of social situations or could confirm cross-cultural social anxiety heterogeneity by using approaches that are less heavily tied to determining social anxiety within given contexts (e.g., a diagnostic interview), as many of the commonly used measures appear to be [ 62 , 63 ].

Our findings also provide mixed support for investigations of other demographic differences in social anxiety. First, previous studies have tended to indicate that female participants score higher than males on measures of social anxiety [ 27 , 64 ]. Although the samples from Brazil and China reflected this, we found no difference between males and females in the overall sample, nor in samples from Indonesia, Russia, Thailand, US, or Vietnam. Sex-related differences in social anxiety have been attributed to gender differences, such as suggestions that girls ruminate more, particularly about relationships with others [ 65 , 66 ]. It is possible that as gender roles and norms vary between countries, and in some instances start to decline, so may differences in social anxiety, which younger generations are likely to reflect first. However, given the unexpected finding that males in Vietnam scored significantly higher than their female counterparts, further investigation is needed to account for the potentially culturally nuanced relationship between sex and social anxiety.

We also confirmed previous findings that higher levels of social anxiety are associated with lower levels of education and being unemployed. Although these findings are in-line with previous research [ 27 , 64 ], our study cannot shed light on causal mechanisms; longitudinal research is required to establish whether social anxiety leads individuals to struggle with school and work, whether struggling in these areas provokes social anxiety, or whether there is a more dynamic relationship.

Finally, we found that 18% of the sample could be classified as “false negatives”. This sizeable group felt they did not have social anxiety, yet their scores on the SIAS considerably exceeded the threshold for SAD. It has been said that SAD often remains undiagnosed [ 67 ], that individuals who seek treatment only do so after 15–20 years of symptoms [ 68 ], and that SAD is often identified when a related condition warrants attention (e.g., depression or alcohol abuse; Schneier [ 5 ]). It has also been reported that many individuals do not recognise social anxiety as a disorder and believe it is just part of their personality and cannot be changed [ 3 ]. Living with an undiagnosed or untreated condition can result in substantial economic consequences for both individuals and society, including a reduced ability to work and a loss of productivity [ 69 ], which may have a greater impact over time compared to those who receive successful treatment. Furthermore, the variety of avoidant (or “safety”) behaviours commonly associated with social anxiety [ 70 , 71 ] mean that affected individuals may struggle or be less able to function socially, and for young people at a time in their lives when relationships with others are particularly crucial [ 72 , 73 ], the consequences may be significant and lasting. Greater awareness of social anxiety and its impact across different domains of functioning may help more young people to recognise the difficulties they experience. This should be accompanied by developing and raising awareness of appropriate services and supports that young people feel comfortable using during these important developmental stages [see 30 , 74 ].

Study limitations

Our ability to infer reasons for the prevalence of SAD is hindered by the present data being cross-sectional, and therefore only allowing for associations to be drawn. We are also unable to confirm the number of clinical cases in the sample, as we did not screen for those who may have received a professional diagnosis of SAD, nor those who are receiving treatment for SAD. Additionally, the use of an online survey incorporating self-report measures incurs the risk of inaccurate responses. Further research could build on this investigation by surveying those in middle and older age to discover whether rates of social anxiety have also risen across other ages, or whether this increase is a youth-related phenomenon. Future investigations could also use diagnostic interviews and track individuals over time to determine the onset and progression of symptoms, including whether those who are subclinical later reach clinical levels, or vice versa, and what might account for such change.

On a global level, we report higher rates of social anxiety symptoms and the prevalence of those meeting the threshold for SAD than have been reported previously. Our findings suggest that levels of social anxiety may be rising among young people, and that those aged 18–24 may be most at risk. Public health initiatives are needed to raise awareness of social anxiety, the challenges associated with it, and the means to combat it.

Acknowledgments

The authors would like to acknowledge the role of Edelman Intelligence for collecting the original data on behalf of Unilever and CLEAR as part of their mission to support the resilience of young people.

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A Cognitive-Behavior Therapy Applied to a Social Anxiety Disorder and a Specific Phobia, Case Study

• November 2014
• Health Psychology Research 2(3)
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• Harokopio University

• National and Kapodistrian University of Athens

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A Case Report of Psychotic Symptoms in Social Anxiety Disorder

Gitanjali natarajan.

Department of Clinical Psychology, Amrita Institute of Medical Sciences, Kochi, Kerala, India

Sangeetha P. Louis

Praveen arathil.

1 Department of Psychiatry, Amrita Institute of Medical Sciences, Kochi, Kerala, India

Social phobias come under the category of phobic anxiety disorders and are centered around a fear of scrutiny by other people, usually leading to avoidance of social situations.[ 1 ] Although social anxiety has been found to be the most common comorbidity in people with psychosis,[ 2 ] social phobia or anxiety per se is a neurotic disorder in which the patient usually maintains an adequate touch with reality and is rarely associated with psychotic symptoms, beyond the self-referential feelings often observed in social anxiety disorder (SAD). Although there are a few contradictory pieces of evidence of the presence of psychotic symptoms in anxiety disorders,[ 3 , 4 ] it is usually accepted that there are clear lines of demarcation between anxiety disorders and psychosis. The exact prevalence of psychotic symptoms in SAD is not known. Although the presence of psychotic symptoms in SAD would have an immense impact on the severity, management, and prognosis of the disorder, there are only case reports available and the matter is not yet studied in a systematic manner. This case report details how a person with SAD gradually developed disorder-congruent delusions.

CASE REPORT

A 34-year-old married male, graduate in business administration, working as a clerical staff in the Middle East, premorbidly having anxious avoidant personality, presented to the clinical psychology department with a 3 years history of gradual onset of fear of blushing when meeting people and avoiding social interactions with familiar people, especially those in authority, after he started working in a new office. He had less anxiety when meeting unfamiliar people. His social phobia and avoidance increased in the last 2 years, with social interactions getting restricted to only his wife and child as well as colleagues during office work. He started avoiding phone conversations with friends and extended family members, as he believed that they would notice the change in his voice and come to know about his discomfort.

For the last 6 months, he started believing that his blushing during social interactions is offensive to others in the office. Moreover, he was convinced that his “fear of blushing” was contagious and was being transmitted to other people. He reported that he had transmitted his blushing to his supervisor who also started blushing during social encounters. He also believed that his supervisor was offended by the patient's presence, as he would blush more. Hence, the patient has been avoiding meeting his supervisor. Off late, he felt that more people in the office were finding him offensive, and he was transmitting the blushing to all of them. He wanted to stop going to the office, as he felt responsible for others’ discomfort. He returned to Kerala to get his problem treated.

There is no history suggestive of severe depression, as the patient did not have marked anhedonia, fatigue, or diminished activity. He had past history of low mood, feeling tired, and increase in sleep and appetite that persisted for a few months after he failed in his pre-degree examination 18 years back and it resolved without treatment. Family history of depression in paternal uncle, personal history of restrictive upbringing by parents, and premorbid anxious-avoidant traits were reported. Mental status examination showed low mood, worries about his social anxiety, and firm belief about others finding him offensive as he was transmitting “fear of blushing” to them. He admitted to the possibility that there could be something wrong in his mind, and hence, wanted treatment.

A detailed psycho-diagnostic assessment indicated average intellectual functioning, social anxiety, depressive symptoms, and a high tendency for fantasy. On Beck Depression Inventory scale, he got a score of 26 indicating moderate depressive symptoms; on Beck Anxiety Inventory scale, a score of 16 indicating mild anxiety symptoms; and on Social Interaction Anxiety scale, a score of 43 indicating presence of social anxiety disorder. The diagnosis of SAD was retained as the client did not fit the criteria for severe depression with psychotic symptoms or persistent delusional disorder.

Management involved a combination of paroxetine controlled release tablets and cognitive behavior therapy (CBT) involving cue-controlled relaxation, graded exposure, and cognitive restructuring. At 1 year follow-up, the patient still continued having the delusion that his boss had developed social anxiety and blushing through him, but it appeared to have become encapsulated and to be not interfering in his daily functioning in the office. He continued interacting with his boss through phone whenever possible. He no longer believed that he was transmitting social anxiety to all his colleagues. His interaction with colleagues was normal, and he was no longer reluctant to go to his office.

This case is different from a typical case of social phobia in two aspects: first by the presence of a firm belief that his symptoms of social anxiety, especially his fear of blushing, were contagious and his concern over spreading this fear to more and more people, and second, by his conviction that others found his social discomfort offensive.

The false belief in this patient is similar to the offensive subtype of Taijin-Kyofusho (TKS), a condition mentioned under SAD in Diagnostic and Statistical Manual of Mental Disorders 5.[ 5 ] The offensive subtype of TKS includes patients with a delusional conviction of offensiveness-persistent and excessive fear of causing offence to others in social circumstances by physical characteristics such as blushing, facial expressions, body odors, or intestinal noises. Cultural and societal norms engendering guilt, shame, and embarrassment are also likely etiological factors.[ 6 ] Belonging to a collective society with restricted upbringing, the patient would be more attentive and sensitive to the thoughts, feelings, and behaviors of significant others.

Three explanations have been suggested for the psychotic manifestations in SAD: (1) the individual's inability to challenge his social fears; (2) stressor and perpetuating role of SAD; and (3) the possibility of a primary thought abnormality leading to psychotic self-reference.[ 3 ] Greater paranoid ideation, in a non-clinical sample, was found to be associated with higher levels of social anxiety, avoidance, apprehension about evaluation, self-observation, and low self-esteem.[ 7 ]

The transformation of social apprehensions to a delusional level could also be explained using the changes in “social brain” and perception because of the increasingly worsening social isolation.[ 8 , 9 ] This could explain how the patient's initial fears of blushing and discomfort progressed into a delusional level with increasing isolation.

