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Sympathetic and Self-Reported Threat Reactivity in Social Anxiety: Modulation by Threat Certainty and Avoidance Behavior. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2019. [DOI: 10.1007/s10862-019-09725-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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52
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Post-event Processing and Alcohol Intoxication: The Moderating Role of Social Anxiety. COGNITIVE THERAPY AND RESEARCH 2019. [DOI: 10.1007/s10608-019-10011-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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53
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Halldorsson B, Castelijn S, Creswell C. Are children with social anxiety disorder more likely than children with other anxiety disorders to anticipate poor social performance and reflect negatively on their performance? J Affect Disord 2019; 245:561-568. [PMID: 30445381 DOI: 10.1016/j.jad.2018.11.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 08/14/2018] [Accepted: 11/03/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND The cognitive theory of social anxiety disorder (SAD) suggests that adults with SAD have a tendency to anticipate poor social performance and reflect negatively on their performance following a social event. While a number of studies with socially anxious adults have supported the role of poor performance anticipation and post-event rumination in SAD, to date, only a few studies have addressed whether this also applies to children with SAD. METHODS Children (7-12 years) diagnosed with SAD (n = 40), other anxious children (n = 40) and non-anxious children (n = 34) were exposed to a social stressor speech task and their pre- and post-performance appraisals assessed, taking into account objective performance ratings. RESULTS Although observers rated some aspects of performance as significantly worse among children with SAD than children with other anxiety disorders, children with SAD were not more likely than their anxious or non-anxious peers to show a general bias in pre- or post-performance appraisals. Furthermore, children with SAD were just as likely as their anxious and non-anxious peers to recognize good performance but were more critical of themselves when their performance was poor. LIMITATIONS The speech task did not involve a same-age peer. Participants were relatively affluent group of predominantly non-minority status. Specificity for SAD in relation to other anxiety disorders remains unclear. CONCLUSIONS Focusing on counteracting pre- and post-event social performance appraisals may potentially be inappropriate for childhood SAD. Children with SAD might benefit from interventions that focus on helping them to become less critical of themselves after social interactions have not gone well.
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Affiliation(s)
- Brynjar Halldorsson
- School of Psychology & Clinical Language Sciences, University of Reading, Reading RG6 6AL, UK.
| | - Saskia Castelijn
- School of Psychology & Clinical Language Sciences, University of Reading, Reading RG6 6AL, UK
| | - Cathy Creswell
- School of Psychology & Clinical Language Sciences, University of Reading, Reading RG6 6AL, UK
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Plans D, Morelli D, Sütterlin S, Ollis L, Derbyshire G, Cropley M. Use of a Biofeedback Breathing App to Augment Poststress Physiological Recovery: Randomized Pilot Study. JMIR Form Res 2019; 3:e12227. [PMID: 30684437 PMCID: PMC6682287 DOI: 10.2196/12227] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 10/20/2018] [Accepted: 10/22/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The speed of physiological recovery from stress may be a marker for cardiovascular disease risk. Stress management programs that incorporate guided breathing have been shown to moderate the stress response and augment recovery. OBJECTIVE The aim of this study was to examine the effectiveness of an app-based brief relaxation intervention (BioBase) for facilitating physiological recovery in individuals exposed to a brief psychological stressor. METHODS A total of 75 participants (44 women) completed a stressor speech task and were randomly assigned to one of three conditions: control, rumination, or an app-based relaxation breathing (BioBase) conditions. Heart rate variability (HRV) was assessed as a measure of autonomic function at baseline (6 min), during stress (6 min), and during recovery (6 min). RESULTS There was a significant increase in subjective stress following stress exposure, but the ratings returned to baseline after recovery in all three groups. In addition, there was a significant decrease in vagally mediated HRV in the poststress period. During recovery, the root mean square of successive differences (P<.001), the percentage of successive interbeat (RR) intervals that differ by >50 ms (pNN50; P<.001), and high-frequency (P<.02) HRV were significantly higher in the BioBase breathing condition than the rumination and control conditions. There was no difference in HRV values between the rumination and control conditions during recovery. CONCLUSIONS App-based relaxed breathing interventions could be effective in reducing cardiovascular disease risk. These results provide additional utility of biofeedback breathing in augmenting physiological recovery from psychological stress.
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Affiliation(s)
- David Plans
- BioBeats Group LTD, London, United Kingdom.,Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - Davide Morelli
- BioBeats Group LTD, London, United Kingdom.,Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, United Kingdom
| | - Stefan Sütterlin
- Faculty for Health and Welfare Sciences, Østfold University College, Østfold, Norway.,Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| | - Lucie Ollis
- Faculty of Health and Medical Sciences, School of Psychology, University of Surrey, Guildford, United Kingdom
| | - Georgia Derbyshire
- Faculty of Health and Medical Sciences, School of Psychology, University of Surrey, Guildford, United Kingdom
| | - Mark Cropley
- Faculty of Health and Medical Sciences, School of Psychology, University of Surrey, Guildford, United Kingdom
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Bortolon C, Lopes B, Capdevielle D, Macioce V, Raffard S. The roles of cognitive avoidance, rumination and negative affect in the association between abusive supervision in the workplace and non-clinical paranoia in a sample of workers working in France. Psychiatry Res 2019; 271:581-589. [PMID: 30554106 DOI: 10.1016/j.psychres.2018.11.065] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 11/27/2018] [Accepted: 11/27/2018] [Indexed: 11/29/2022]
Abstract
This study examined the relationship between abusive supervision and non-clinical paranoia and explored which cognitive mechanisms are mediating this association (i.e. rumination, cognitive avoidance and negative affect). A sample of two hundred and five French-speaking workers currently in employment in France was recruited to fill in a battery of online questionnaires comprising of the French adaptations of the Abusive Supervision Scale, the State Social Paranoia Scales, the Depression and Anxiety and Stress Scales, the Cognitive Avoidance Questionnaire and the Mini-Cambridge Exeter Repetitive Thought Scale. Mediation analyses showed that the experience of supervisory abuse directly influences state paranoia, however, there were significant mediation effects. Abusive supervision impacted on cognitive avoidance that led to more rumination, which in its turn increased negative affect and this increased state paranoia. Rumination impacted on state paranoia but through the effect of negative affect only. This study showed that abusive supervision works together with cognitive and affective factors to impact on non-clinical paranoia. It is recommended that Cognitive and Behavioural therapy (CBT) is tailored to help workers to cope with experiences of supervisory abuse and associated paranoid thoughts by focusing on replacing rumination and cognitive avoidance strategies for more adaptive cognitive strategies and on how to manage depression.
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Affiliation(s)
- Catherine Bortolon
- Laboratoire Inter-universitaire de Psychologie: Personnalité, Cognition et Changement Social - Université Grenoble Alpes, Grenoble, France; CHU Montpellier, Epsylon Laboratory, University Department of Adult Psychiatry, Rue du Pr. Henri Serre, 34000, Montpellier, EA 4556, France.
| | - Bárbara Lopes
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), Faculdade de Psicologia e de Ciências da Educação da Universidade de Coimbra, Apartado 602, 3001-802, Coimbra, Portugal.
| | - Delphine Capdevielle
- CHU Montpellier, Epsylon Laboratory, University Department of Adult Psychiatry, Rue du Pr. Henri Serre, 34000, Montpellier, EA 4556, France; French National Institute of Health and Medical Research (INSERM), U1061Pathologies of the Nervous System: Epidemiological and Clinical Research, Montpellier, France
| | - Valéry Macioce
- Department of Medical Information, CHU Montpellier, Clinical Research and Epidemiology Unity, Montpellier, France
| | - Stéphane Raffard
- Univ Paul Valéry Montpellier 3, Univ. Montpellier, EPSYLON EA 4556, F34000, Montpellier, France; CHU Montpellier, Epsylon Laboratory, University Department of Adult Psychiatry, Rue du Pr. Henri Serre, 34000, Montpellier, EA 4556, France
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56
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Arditte Hall KA, Quinn ME, Vanderlind WM, Joormann J. Comparing cognitive styles in social anxiety and major depressive disorders: An examination of rumination, worry, and reappraisal. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2018; 58:231-244. [PMID: 30484868 DOI: 10.1111/bjc.12210] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 10/31/2018] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Social anxiety disorder (SAD) and major depressive disorder (MDD) are commonly occurring and frequently comorbid disorders. Though individuals with SAD and MDD are more likely to engage in rumination and worry, relatively few studies have compared individuals with SAD, MDD, or both disorders on their use of these cognitive styles. Similarly, the extent to which the disorders differ in their use of reappraisal remains unclear. Thus, the current study sought to systematically examine rumination, worry, and reappraisal in individuals with and without SAD, MDD, or both disorders. METHODS The study comprised 330 participants recruited from the community (n = 54 with SAD, n = 61 with MDD, n = 69 with comorbid SAD/MDD, and n = 146 healthy controls). Following confirmation of diagnostic status via clinical interview, participants completed measures of rumination, worry, and reappraisal. RESULTS Healthy controls reported less use of rumination (i.e., brooding and reflection) and worry than individuals with a psychiatric diagnosis. Individuals with SAD or MDD did not differ from each other, but participants in both groups reported less rumination, particularly brooding, than individuals with comorbid SAD/MDD. Diagnostic group differences in reappraisal only emerged when reappraisal was considered alongside other cognitive styles. Further, moderation analyses indicated that reappraisal was only associated with SAD or MDD when participants also reported high levels of rumination and worry. CONCLUSIONS Results support transdiagnostic conceptualizations of rumination and worry. They also suggest that reappraisal is only useful when it is used by people who experience frequent and habitual negative cognitions. PRACTITIONER POINTS Individuals with SAD or MDD report more rumination and worry than healthy controls, but do not differ from each other in their reliance on these cognitive styles. Individuals with comorbid SAD/MDD endorse more rumination than individuals with SAD or MDD alone, even after adjusting for differences in symptom severity. Reappraisal may only predict diagnostic group status when considered alongside other cognitive styles. In particular, high reappraisal may be associated with reduced risk of psychiatric disorder, but only when rumination and worry are also high. LIMITATIONS The study was limited by its cross-sectional design and reliance on self-report measures. Participants were diagnosed using DSM-IV-TR criteria for SAD and MDD.
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Affiliation(s)
- Kimberly A Arditte Hall
- VA National Center for PTSD at VA Boston Healthcare System, Massachusetts, USA.,Boston University School of Medicine, Massachusetts, USA
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57
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Self-critical rumination as a mediator between attachment orientations and perceived stress: Evidence from a cross-cultural validation of the self-critical rumination scale. CURRENT PSYCHOLOGY 2018. [DOI: 10.1007/s12144-018-0025-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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58
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Maeda S, Shimada H, Sato T. Cognitive Reappraisal Moderates the Effect of Post-event Processing on Social Anxiety: A Short-Term Prospective Study. Int J Cogn Ther 2018. [DOI: 10.1007/s41811-018-0031-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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59
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Leigh E, Clark DM. Understanding Social Anxiety Disorder in Adolescents and Improving Treatment Outcomes: Applying the Cognitive Model of Clark and Wells (1995). Clin Child Fam Psychol Rev 2018; 21:388-414. [PMID: 29654442 PMCID: PMC6447508 DOI: 10.1007/s10567-018-0258-5] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Social anxiety disorder is a condition characterised by a marked and persistent fear of being humiliated or scrutinised by others. Age-of-onset data point to adolescence as a developmentally sensitive period for the emergence of the condition, at a time when the peer group becomes increasingly important. Social anxiety in adolescence is associated with considerable impairment that persists through to adulthood. There are clear potential benefits to delivering effective interventions during adolescence. However, there is limited evidence on the specific efficacy of available therapies. This is in contrast to adults, for whom we have interventions with very specific treatment effects. One such treatment is individual cognitive therapy. Cognitive therapy is based on the cognitive model of social anxiety proposed by Clark and Wells (in: Heimberg, Leibowitz, Hope, Scheiber (eds) Social phobia: diagnosis, assessment and treatment, The Guilford Press, New York, 1995). The present review examines the potential application of this adult cognitive model to the understanding of adolescent social anxiety and considers additional adolescent-specific factors that need to be accommodated. It is suggested that a developmentally sensitive adoption of the cognitive model of social anxiety disorder (Clark and Wells 1995) for adolescents may lead to better treatment outcomes.
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Affiliation(s)
- Eleanor Leigh
- Department of Experimental Psychology, University of Oxford, Oxford, UK.