The patient improved with treatment focused on SAD - using Selective Serotonin Reuptake Inhibitor and CBT. Antipsychotics have been found to have a lower efficacy in SAD even when delusions are present. This may be because of the hypoactivity of dopaminergic circuits and D2 receptor found in SAD. Antipsychotics could further reduce dopamine action in a system that is already in deficit.[ 3 ]

The above case highlights that the commonly assumed demarcation between anxiety disorders and psychosis is questionable and points to the fragility of current diagnostic constructs. Affective and psychotic phenomena often co-occur, and such a co-occurrence predicts a poorer course and outcome, with greater persistence of schizotypal and negative symptoms, more illness behavior, greater likelihood of service use, and more evidence of familial liability for mental illness.[ 4 ] New diagnostic subcategories or expanding the social anxiety diagnosis to include psychotic symptoms, as in mood disorders, would have to be considered. This case also suggests that SAD with psychosis could be an entity midway in the dimensional spectrum between SAD and delusional disorder. In addition, the role of social isolation, secondary to social phobia, in the development of psychotic symptoms among patients with social phobia also needs to be further explored.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest.

There are no conflicts of interest.

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• Published: 08 September 2024

Longitudinal analysis of teacher self-efficacy evolution during a STEAM professional development program: a qualitative case study

• Haozhe Jiang   ORCID: orcid.org/0000-0002-7870-0993 1 ,
• Ritesh Chugh   ORCID: orcid.org/0000-0003-0061-7206 2 ,
• Xuesong Zhai   ORCID: orcid.org/0000-0002-4179-7859 1 , 3   nAff7 ,
• Ke Wang 4 &
• Xiaoqin Wang 5 , 6  

Humanities and Social Sciences Communications volume  11 , Article number:  1162 ( 2024 ) Cite this article

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Despite the widespread advocacy for the integration of arts and humanities (A&H) into science, technology, engineering, and mathematics (STEM) education on an international scale, teachers face numerous obstacles in practically integrating A&H into STEM teaching (IAT). To tackle the challenges, a comprehensive five-stage framework for teacher professional development programs focussed on IAT has been developed. Through the use of a qualitative case study approach, this study outlines the shifts in a participant teacher’s self-efficacy following their exposure to each stage of the framework. The data obtained from interviews and reflective analyses were analyzed using a seven-stage inductive method. The findings have substantiated the significant impact of a teacher professional development program based on the framework on teacher self-efficacy, evident in both individual performance and student outcomes observed over eighteen months. The evolution of teacher self-efficacy in IAT should be regarded as an open and multi-level system, characterized by interactions with teacher knowledge, skills and other entrenched beliefs. Building on our research findings, an enhanced model of teacher professional learning is proposed. The revised model illustrates that professional learning for STEAM teachers should be conceived as a continuous and sustainable process, characterized by the dynamic interaction among teaching performance, teacher knowledge, and teacher beliefs. The updated model further confirms the inseparable link between teacher learning and student learning within STEAM education. This study contributes to the existing body of literature on teacher self-efficacy, teacher professional learning models and the design of IAT teacher professional development programs.

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Introduction.

In the past decade, there has been a surge in the advancement and widespread adoption of Science, Technology, Engineering, and Mathematics (STEM) education on a global scale (Jiang et al. 2021 ; Jiang et al. 2022 ; Jiang et al. 2023 ; Jiang et al. 2024a , b ; Zhan et al. 2023 ; Zhan and Niu 2023 ; Zhong et al. 2022 ; Zhong et al. 2024 ). Concurrently, there has been a growing chorus of advocates urging the integration of Arts and Humanities (A&H) into STEM education (e.g., Alkhabra et al. 2023 ; Land 2020 ; Park and Cho 2022 ; Uştu et al. 2021 ; Vaziri and Bradburn 2021 ). STEM education is frequently characterized by its emphasis on logic and analysis; however, it may be perceived as deficient in emotional and intuitive elements (Ozkan and Umdu Topsakal 2021 ). Through the integration of Arts and Humanities (A&H), the resulting STEAM approach has the potential to become more holistic, incorporating both rationality and emotional intelligence (Ozkan and Umdu Topsakal 2021 ). Many studies have confirmed that A&H can help students increase interest and develop their understanding of the contents in STEM fields, and thus, A&H can attract potential underrepresented STEM learners such as female students and minorities (Land 2020 ; Park and Cho 2022 ; Perignat and Katz-Buonincontro 2019 ). Despite the increasing interest in STEAM, the approaches to integrating A&H, which represent fundamentally different disciplines, into STEM are theoretically and practically ambiguous (Jacques et al. 2020 ; Uştu et al. 2021 ). Moreover, studies have indicated that the implementation of STEAM poses significant challenges, with STEM educators encountering difficulties in integrating A&H into their teaching practices (e.g., Boice et al. 2021 ; Duong et al. 2024 ; Herro et al. 2019 ; Jacques et al. 2020 ; Park and Cho 2022 ; Perignat and Katz-Buonincontro 2019 ). Hence, there is a pressing need to provide STEAM teachers with effective professional training.

Motivated by this gap, this study proposes a novel five-stage framework tailored for teacher professional development programs specifically designed to facilitate the integration of A&H into STEM teaching (IAT). Following the establishment of this framework, a series of teacher professional development programs were implemented. To explain the framework, a qualitative case study is employed, focusing on examining a specific teacher professional development program’s impact on a pre-service teacher’s self-efficacy. The case narratives, with a particular focus on the pre-service teacher’s changes in teacher self-efficacy, are organized chronologically, delineating stages before and after each stage of the teacher professional development program. More specifically, meaningful vignettes of the pre-service teacher’s learning and teaching experiences during the teacher professional development program are offered to help understand the five-stage framework. This study contributes to understanding teacher self-efficacy, teacher professional learning model and the design of IAT teacher professional development programs.

Theoretical background

The conceptualization of steam education.

STEM education can be interpreted through various lenses (e.g., Jiang et al. 2021 ; English 2016 ). As Li et al. (2020) claimed, on the one hand, STEM education can be defined as individual STEM disciplinary-based education (i.e., science education, technology education, engineering education and mathematics education). On the other hand, STEM education can also be defined as interdisciplinary or cross-disciplinary education where individual STEM disciplines are integrated (Jiang et al. 2021 ; English 2016 ). In this study, we view it as individual disciplinary-based education separately in science, technology, engineering and mathematics (English 2016 ).

STEAM education emerged as a new pedagogy during the Americans for the Arts-National Policy Roundtable discussion in 2007 (Perignat and Katz-Buonincontro 2019 ). This pedagogy was born out of the necessity to enhance students’ engagement, foster creativity, stimulate innovation, improve problem-solving abilities, and cultivate employability skills such as teamwork, communication and adaptability (Perignat and Katz-Buonincontro 2019 ). In particular, within the framework of STEAM education, the ‘A’ should be viewed as a broad concept that represents arts and humanities (A&H) (Herro and Quigley 2016 ; de la Garza 2021 , Park and Cho 2022 ). This conceptualization emphasizes the need to include humanities subjects alongside arts (Herro and Quigley 2016 ; de la Garza 2021 ; Park and Cho 2022 ). Sanz-Camarero et al. ( 2023 ) listed some important fields of A&H, including physical arts, fine arts, manual arts, sociology, politics, philosophy, history, psychology and so on.

In general, STEM education does not necessarily entail the inclusion of all STEM disciplines collectively (Ozkan and Umdu Topsakal 2021 ), and this principle also applies to STEAM education (Gates 2017 ; Perignat and Katz-Buonincontro 2019 ; Quigley et al. 2017 ; Smith and Paré 2016 ). As an illustration, Smith and Paré ( 2016 ) described a STEAM activity in which pottery (representing A&H) and mathematics were integrated, while other STEAM elements such as science, technology and engineering were not included. In our study, STEAM education is conceptualized as an interdisciplinary approach that involves the integration of one or more components of A&H into one or more STEM school subjects within educational activities (Ozkan and Umdu Topsakal 2021 ; Vaziri and Bradburn 2021 ). Notably, interdisciplinary collaboration entails integrating one or more elements from arts and humanities (A&H) with one or more STEM school subjects, cohesively united by a shared theme while maintaining their distinct identities (Perignat and Katz-Buonincontro 2019 ).

In our teacher professional development programs, we help mathematics, technology, and science pre-service teachers integrate one component of A&H into their disciplinary-based teaching practices. For instance, we help mathematics teachers integrate history (a component of A&H) into mathematics teaching. In other words, in our study, integrating A&H into STEM teaching (IAT) can be defined as integrating one component of A&H into the teaching of one of the STEM school subjects. The components of A&H and the STEM school subject are brought together under a common theme, but each of them remains discrete. Engineering is not taught as an individual subject in the K-12 curriculum in mainland China. Therefore, A&H is not integrated into engineering teaching in our teacher professional development programs.

Self-efficacy and teacher self-efficacy

Self-efficacy was initially introduced by Bandura ( 1977 ) as a key concept within his social cognitive theory. Bandura ( 1997 ) defined self-efficacy as “people’s beliefs about their capabilities to produce designated levels of performance that exercise influence over events that affect their lives” (p. 71). Based on Bandura’s ( 1977 ) theory, Tschannen-Moran et al. ( 1998 ) defined the concept of teacher self-efficacy Footnote 1 as “a teacher’s belief in her or his ability to organize and execute the courses of action required to successfully accomplish a specific teaching task in a particular context” (p. 233). Blonder et al. ( 2014 ) pointed out that this definition implicitly included teachers’ judgment of their ability to bring about desired outcomes in terms of students’ engagement and learning. Moreover, OECD ( 2018 ) defined teacher self-efficacy as “the beliefs that teachers have of their ability to enact certain teaching behavior that influences students’ educational outcomes, such as achievement, interest, and motivation” (p. 51). This definition explicitly included two dimensions: teachers’ judgment of the ability related to their teaching performance (i.e., enacting certain teaching behavior) and their influence on student outcomes.

It is argued that teacher self-efficacy should not be regarded as a general or overarching construct (Zee et al. 2017 ; Zee and Koomen 2016 ). Particularly, in the performance-driven context of China, teachers always connect their beliefs in their professional capabilities with the educational outcomes of their students (Liu et al. 2018 ). Therefore, we operationally conceptualize teacher self-efficacy as having two dimensions: self-efficacy in individual performance and student outcomes (see Table 1 ).

Most importantly, given its consistent association with actual teaching performance and student outcomes (Bray-Clark and Bates 2003 ; Kelley et al. 2020 ), teacher self-efficacy is widely regarded as a pivotal indicator of teacher success (Kelley et al. 2020 ). Moreover, the enhancement of teaching self-efficacy reflects the effectiveness of teacher professional development programs (Bray-Clark and Bates 2003 ; Kelley et al. 2020 ; Wong et al. 2022 ; Zhou et al. 2023 ). For instance, Zhou et al. ( 2023 ) claimed that in STEM teacher education, effective teacher professional development programs should bolster teachers’ self-efficacy “in teaching the content in the STEM discipline” (p. 2).

It has been documented that teachers frequently experience diminished confidence and comfort when teaching subject areas beyond their expertise (Kelley et al. 2020 ; Stohlmann et al. 2012 ). This diminished confidence extends to their self-efficacy in implementing interdisciplinary teaching approaches, such as integrated STEM teaching and IAT (Kelley et al. 2020 ). For instance, Geng et al. ( 2019 ) found that STEM teachers in Hong Kong exhibited low levels of self-efficacy, with only 5.53% of teachers rating their overall self-efficacy in implementing STEM education as higher than a score of 4 out of 5. Additionally, Hunter-Doniger and Sydow ( 2016 ) found that teachers may experience apprehension and lack confidence when incorporating A&H elements into the classroom context, particularly within the framework of IAT. Considering the critical importance of teacher self-efficacy in STEM and STEAM education (Kelley et al. 2020 ; Zakariya, 2020 ; Zhou et al. 2023 ), it is necessary to explore effective measures, frameworks and teacher professional development programs to help teachers improve their self-efficacy regarding interdisciplinary teaching (e.g., IAT).

Teacher professional learning models

The relationship between teachers’ professional learning and students’ outcomes (such as achievements, skills and attitudes) has been a subject of extensive discussion and research for many years (Clarke and Hollingsworth 2002 ). For instance, Clarke and Hollingsworth ( 2002 ) proposed and validated the Interconnected Model of Professional Growth, which illustrates that teacher professional development is influenced by the interaction among four interconnected domains: the personal domain (teacher knowledge, beliefs and attitudes), the domain of practice (professional experimentation), the domain of consequence (salient outcomes), and the external domain (sources of information, stimulus or support). Sancar et al. ( 2021 ) emphasized that teachers’ professional learning or development never occurs independently. In practice, this process is inherently intertwined with many variables, including student outcomes, in various ways (Sancar et al. 2021 ). However, many current teacher professional development programs exclude real in-class teaching and fail to establish a comprehensive link between teachers’ professional learning and student outcomes (Cai et al. 2020 ; Sancar et al. 2021 ). Sancar et al. ( 2021 ) claimed that exploring the complex relationships between teachers’ professional learning and student outcomes should be grounded in monitoring and evaluating real in-class teaching, rather than relying on teachers’ self-assessment. It is essential to understand these relationships from a holistic perspective within the context of real classroom teaching (Sancar et al. 2021 ). However, as Sancar et al. ( 2021 ) pointed out, such efforts in teacher education are often considered inadequate. Furthermore, in the field of STEAM education, such efforts are further exacerbated.

Cai et al. ( 2020 ) proposed a teacher professional learning model where student outcomes are emphasized. This model was developed based on Cai ( 2017 ), Philipp ( 2007 ) and Thompson ( 1992 ). It has also been used and justified in a series of teacher professional development programs (e.g., Calabrese et al. 2024 ; Hwang et al. 2024 ; Marco and Palatnik 2024 ; Örnek and Soylu 2021 ). The model posits that teachers typically increase their knowledge and modify their beliefs through professional teacher learning, subsequently improving their classroom instruction, enhancing teaching performance, and ultimately fostering improved student learning outcomes (Cai et al. 2020 ). Notably, this model can be updated in several aspects. Firstly, prior studies have exhibited the interplay between teacher knowledge and beliefs (e.g., Basckin et al. 2021 ; Taimalu and Luik 2019 ). This indicates that the increase in teacher knowledge and the change in teacher belief may not be parallel. The two processes can be intertwined. Secondly, the Interconnected Model of Professional Growth highlights that the personal domain and the domain of practice are interconnected (Clarke and Hollingsworth 2002 ). Liu et al. ( 2022 ) also confirmed that improvements in classroom instruction may, in turn, influence teacher beliefs. This necessitates a reconsideration of the relationships between classroom instruction, teacher knowledge and teacher beliefs in Cai et al.’s ( 2020 ) model. Thirdly, the Interconnected Model of Professional Growth also exhibits the connections between the domain of consequence and the personal domain (Clarke and Hollingsworth 2002 ). Hence, the improvement of learning outcomes may signify the end of teacher learning. For instance, students’ learning feedback may be a vital source of teacher self-efficacy (Bandura 1977 ). Therefore, the improvement of student outcomes may, in turn, affect teacher beliefs. The aforementioned arguments highlight the need for an updated model that integrates Cai et al.’s ( 2020 ) teacher professional learning model with Clarke and Hollingsworth’s ( 2002 ) Interconnected Model of Professional Growth. This integration may provide a holistic view of the teacher’s professional learning process, especially within the complex contexts of STEAM teacher education.

The framework for teacher professional development programs of integrating arts and humanities into STEM teaching

In this section, we present a framework for IAT teacher professional development programs, aiming to address the practical challenges associated with STEAM teaching implementation. Our framework incorporates the five features of effective teacher professional development programs outlined by Archibald et al. ( 2011 ), Cai et al. ( 2020 ), Darling-Hammond et al. ( 2017 ), Desimone and Garet ( 2015 ) and Roth et al. ( 2017 ). These features include: (a) alignment with shared goals (e.g., school, district, and national policies and practice), (b) emphasis on core content and modeling of teaching strategies for the content, (c) collaboration among teachers within a community, (d) adequate opportunities for active learning of new teaching strategies, and (e) embedded follow-up and continuous feedback. It is worth noting that two concepts, namely community of practice and lesson study, have been incorporated into our framework. Below, we delineate how these features are reflected in our framework.

(a) The Chinese government has issued a series of policies to facilitate STEAM education in K-12 schools (Jiang et al. 2021 ; Li and Chiang 2019 ; Lyu et al. 2024 ; Ro et al. 2022 ). The new curriculum standards released in 2022 mandate that all K-12 teachers implement interdisciplinary teaching, including STEAM education. Our framework for teacher professional development programs, which aims to help teachers integrate A&H into STEM teaching, closely aligns with these national policies and practices supporting STEAM education in K-12 schools.

(b) The core content of the framework is IAT. Specifically, as A&H is a broad concept, we divide it into several subcomponents, such as history, culture, and visual and performing arts (e.g., drama). We are implementing a series of teacher professional development programs to help mathematics, technology and science pre-service teachers integrate these subcomponents of A&H into their teaching Footnote 2 . Notably, pre-service teachers often lack teaching experience, making it challenging to master and implement new teaching strategies. Therefore, our framework provides five step-by-step stages designed to help them effectively model the teaching strategies of IAT.

(c) Our framework advocates for collaboration among teachers within a community of practice. Specifically, a community of practice is “a group of people who share an interest in a domain of human endeavor and engage in a process of collective learning that creates bonds between them” (Wenger et al. 2002 , p. 1). A teacher community of practice can be considered a group of teachers “sharing and critically observing their practices in growth-promoting ways” (Näykki et al. 2021 , p. 497). Long et al. ( 2021 ) claimed that in a teacher community of practice, members collaboratively share their teaching experiences and work together to address teaching problems. Our community of practice includes three types of members. (1) Mentors: These are professors and experts with rich experience in helping pre-service teachers practice IAT. (2) Pre-service teachers: Few have teaching experience before the teacher professional development programs. (3) In-service teachers: All in-service teachers are senior teachers with rich teaching experience. All the members work closely together to share and improve their IAT practice. Moreover, our community includes not only mentors and in-service teachers but also pre-service teachers. We encourage pre-service teachers to collaborate with experienced in-service teachers in various ways, such as developing IAT lesson plans, writing IAT case reports and so on. In-service teachers can provide cognitive and emotional support and share their practical knowledge and experience, which may significantly benefit the professional growth of pre-service teachers (Alwafi et al. 2020 ).

(d) Our framework offers pre-service teachers various opportunities to engage in lesson study, allowing them to actively design and implement IAT lessons. Based on the key points of effective lesson study outlined by Akiba et al. ( 2019 ), Ding et al. ( 2024 ), and Takahashi and McDougal ( 2016 ), our lesson study incorporates the following seven features. (1) Study of IAT materials: Pre-service teachers are required to study relevant IAT materials under the guidance of mentors. (2) Collaboration on lesson proposals: Pre-service teachers should collaborate with in-service teachers to develop comprehensive lesson proposals. (3) Observation and data collection: During the lesson, pre-service teachers are required to carefully observe and collect data on student learning and development. (4) Reflection and analysis: Pre-service teachers use the collected data to reflect on the lesson and their teaching effects. (5) Lesson revision and reteaching: If needed, pre-service teachers revise and reteach the lesson based on their reflections and data analysis. (6) Mentor and experienced in-service teacher involvement: Mentors and experienced in-service teachers, as knowledgeable others, are involved throughout the lesson study process. (7) Collaboration on reporting: Pre-service teachers collaborate with in-service teachers to draft reports and disseminate the results of the lesson study. Specifically, recognizing that pre-service teachers often lack teaching experience, we do not require them to complete all the steps of lesson study independently at once. Instead, we guide them through the lesson study process in a step-by-step manner, allowing them to gradually build their IAT skills and confidence. For instance, in Stage 1, pre-service teachers primarily focus on studying IAT materials. In Stage 2, they develop lesson proposals, observe and collect data, and draft reports. However, the implementation of IAT lessons is carried out by in-service teachers. This approach prevents pre-service teachers from experiencing failures due to their lack of teaching experience. In Stage 3, pre-service teachers implement, revise, and reteach IAT lessons, experiencing the lesson study process within a simulated environment. In Stage 4, pre-service teachers engage in lesson study in an actual classroom environment. However, their focus is limited to one micro-course during each lesson study session. It is not until the fifth stage that they experience a complete lesson study in an actual classroom environment.

(e) Our teacher professional development programs incorporate assessments specifically designed to evaluate pre-service teachers’ IAT practices. We use formative assessments to measure their understanding and application of IAT strategies. Pre-service teachers receive ongoing and timely feedback from peers, mentors, in-service teachers, and students, which helps them continuously refine their IAT practices throughout the program. Recognizing that pre-service teachers often have limited contact with real students and may not fully understand students’ learning needs, processes and outcomes, our framework requires them to actively collect and analyze student feedback. By doing so, they can make informed improvements to their instructional practice based on student feedback.

After undergoing three rounds of theoretical and practical testing and revision over the past five years, we have successfully finalized the optimization of the framework design (Zhou 2021 ). Throughout each cycle, we collected feedback from both participants and researchers on at least three occasions. Subsequently, we analyzed this feedback and iteratively refined the framework. For example, we enlisted the participation of in-service teachers to enhance the implementation of STEAM teaching, extended practice time through micro-teaching sessions, and introduced a stage of micro-course development within the framework to provide more opportunities for pre-service teachers to engage with real teaching situations. In this process, we continuously improved the coherence between each stage of the framework, ensuring that they mutually complement one another. The five-stage framework is described as follows.

Stage 1 Literature study

Pre-service teachers are provided with a series of reading materials from A&H. On a weekly basis, two pre-service teachers are assigned to present their readings and reflections to the entire group, followed by critical discussions thereafter. Mentors and all pre-service teachers discuss and explore strategies for translating the original A&H materials into viable instructional resources suitable for classroom use. Subsequently, pre-service teachers select topics of personal interest for further study under mentor guidance.

Stage 2 Case learning

Given that pre-service teachers have no teaching experience, collaborative efforts between in-service teachers and pre-service teachers are undertaken to design IAT lesson plans. Subsequently, the in-service teachers implement these plans. Throughout this process, pre-service teachers are afforded opportunities to engage in lesson plan implementation. Figure 1 illustrates the role of pre-service teachers in case learning. In the first step, pre-service teachers read about materials related to A&H, select suitable materials, and report their ideas on IAT lesson design to mentors, in-service teachers, and fellow pre-service teachers.

Note: A&H refers to arts and humanities.

In the second step, they liaise with the in-service teachers responsible for implementing the lesson plan, discussing the integration of A&H into teaching practices. Pre-service teachers then analyze student learning objectives aligned with curriculum standards, collaboratively designing the IAT lesson plan with in-service teachers. Subsequently, pre-service teachers present lesson plans for feedback from mentors and other in-service teachers.

In the third step, pre-service teachers observe the lesson plan’s implementation, gathering and analyzing feedback from students and in-service teachers using an inductive approach (Merriam 1998 ). Feedback includes opinions on the roles and values of A&H, perceptions of the teaching effect, and recommendations for lesson plan implementation and modification. The second and third steps may iterate multiple times to refine the IAT lesson plan. In the fourth step, pre-service teachers consolidate all data, including various versions of teaching instructions, classroom videos, feedback, and discussion notes, composing reflection notes. Finally, pre-service teachers collaborate with in-service teachers to compile the IAT case report and submit it for publication.

Stage 3 Micro-teaching

Figure 2 illustrates the role of pre-service teachers in micro-teaching. Before entering the micro-classrooms Footnote 3 , all the discussions and communications occur within the pre-service teacher group, excluding mentors and in-service teachers. After designing the IAT lesson plan, pre-service teachers take turns implementing 40-min lesson plans in a simulated micro-classroom setting. Within this simulated environment, one pre-service teacher acts as the teacher, while others, including mentors, in-service teachers, and other fellow pre-service teachers, assume the role of students Footnote 4 . Following the simulated teaching, the implementer reviews the video of their session and self-assesses their performance. Subsequently, the implementer receives feedback from other pre-service teachers, mentors, and in-service teachers. Based on this feedback, the implementer revisits steps 2 and 3, revising the lesson plan and conducting the simulated teaching again. This iterative process typically repeats at least three times until the mentors, in-service teachers, and other pre-service teachers are satisfied with the implementation of the revised lesson plan. Finally, pre-service teachers complete reflection notes and submit a summary of their reflections on the micro-teaching experience. Each pre-service teacher is required to choose at least three topics and undergo at least nine simulated teaching sessions.

Stage 4 Micro-course development

While pre-service teachers may not have the opportunity to execute the whole lesson plans in real classrooms, they can design and create five-minute micro-courses Footnote 5 before class, subsequently presenting these videos to actual students. The process of developing micro-courses closely mirrors that of developing IAT cases in the case learning stage (see Fig. 1 ). However, in Step 3, pre-service teachers assume dual roles, not only as observers of IAT lesson implementation but also as implementers of a five-minute IAT micro-course.

Stage 5 Classroom teaching

Pre-service teachers undertake the implementation of IAT lesson plans independently, a process resembling micro-teaching (see Fig. 2 ). However, pre-service teachers engage with real school students in partner schools Footnote 6 instead of simulated classrooms. Furthermore, they collect feedback not only from the mentors, in-service teachers, and fellow pre-service teachers but also from real students.

To provide our readers with a better understanding of the framework, we provide meaningful vignettes of a pre-service teacher’s learning and teaching experiences in one of the teacher professional development programs based on the framework. In addition, we choose teacher self-efficacy as an indicator to assess the framework’s effectiveness, detailing the pre-service teacher’s changes in teacher self-efficacy.

Research design

Research method.

Teacher self-efficacy can be measured both quantitatively and qualitatively (Bandura 1986 , 1997 ; Lee and Bobko 1994 ; Soprano and Yang 2013 ; Unfried et al. 2022 ). However, researchers and theorists in the area of teacher self-efficacy have called for more qualitative and longitudinal studies (Klassen et al. 2011 ). As some critiques stated, most studies were based on correlational and cross-sectional data obtained from self-report surveys, and qualitative studies of teacher efficacy were overwhelmingly neglected (Henson 2002 ; Klassen et al. 2011 ; Tschannen-Moran et al. 1998 ; Xenofontos and Andrews 2020 ). There is an urgent need for more longitudinal studies to shed light on the development of teacher efficacy (Klassen et al. 2011 ; Xenofontos and Andrews 2020 ).

This study utilized a longitudinal qualitative case study methodology to delve deeply into the context (Jiang et al. 2021 ; Corden and Millar 2007 ; Dicks et al. 2023 ; Henderson et al. 2012 ; Matusovich et al. 2010 ; Shirani and Henwood 2011 ), presenting details grounded in real-life situations and analyzing the inner relationships rather than generalize findings about the change of a large group of pre-service teachers’ self-efficacy.

Participant

This study forms a component of a broader multi-case research initiative examining teachers’ professional learning in the STEAM teacher professional development programs in China (Jiang et al. 2021 ; Wang et al. 2018 ; Wang et al. 2024 ). Within this context, one participant, Shuitao (pseudonym), is selected and reported in this current study. Shuitao was a first-year graduate student at a first-tier Normal university in Shanghai, China. Normal universities specialize in teacher education. Her graduate major was mathematics curriculum and instruction. Teaching practice courses are offered to students in this major exclusively during their third year of study. The selection of Shuitao was driven by three primary factors. Firstly, Shuitao attended the entire teacher professional development program and actively engaged in nearly all associated activities. Table 2 illustrates the timeline of the five stages in which Shuitao was involved. Secondly, her undergraduate major was applied mathematics, which was not related to mathematics teaching Footnote 7 . She possessed no prior teaching experience and had not undergone any systematic study of IAT before her involvement in the teacher professional development program. Thirdly, her other master’s courses during her first two years of study focused on mathematics education theory and did not include IAT Footnote 8 . Additionally, she scarcely participated in any other teaching practice outside of the teacher professional development program. As a pre-service teacher, Shuitao harbored a keen interest in IAT. Furthermore, she discovered that she possessed fewer teaching skills compared to her peers who had majored in education during their undergraduate studies. Hence, she had a strong desire to enhance her teaching skills. Consequently, Shuitao decided to participate in our teacher professional development program.

Shuitao was grouped with three other first-year graduate students during the teacher professional development program. She actively collaborated with them at every stage of the program. For instance, they advised each other on their IAT lesson designs, observed each other’s IAT practice and offered constructive suggestions for improvement.

Research question

Shuitao was a mathematics pre-service teacher who participated in one of our teacher professional development programs, focusing on integrating history into mathematics teaching (IHT) Footnote 9 . Notably, this teacher professional development program was designed based on our five-stage framework for teacher professional development programs of IAT. To examine the impact of this teacher professional development program on Shuitao’s self-efficacy related to IHT, this case study addresses the following research question:

What changes in Shuitao’s self-efficacy in individual performance regarding integrating history into mathematics teaching (SE-IHT-IP) may occur through participation in the teacher professional development program?

What changes in Shuitao’s self-efficacy in student outcomes regarding integrating history into mathematics teaching (SE-IHT-SO) may occur through participation in the teacher professional development program?

Data collection and analysis

Before Shuitao joined the teacher professional development program, a one-hour preliminary interview was conducted to guide her in self-narrating her psychological and cognitive state of IHT.

During the teacher professional development program, follow-up unstructured interviews were conducted once a month with Shuitao. All discussions in the development of IHT cases were recorded, Shuitao’s teaching and micro-teaching were videotaped, and the reflection notes, journals, and summary reports written by Shuitao were collected.

After completing the teacher professional development program, Shuitao participated in a semi-structured three-hour interview. The objectives of this interview were twofold: to reassess her self-efficacy and to explore the relationship between her self-efficacy changes and each stage of the teacher professional development program.

Interview data, discussions, reflection notes, journals, summary reports and videos, and analysis records were archived and transcribed before, during, and after the teacher professional development program.

In this study, we primarily utilized data from seven interviews: one conducted before the teacher professional development program, five conducted after each stage of the program, and one conducted upon completion of the program. Additionally, we reviewed Shuitao’s five reflective notes, which were written after each stage, as well as her final summary report that encompassed the entire teacher professional development program.

Merriam’s ( 1998 ) approach to coding data and inductive approach to retrieving possible concepts and themes were employed using a seven-stage method. Considering theoretical underpinnings in qualitative research is common when interpreting data (Strauss and Corbin 1990 ). First, a list based on our conceptual framework of teacher self-efficacy (see Table 1 ) was developed. The list included two codes (i.e., SE-IHT-IP and SE-IHT-SO). Second, all data were sorted chronologically, read and reread to be better understood. Third, texts were coded into multi-colored highlighting and comment balloons. Fourth, the data for groups of meanings, themes, and behaviors were examined. How these groups were connected within the conceptual framework of teacher self-efficacy was confirmed. Fifth, after comparing, confirming, and modifying, the selective codes were extracted and mapped onto the two categories according to the conceptual framework of teacher self-efficacy. Accordingly, changes in SE-IHT-IP and SE-IHT-SO at the five stages of the teacher professional development program were identified, respectively, and then the preliminary findings came (Strauss and Corbin 1990 ). In reality, in Shuitao’s narratives, SE-IHT-IP and SE-IHT-SO were frequently intertwined. Through our coding process, we differentiated between SE-IHT-IP and SE-IHT-SO, enabling us to obtain a more distinct understanding of how these two aspects of teacher self-efficacy evolved over time. This helped us address the two research questions effectively.

Reliability and validity

Two researchers independently analyzed the data to establish inter-rater reliability. The inter-rater reliability was established as kappa = 0.959. Stake ( 1995 ) suggested that the most critical assertions in a study require the greatest effort toward confirmation. In this study, three methods served this purpose and helped ensure the validity of the findings. The first way to substantiate the statement about the changes in self-efficacy was by revisiting each transcript to confirm whether the participant explicitly acknowledged the changes (Yin 2003 ). Such a check was repeated in the analysis of this study. The second way to confirm patterns in the data was by examining whether Shuitao’s statements were replicated in separate interviews (Morris and Usher 2011 ). The third approach involved presenting the preliminary conclusions to Shuitao and affording her the opportunity to provide feedback on the data and conclusions. This step aimed to ascertain whether we accurately grasped the true intentions of her statements and whether our subjective interpretations inadvertently influenced our analysis of her statements. Additionally, data from diverse sources underwent analysis by at least two researchers, with all researchers reaching consensus on each finding.

As each stage of our teacher professional development programs spanned a minimum of three months, numerous documented statements regarding the enhancement of Shuitao’s self-efficacy regarding IHT were recorded. Notably, what we present here offers only a concise overview of findings derived from our qualitative analysis. The changes in Shuitao’s SE-IHT-IP and SE-IHT-SO are organized chronologically, delineating the period before and during the teacher professional development program.

Before the teacher professional development program: “I have no confidence in IHT”

Before the teacher professional development program, Shuitao frequently expressed her lack of confidence in IHT. On the one hand, Shuitao expressed considerable apprehension about her individual performance in IHT. “How can I design and implement IHT lesson plans? I do not know anything [about it]…” With a sense of doubt, confusion and anxiety, Shuitao voiced her lack of confidence in her ability to design and implement an IHT case that would meet the requirements of the curriculum standards. Regarding the reasons for her lack of confidence, Shuitao attributed it to her insufficient theoretical knowledge and practical experience in IHT:

I do not know the basic approaches to IHT that I could follow… it is very difficult for me to find suitable historical materials… I am very confused about how to organize [historical] materials logically around the teaching goals and contents… [Furthermore,] I am [a] novice, [and] I have no IHT experience.

On the other hand, Shuitao articulated very low confidence in the efficacy of her IHT on student outcomes:

I think my IHT will have a limited impact on student outcomes… I do not know any specific effects [of history] other than making students interested in mathematics… In fact, I always think it is difficult for [my] students to understand the history… If students cannot understand [the history], will they feel bored?

This statement suggests that Shuitao did not fully grasp the significance of IHT. In fact, she knew little about the educational significance of history for students, and she harbored no belief that her IHT approach could positively impact students. In sum, her SE-IHT-SO was very low.

After stage 1: “I can do well in the first step of IHT”

After Stage 1, Shuitao indicated a slight improvement in her confidence in IHT. She attributed this improvement to her acquisition of theoretical knowledge in IHT, the approaches for selecting history-related materials, and an understanding of the educational value of history.

One of Shuitao’s primary concerns about implementing IHT before the teacher professional development program was the challenge of sourcing suitable history-related materials. However, after Stage 1, Shuitao explicitly affirmed her capability in this aspect. She shared her experience of organizing history-related materials related to logarithms as an example.

Recognizing the significance of suitable history-related materials in effective IHT implementation, Shuitao acknowledged that conducting literature studies significantly contributed to enhancing her confidence in undertaking this initial step. Furthermore, she expressed increased confidence in designing IHT lesson plans by utilizing history-related materials aligned with teaching objectives derived from the curriculum standards. In other words, her SE-IHT-IP was enhanced. She said:

After experiencing multiple discussions, I gradually know more about what kinds of materials are essential and should be emphasized, what kinds of materials should be adapted, and what kinds of materials should be omitted in the classroom instructions… I have a little confidence to implement IHT that could meet the requirements [of the curriculum standards] since now I can complete the critical first step [of IHT] well…

However, despite the improvement in her confidence in IHT following Stage 1, Shuitao also expressed some concerns. She articulated uncertainty regarding her performance in the subsequent stages of the teacher professional development program. Consequently, her confidence in IHT experienced only a modest increase.

After stage 2: “I participate in the development of IHT cases, and my confidence is increased a little bit more”

Following Stage 2, Shuitao reported further increased confidence in IHT. She attributed this growth to two main factors. Firstly, she successfully developed several instructional designs for IHT through collaboration with in-service teachers. These collaborative experiences enabled her to gain a deeper understanding of IHT approaches and enhance her pedagogical content knowledge in this area, consequently bolstering her confidence in her ability to perform effectively. Secondly, Shuitao observed the tangible impact of IHT cases on students in real classroom settings, which reinforced her belief in the efficacy of IHT. These experiences instilled in her a greater sense of confidence in her capacity to positively influence her students through her implementation of IHT. Shuitao remarked that she gradually understood how to integrate suitable history-related materials into her instructional designs (e.g., employ a genetic approach Footnote 10 ), considering it as the second important step of IHT. She shared her experience of developing IHT instructional design on the concept of logarithms. After creating several iterations of IHT instructional designs, Shuitao emphasized that her confidence in SE-IHT-IP has strengthened. She expressed belief in her ability to apply these approaches to IHT, as well as the pedagogical content knowledge of IHT, acquired through practical experience, in her future teaching endeavors. The following is an excerpt from the interview:

I learned some effective knowledge, skills, techniques and approaches [to IHT]… By employing these approaches, I thought I could [and] I had the confidence to integrate the history into instructional designs very well… For instance, [inspired] by the genetic approach, we designed a series of questions and tasks based on the history of logarithms. The introduction of the new concept of logarithms became very natural, and it perfectly met the requirements of our curriculum standards, [which] asked students to understand the necessity of learning the concept of logarithms…

Shuitao actively observed the classroom teaching conducted by her cooperating in-service teacher. She helped her cooperating in-service teacher in collecting and analyzing students’ feedback. Subsequently, discussions ensued on how to improve the instructional designs based on this feedback. The refined IHT instructional designs were subsequently re-implemented by the in-service teacher. After three rounds of developing IHT cases, Shuitao became increasingly convinced of the significance and efficacy of integrating history into teaching practices, as evidenced by the following excerpt:

The impacts of IHT on students are visible… For instance, more than 93% of the students mentioned in the open-ended questionnaires that they became more interested in mathematics because of the [historical] story of Napier… For another example, according to the results of our surveys, more than 75% of the students stated that they knew log a ( M  +  N ) = log a M  × log a N was wrong because of history… I have a little bit more confidence in the effects of my IHT on students.

This excerpt highlights that Shuitao’s SE-IHT-SO was enhanced. She attributed this enhancement to her realization of the compelling nature of history and her belief in her ability to effectively leverage its power to positively influence her students’ cognitive and emotional development. This also underscores the importance of reinforcing pre-service teachers’ awareness of the significance of history. Nonetheless, Shuiato elucidated that she still retained concerns regarding the effectiveness of her IHT implementation. Her following statement shed light on why her self-efficacy only experienced a marginal increase in this stage:

Knowing how to do it successfully and doing it successfully in practice are two totally different things… I can develop IHT instructional designs well, but I have no idea whether I can implement them well and whether I can introduce the history professionally in practice… My cooperation in-service teacher has a long history of teaching mathematics and gains rich experience in educational practices… If I cannot acquire some required teaching skills and capabilities, I still cannot influence my students powerfully.

After stage 3: “Practice makes perfect, and my SE-IHT-IP is steadily enhanced after a hit”

After successfully developing IHT instructional designs, the next critical step was the implementation of these designs. Drawing from her observations of her cooperating in-service teachers’ IHT implementations and discussions with other pre-service teachers, Shuitao developed her own IHT lesson plans. In Stage 3, she conducted simulated teaching sessions and evaluated her teaching performance ten times Footnote 11 . Shuitao claimed that her SE-IHT-IP steadily improved over the course of these sessions. According to Shuitao, two main processes in Stage 3 facilitated this steady enhancement of SE-IHT-IP.

On the one hand, through the repeated implementation of simulated teaching sessions, Shuitao’s teaching proficiency and fluency markedly improved. Shuitao first described the importance of teaching proficiency and fluency:

Since the detailed history is not included in our curriculum standards and textbooks, if I use my historical materials in class, I have to teach more contents than traditional teachers. Therefore, I have to teach proficiently so that teaching pace becomes a little faster than usual… I have to teach fluently so as to use each minute efficiently in my class. Otherwise, I cannot complete the teaching tasks required [by curriculum standards].

As Shuitao said, at the beginning of Stage 3, her self-efficacy even decreased because she lacked teaching proficiency and fluency and was unable to complete the required teaching tasks:

In the first few times of simulated teaching, I always needed to think for a second about what I should say next when I finish one sentence. I also felt very nervous when I stood in the front of the classrooms. This made my narration of the historical story between Briggs and Napier not fluent at all. I paused many times to look for some hints on my notes… All these made me unable to complete the required teaching tasks… My [teaching] confidence took a hit.

Shuitao quoted the proverb, “practice makes perfect”, and she emphasized that it was repeated practice that improved her teaching proficiency and fluency:

I thought I had no other choice but to practice IHT repeatedly… [At the end of Stage 3,] I could naturally remember most words that I should say when teaching the topics that I selected… My teaching proficiency and fluency was improved through my repeated review of my instructional designs and implementation of IHT in the micro-classrooms… With the improvement [of my teaching proficiency and fluency], I could complete the teaching tasks, and my confidence was increased as well.

In addition, Shuitao also mentioned that through this kind of self-exploration in simulated teaching practice, her teaching skills and capabilities (e.g., blackboard writing, abilities of language organization abilities, etc.) improved. This process was of great help to her enhancement of SE-IHT-IP.

On the other hand, Shuitao’s simulated teaching underwent assessment by herself, with mentors, in-service teachers and fellow pre-service teachers. This comprehensive evaluation process played a pivotal role in enhancing her individual performance and self-efficacy. Reflecting on this aspect, Shuitao articulated the following sentiments in one of her reflection reports:

By watching the videos, conducting self-assessment, and collecting feedback from others, I can understand what I should improve or emphasize in my teaching. [Then,] I think my IHT can better meet the requirements [of curriculum standards]… I think my teaching performance is getting better and better.

After stage 4: “My micro-courses influenced students positively, and my SE-IHT-SO is steadily enhanced”

In Stage 4, Shuitao commenced by creating 5-min micro-course videos. Subsequently, she played these videos in her cooperating in-service teachers’ authentic classroom settings and collected student feedback. This micro-course was played at the end of her cooperating in-service teachers’ lesson Footnote 12 . Shuitao wrote in her reflections that this micro-course of logarithms helped students better understand the nature of mathematics:

According to the results of our surveys, many students stated that they knew the development and evolution of the concept of logarithms is a long process and many mathematicians from different countries have contributed to the development of the concept of logarithms… This indicated that my micro-course helped students better understand the nature of mathematics… My micro-course about the history informed students that mathematics is an evolving and human subject and helped them understand the dynamic development of the [mathematics] concept…

Meanwhile, Shuitao’s micro-course positively influenced some students’ beliefs towards mathematics. As evident from the quote below, integrating historical context into mathematics teaching transformed students’ perception of the subject, boosting Shuitao’s confidence too.

Some students’ responses were very exciting… [O]ne [typical] response stated, he always regarded mathematics as abstract, boring, and dreadful subject; but after seeing the photos of mathematicians and great men and learning the development of the concept of logarithms through the micro-course, he found mathematics could be interesting. He wanted to learn more the interesting history… Students’ such changes made me confident.

Furthermore, during post-class interviews, several students expressed their recognition of the significance of the logarithms concept to Shuitao, attributing this realization to the insights provided by prominent figures in the micro-courses. They also conveyed their intention to exert greater effort in mastering the subject matter. This feedback made Shuitao believe that her IHT had the potential to positively influence students’ attitudes towards learning mathematics.

In summary, Stage 4 marked Shuitao’s first opportunity to directly impact students through her IHT in authentic classroom settings. Despite implementing only brief 5-min micro-courses integrating history during each session, the effectiveness of her short IHT implementation was validated by student feedback. Shuitao unequivocally expressed that students actively engaged with her micro-courses and that these sessions positively influenced them, including attitudes and motivation toward mathematics learning, understanding of mathematics concepts, and beliefs regarding mathematics. These collective factors contributed to a steady enhancement of her confidence in SE-IHT-SO.

After stage 5: “My overall self-efficacy is greatly enhanced”

Following Stage 5, Shuitao reported a significant increase in her overall confidence in IHT, attributing it to gaining mastery through successful implementations of IHT in real classroom settings. On the one hand, Shuitao successfully designed and executed her IHT lesson plans, consistently achieving the teaching objectives mandated by curriculum standards. This significantly enhanced her SE-IHT-IP. On the other hand, as Shuitao’s IHT implementation directly influenced her students, her confidence in SE-IHT-SO experienced considerable improvement.

According to Bandura ( 1997 ), mastery experience is the most powerful source of self-efficacy. Shuitao’s statements confirmed this. As she claimed, her enhanced SE-IHT-IP in Stage 5 mainly came from the experience of successful implementations of IHT in real classrooms:

[Before the teacher professional development program,] I had no idea about implementing IHT… Now, I successfully implemented IHT in senior high school [classrooms] many times… I can complete the teaching tasks and even better completed the teaching objectives required [by the curriculum standards]… The successful experience greatly enhances my confidence to perform well in my future implementation of IHT… Yeah, I think the successful teaching practice experience is the strongest booster of my confidence.

At the end of stage 5, Shuitao’s mentors and in-service teachers gave her a high evaluation. For instance, after Shuitao’s IHT implementation of the concept of logarithms, all mentors and in-service teachers consistently provided feedback that her IHT teaching illustrated the necessity of learning the concept of logarithms and met the requirements of the curriculum standards very well. This kind of verbal persuasion (Bandura 1997 ) enhanced her SE-IHT-IP.

Similarly, Shuitao’s successful experience of influencing students positively through IHT, as one kind of mastery experience, powerfully enhanced her SE-IHT-SO. She described her changes in SE-IHT-SO as follows:

I could not imagine my IHT could be so influential [before]… But now, my IHT implementation directly influenced students in so many aspects… When I witnessed students’ real changes in various cognitive and affective aspects, my confidence was greatly improved.

Shuitao described the influence of her IHT implementation of the concept of logarithms on her students. The depiction is grounded in the outcomes of surveys conducted by Shuitao following her implementation. Shuitao asserted that these results filled her with excitement and confidence regarding her future implementation of IHT.

In summary, following Stage 5 of the teacher professional development program, Shuitao experienced a notable enhancement in her overall self-efficacy, primarily attributed to her successful practical experience in authentic classroom settings during this stage.

A primary objective of our teacher professional development programs is to equip pre-service teachers with the skills and confidence needed to effectively implement IAT. Our findings show that one teacher professional development program, significantly augmented a participant’s TSE-IHT across two dimensions: individual performance and student outcomes. Considering the pressing need to provide STEAM teachers with effective professional training (e.g., Boice et al. 2021 ; Duong et al. 2024 ; Herro et al. 2019 ; Jacques et al. 2020 ; Park and Cho 2022 ; Perignat and Katz-Buonincontro 2019 ), the proposed five-stage framework holds significant promise in both theoretical and practical realms. Furthermore, this study offers a viable solution to address the prevalent issue of low levels of teacher self-efficacy in interdisciplinary teaching, including IAT, which is critical in STEAM education (Zhou et al. 2023 ). This study holds the potential to make unique contributions to the existing body of literature on teacher self-efficacy, teacher professional learning models and the design of teacher professional development programs of IAT.

Firstly, this study enhances our understanding of the development of teacher self-efficacy. Our findings further confirm the complexity of the development of teacher self-efficacy. On the one hand, the observed enhancement of the participant’s teacher self-efficacy did not occur swiftly but unfolded gradually through a protracted, incremental process. Moreover, it is noteworthy that the participant’s self-efficacy exhibited fluctuations, underscoring that the augmentation of teacher self-efficacy is neither straightforward nor linear. On the other hand, the study elucidated that the augmentation of teacher self-efficacy constitutes an intricate, multi-level system that interacts with teacher knowledge, skills, and other beliefs. This finding resonates with prior research on teacher self-efficacy (Morris et al. 2017 ; Xenofontos and Andrews 2020 ). For example, our study revealed that Shuitao’s enhancement of SE-IHT-SO may always be interwoven with her continuous comprehension of the significance of the A&H in classroom settings. Similarly, the participant progressively acknowledged the educational value of A&H in classroom contexts in tandem with the stepwise enhancement of SE-IHT-SO. Factors such as the participant’s pedagogical content knowledge of IHT, instructional design, and teaching skills were also identified as pivotal components of SE-IHT-IP. This finding corroborates Morris and Usher ( 2011 ) assertion that sustained improvements in self-efficacy stem from developing teachers’ skills and knowledge. With the bolstering of SE-IHT-IP, the participant’s related teaching skills and content knowledge also exhibited improvement.

Methodologically, many researchers advocate for qualitative investigations into self-efficacy (e.g., Philippou and Pantziara 2015; Klassen et al. 2011 ; Wyatt 2015 ; Xenofontos and Andrews 2020 ). While acknowledging limitations in sample scope and the generalizability of the findings, this study offers a longitudinal perspective on the stage-by-stage development of teacher self-efficacy and its interactions with different factors (i.e., teacher knowledge, skills, and beliefs), often ignored by quantitative studies. Considering that studies of self-efficacy have been predominantly quantitative, typically drawing on survey techniques and pre-determined scales (Xenofontos and Andrews, 2020 ; Zhou et al. 2023 ), this study highlights the need for greater attention to qualitative studies so that more cultural, situational and contextual factors in the development of self-efficacy can be captured.

Our study provides valuable practical implications for enhancing pre-service teachers’ self-efficacy. We conceptualize teacher self-efficacy in two primary dimensions: individual performance and student outcomes. On the one hand, pre-service teachers can enhance their teaching qualities, boosting their self-efficacy in individual performance. The adage “practice makes perfect” underscores the necessity of ample teaching practice opportunities for pre-service teachers who lack prior teaching experience. Engaging in consistent and reflective practice helps them develop confidence in their teaching qualities. On the other hand, pre-service teachers should focus on positive feedback from their students, reinforcing their self-efficacy in individual performance. Positive student feedback serves as an affirmation of their teaching effectiveness and encourages continuous improvement. Furthermore, our findings highlight the significance of mentors’ and peers’ positive feedback as critical sources of teacher self-efficacy. Mentors and peers play a pivotal role in the professional growth of pre-service teachers by actively encouraging them and recognizing their teaching achievements. Constructive feedback from experienced mentors and supportive peers fosters a collaborative learning environment and bolsters the self-confidence of pre-service teachers. Additionally, our research indicates that pre-service teachers’ self-efficacy may fluctuate. Therefore, mentors should be prepared to help pre-service teachers manage teaching challenges and setbacks, and alleviate any teaching-related anxiety. Mentors can help pre-service teachers build resilience and maintain a positive outlook on their teaching journey through emotional support and guidance. Moreover, a strong correlation exists between teacher self-efficacy and teacher knowledge and skills. Enhancing pre-service teachers’ knowledge base and instructional skills is crucial for bolstering their overall self-efficacy.

Secondly, this study also responds to the appeal to understand teachers’ professional learning from a holistic perspective and interrelate teachers’ professional learning process with student outcome variables (Sancar et al. 2021 ), and thus contributes to the understanding of the complexity of STEAM teachers’ professional learning. On the one hand, we have confirmed Cai et al.’s ( 2020 ) teacher professional learning model in a new context, namely STEAM teacher education. Throughout the teacher professional development program, the pre-service teacher, Shuitao, demonstrated an augmentation in her knowledge, encompassing both content knowledge and pedagogical understanding concerning IHT. Moreover, her beliefs regarding IHT transformed as a result of her engagement in teacher learning across the five stages. This facilitated her in executing effective IHT teaching and improving her students’ outcomes. On the other hand, notably, in our studies (including this current study and some follow-up studies), student feedback is a pivotal tool to assist teachers in discerning the impact they are effectuating. This enables pre-service teachers to grasp the actual efficacy of their teaching efforts and subsequently contributes significantly to the augmentation of their self-efficacy. Such steps have seldom been conducted in prior studies (e.g., Cai et al. 2020 ), where student outcomes are often perceived solely as the results of teachers’ instruction rather than sources informing teacher beliefs. Additionally, this study has validated both the interaction between teaching performance and teacher beliefs and between teacher knowledge and teacher beliefs. These aspects were overlooked in Cai et al.’s ( 2020 ) model. More importantly, while Clarke and Hollingsworth’s ( 2002 ) Interconnected Model of Professional Growth illustrates the connections between the domain of consequence and the personal domain, as well as between the personal domain and the domain of practice, it does not adequately clarify the complex relationships among the factors within the personal domain (e.g., the interaction between teacher knowledge and teacher beliefs). Therefore, our study also supplements Clarke and Hollingsworth’s ( 2002 ) model by addressing these intricacies. Based on our findings, an updated model of teacher professional learning has been proposed, as shown in Fig. 3 . This expanded model indicates that teacher learning should be an ongoing and sustainable process, with the enhancement of student learning not marking the conclusion of teacher learning, but rather serving as the catalyst for a new phase of learning. In this sense, we advocate for further research to investigate the tangible impacts of teacher professional development programs on students and how those impacts stimulate subsequent cycles of teacher learning.

Note: Paths in blue were proposed by Cai et al. ( 2020 ), and paths in yellow are proposed and verified in this study.

Thirdly, in light of the updated model of teacher professional learning (see Fig. 3 ), this study provides insights into the design of teacher professional development programs of IAT. According to Huang et al. ( 2022 ), to date, very few studies have set goals to “develop a comprehensive understanding of effective designs” for STEM (or STEAM) teacher professional development programs (p. 15). To fill this gap, this study proposes a novel and effective five-stage framework for teacher professional development programs of IAT. This framework provides a possible and feasible solution to the challenges of STEAM teacher professional development programs’ design and planning, and teachers’ IAT practice (Boice et al. 2021 ; Herro et al. 2019 ; Jacques et al. 2020 ; Park and Cho 2022 ; Perignat and Katz-Buonincontro 2019 ).

Specifically, our five-stage framework incorporates at least six important features. Firstly, teacher professional development programs should focus on specific STEAM content. Given the expansive nature of STEAM, teacher professional development programs cannot feasibly encompass all facets of its contents. Consistent with recommendations by Cai et al. ( 2020 ), Desimone et al. ( 2002 ) and Garet et al. ( 2001 ), an effective teacher professional development program should prioritize content focus. Our five-stage framework is centered on IAT. Throughout an 18-month duration, each pre-service teacher is limited to selecting one subcomponent of A&H, such as history, for integration into their subject teaching (i.e., mathematics teaching, technology teaching or science teaching) within one teacher professional development program. Secondly, in response to the appeals that teacher professional development programs should shift from emphasizing teaching and instruction to emphasizing student learning (Cai et al. 2020 ; Calabrese et al. 2024 ; Hwang et al. 2024 ; Marco and Palatnik 2024 ; Örnek and Soylu 2021 ), our framework requires pre-service teachers to pay close attention to the effects of IAT on student learning outcomes, and use students’ feedback as the basis of improving their instruction. Thirdly, prior studies found that teacher education with a preference for theory led to pre-service teachers’ dissatisfaction with the quality of teacher professional development program and hindered the development of pre-service teachers’ teaching skills and teaching beliefs, which also widened the gap between theory and practice (Hennissen et al. 2017 ; Ord and Nuttall 2016 ). In this regard, our five-stage framework connects theory and teaching practice closely. In particular, pre-service teachers can experience the values of IAT not only through theoretical learning but also through diverse teaching practices. Fourthly, we build a teacher community of practice tailored for pre-service teachers. Additionally, we aim to encourage greater participation of in-service teachers in such teacher professional development programs designed for pre-service educators in STEAM teacher education. By engaging in such programs, in-service teachers can offer valuable teaching opportunities for pre-service educators and contribute their insights and experiences from teaching practice. Importantly, pre-service teachers stand to gain from the in-service teachers’ familiarity with textbooks, subject matter expertise, and better understanding of student dynamics. Fifthly, our five-stage framework lasts for an extended period, spanning 18 months. This duration ensures that pre-service teachers engage in a sustained and comprehensive learning journey. Lastly, our framework facilitates a practical understanding of “integration” by offering detailed, sequential instructions for blending two disciplines in teaching. For example, our teacher professional development programs prioritize systematic learning of pedagogical theories and simulated teaching experiences before pre-service teachers embark on real STEAM teaching endeavors. This approach is designed to mitigate the risk of unsuccessful experiences during initial teaching efforts, thereby safeguarding pre-service teachers’ teacher self-efficacy. Considering the complexity of “integration” in interdisciplinary teaching practices, including IAT (Han et al. 2022 ; Ryu et al. 2019 ), we believe detailed stage-by-stage and step-by-step instructions are crucial components of relevant pre-service teacher professional development programs. Notably, this aspect, emphasizing structural instructional guidance, has not been explicitly addressed in prior research (e.g., Cai et al. 2020 ). Figure 4 illustrates the six important features outlined in this study, encompassing both established elements and the novel addition proposed herein, describing an effective teacher professional development program.

Note: STEAM refers to science, technology, engineering, arts and humanities, and mathematics.

The successful implementation of this framework is also related to the Chinese teacher education system and cultural background. For instance, the Chinese government has promoted many university-school collaboration initiatives, encouraging in-service teachers to provide guidance and practical opportunities for pre-service teachers (Lu et al. 2019 ). Influenced by Confucian values emphasizing altruism, many experienced in-service teachers in China are eager to assist pre-service teachers, helping them better realize their teaching career aspirations. It is reported that experienced in-service teachers in China show significantly higher motivation than their international peers when mentoring pre-service teachers (Lu et al. 2019 ). Therefore, for the successful implementation of this framework in other countries, it is crucial for universities to forge close collaborative relationships with K-12 schools and actively involve K-12 teachers in pre-service teacher education.

Notably, approximately 5% of our participants dropped out midway as they found that the IAT practice was too challenging or felt overwhelmed by the number of required tasks in the program. Consequently, we are exploring options to potentially simplify this framework in future iterations.

Without minimizing the limitations of this study, it is important to recognize that a qualitative longitudinal case study can be a useful means of shedding light on the development of a pre-service STEAM teacher’s self-efficacy. However, this methodology did not allow for a pre-post or a quasi-experimental design, and the effectiveness of our five-stage framework could not be confirmed quantitatively. In the future, conducting more experimental or design-based studies could further validate the effectiveness of our framework and broaden our findings. Furthermore, future studies should incorporate triangulation methods and utilize multiple data sources to enhance the reliability and validity of the findings. Meanwhile, owing to space limitations, we could only report the changes in Shuitao’s SE-IHT-IP and SE-IHT-SO here, and we could not describe the teacher self-efficacy of other participants regarding IAT. While nearly all of the pre-service teachers experienced an improvement in their teacher self-efficacy concerning IAT upon participating in our teacher professional development programs, the processes of their change were not entirely uniform. We will need to report the specific findings of these variations in the future. Further studies are also needed to explore the factors contributing to these variations. Moreover, following this study, we are implementing more teacher professional development programs of IAT. Future studies can explore the impact of this framework on additional aspects of pre-service STEAM teachers’ professional development. This will help gain a more comprehensive understanding of its effectiveness and potential areas for further improvement. Additionally, our five-stage framework was initially developed and implemented within the Chinese teacher education system. Future research should investigate how this framework can be adapted in other educational systems and cultural contexts.

The impetus behind this study stems from the burgeoning discourse advocating for the integration of A&H disciplines into STEM education on a global scale (e.g., Land 2020 ; Park and Cho 2022 ; Uştu et al. 2021 ; Vaziri and Bradburn 2021 ). Concurrently, there exists a pervasive concern regarding the challenges teachers face in implementing STEAM approaches, particularly in the context of IAT practices (e.g., Boice et al. 2021 ; Herro et al. 2019 ; Jacques et al. 2020 ; Park and Cho 2022 ; Perignat and Katz-Buonincontro 2019 ). To tackle this challenge, we first proposed a five-stage framework designed for teacher professional development programs of IAT. Then, utilizing this innovative framework, we implemented a series of teacher professional development programs. Drawing from the recommendations of Bray-Clark and Bates ( 2003 ), Kelley et al. ( 2020 ) and Zhou et al. ( 2023 ), we have selected teacher self-efficacy as a key metric to examine the effectiveness of the five-stage framework. Through a qualitative longitudinal case study, we scrutinized the influence of a specific teacher professional development program on the self-efficacy of a single pre-service teacher over an 18-month period. Our findings revealed a notable enhancement in teacher self-efficacy across both individual performance and student outcomes. The observed enhancement of the participant’s teacher self-efficacy did not occur swiftly but unfolded gradually through a prolonged, incremental process. Building on our findings, an updated model of teacher learning has been proposed. The updated model illustrates that teacher learning should be viewed as a continuous and sustainable process, wherein teaching performance, teacher beliefs, and teacher knowledge dynamically interact with one another. The updated model also confirms that teacher learning is inherently intertwined with student learning in STEAM education. Furthermore, this study also summarizes effective design features of STEAM teacher professional development programs.

Data availability

The datasets generated and/or analyzed during this study are not publicly available due to general data protection regulations, but are available from the corresponding author on reasonable request.

In their review article, Morris et al. ( 2017 ) equated “teaching self-efficacy” and “teacher self-efficacy” as synonymous concepts. This perspective is also adopted in this study.

An effective teacher professional development program should have specific, focused, and clear content instead of broad and scattered ones. Therefore, each pre-service teacher can only choose to integrate one subcomponent of A&H into their teaching in one teacher professional development program. For instance, Shuitao, a mathematics pre-service teacher, participated in one teacher professional development program focused on integrating history into mathematics teaching. However, she did not explore the integration of other subcomponents of A&H into her teaching during her graduate studies.

In the micro-classrooms, multi-angle, and multi-point high-definition video recorders are set up to record the teaching process.

In micro-teaching, mentors, in-service teachers, and other fellow pre-service teachers take on the roles of students.

In China, teachers can video record one section of a lesson and play them in formal classes. This is a practice known as a micro-course. For instance, in one teacher professional development program of integrating history into mathematics teaching, micro-courses encompass various mathematics concepts, methods, ideas, history-related material and related topics. Typically, teachers use these micro-courses to broaden students’ views, foster inquiry-based learning, and cultivate critical thinking skills. Such initiatives play an important role in improving teaching quality.

Many university-school collaboration initiatives in China focus on pre-service teachers’ practicum experiences (Lu et al. 2019 ). Our teacher professional development program is also supported by many K-12 schools in Shanghai. Personal information in videos is strictly protected.

In China, students are not required to pursue a graduate major that matches their undergraduate major. Most participants in our teacher professional development programs did not pursue undergraduate degrees in education-related fields.

Shuitao’s university reserves Wednesday afternoons for students to engage in various programs or clubs, as classes are not scheduled during this time. Similarly, our teacher professional development program activities are planned for Wednesday afternoons to avoid overlapping with participants’ other coursework commitments.

History is one of the most important components of A&H (Park and Cho 2022 ).

To learn more about genetic approach (i.e., genetic principle), see Jankvist ( 2009 ).

For the assessment process, see Fig. 2 .

Shuitao’s cooperating in-service teacher taught the concept of logarithms in Stage 2. In Stage 4, the teaching objective of her cooperating in-service teacher’s review lesson was to help students review the concept of logarithms to prepare students for the final exam.

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Acknowledgements

This research is funded by 2021 National Natural Science Foundation of China (Grant No.62177042), 2024 Zhejiang Provincial Natural Science Foundation of China (Grant No. Y24F020039), and 2024 Zhejiang Educational Science Planning Project (Grant No. 2024SCG247).

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Xuesong Zhai

Present address: School of Education, City University of Macau, Macau, China

Authors and Affiliations

College of Education, Zhejiang University, Hangzhou, China

Haozhe Jiang & Xuesong Zhai

School of Engineering and Technology, CML‑NET & CREATE Research Centres, Central Queensland University, North Rockhampton, QLD, Australia

Ritesh Chugh

Hangzhou International Urbanology Research Center & Zhejiang Urban Governance Studies Center, Hangzhou, China

Department of Teacher Education, Nicholls State University, Thibodaux, LA, USA

School of Mathematical Sciences, East China Normal University, Shanghai, China

Xiaoqin Wang

College of Teacher Education, Faculty of Education, East China Normal University, Shanghai, China

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Conceptualization - Haozhe Jiang; methodology - Haozhe Jiang; software - Xuesong Zhai; formal analysis - Haozhe Jiang & Ke Wang; investigation - Haozhe Jiang; resources - Haozhe Jiang, Xuesong Zhai & Xiaoqin Wang; data curation - Haozhe Jiang & Ke Wang; writing—original draft preparation - Haozhe Jiang & Ritesh Chugh; writing—review and editing - Ritesh Chugh & Ke Wang; visualization - Haozhe Jiang, Ke Wang & Xiaoqin Wang; supervision - Xuesong Zhai & Xiaoqin Wang; project administration - Xuesong Zhai & Xiaoqin Wang; and funding acquisition - Xuesong Zhai & Xiaoqin Wang. All authors have read and agreed to the published version of the manuscript.

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Correspondence to Xuesong Zhai .

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This research was approved by the Committee for Human Research of East China Normal University (Number: HR 347-2022). The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

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Written informed consent was obtained from all participants in this study before data collection.

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Jiang, H., Chugh, R., Zhai, X. et al. Longitudinal analysis of teacher self-efficacy evolution during a STEAM professional development program: a qualitative case study. Humanit Soc Sci Commun 11 , 1162 (2024). https://doi.org/10.1057/s41599-024-03655-5

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Received : 27 April 2024

Accepted : 12 August 2024

Published : 08 September 2024

DOI : https://doi.org/10.1057/s41599-024-03655-5

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