- Oxford Centre for Anxiety Disorders and Trauma, The Old Rectory, Paradise Square, Oxford, OX1 1TW, UK.
| | - David M Clark
- Department of Experimental Psychology, University of Oxford, Oxford, UK
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60
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Walczak M, Ollendick T, Ryan S, Esbjørn BH. Does comorbidity predict poorer treatment outcome in pediatric anxiety disorders? An updated 10-year review. Clin Psychol Rev 2018; 60:45-61. [DOI: 10.1016/j.cpr.2017.12.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 12/18/2017] [Accepted: 12/20/2017] [Indexed: 11/25/2022]
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61
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Reilly EE, Gordis EB, Boswell JF, Donahue JM, Emhoff SM, Anderson DA. Evaluating the role of repetitive negative thinking in the maintenance of social appearance anxiety: An experimental manipulation. Behav Res Ther 2018; 102:36-41. [DOI: 10.1016/j.brat.2018.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 12/16/2017] [Accepted: 01/04/2018] [Indexed: 02/06/2023]
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62
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Ecker AH, Buckner JD. Cannabis-Related Problems and Social Anxiety: The Mediational Role of Post-Event Processing. Subst Use Misuse 2018; 53:36-41. [PMID: 28813188 PMCID: PMC6081747 DOI: 10.1080/10826084.2017.1322984] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Cannabis is the most commonly used illicit drug in the US, and is associated with a range of psychological, social, and physical health-related problems. Individuals who endorse elevated levels of social anxiety are especially at risk for experiencing cannabis-related problems, including cannabis use disorder, despite not using cannabis more often than those with more normative social anxiety. Identification of mechanisms that underlie the relationship between social anxiety and cannabis-related problems may inform treatment and prevention efforts. Post-event processing (PEP, i.e., cognitively reviewing past social interactions/performances) is a social anxiety-related phenomenon that may be one such mechanism. OBJECTIVES The current study sought to test PEP as a mediator of the relationship between social anxiety and cannabis-related problems, adjusting for cannabis use frequency. METHOD Cannabis-using (past 3-month) undergraduate students recruited in 2015 (N = 244; 76.2% female; 74.2% Non-Hispanic Caucasian) completed an online survey of cannabis use, cannabis-related problems, social anxiety, and PEP. RESULTS Bootstrap estimate of the indirect effect of social anxiety through PEP was significant, suggesting PEP is a mediator of the social anxiety-cannabis-related problems relationship. Conclusions/Importance: Treatment and prevention efforts may benefit from targeting PEP among individuals with elevated social anxiety and cannabis-related problems.
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Affiliation(s)
- Anthony H Ecker
- a Department of Veterans Affairs , South Central MIRECC , Houston , Texas , USA.,b Menninger Department of Psychiatry and Behavioral Sciences , Baylor College of Medicine , Houston , Texas , USA
| | - Julia D Buckner
- c Department of Psychology , Louisiana State University , Baton Rouge , Louisiana , USA
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63
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Hearn CS, Donovan CL, Spence SH, March S. Do worry and its associated cognitive variables alter following CBT treatment in a youth population with Social Anxiety Disorder? Results from a randomized controlled trial. J Anxiety Disord 2018; 53:46-57. [PMID: 29195187 DOI: 10.1016/j.janxdis.2017.11.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 08/10/2017] [Accepted: 11/22/2017] [Indexed: 12/22/2022]
Affiliation(s)
- Cate S Hearn
- School of Applied Psychology and the Menzies Health Institute Queensland, Griffith University, Mount Gravatt Campus, Mount Gravatt, QLD, 4122, Australia.
| | - Caroline L Donovan
- School of Applied Psychology and the Menzies Health Institute Queensland, Griffith University, Mount Gravatt Campus, Mount Gravatt, QLD, 4122, Australia.
| | - Susan H Spence
- School of Applied Psychology and the Menzies Health Institute Queensland, Griffith University, Mount Gravatt Campus, Mount Gravatt, QLD, 4122, Australia.
| | - Sonja March
- Institute for Resilient Regions & School of Psychology and Counselling, University of Southern Queensland, Springfield, QLD, 4300, Australia.
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64
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Blackie RA, Kocovski NL. Examining the Relationships Among Self-Compassion, Social Anxiety, and Post-Event Processing. Psychol Rep 2017; 121:669-689. [DOI: 10.1177/0033294117740138] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Post-event processing refers to negative and repetitive thinking following anxiety provoking social situations. Those who engage in post-event processing may lack self-compassion in relation to social situations. As such, the primary aim of this research was to evaluate whether those high in self-compassion are less likely to engage in post-event processing and the specific self-compassion domains that may be most protective. In study 1 ( N = 156 undergraduate students) and study 2 ( N = 150 individuals seeking help for social anxiety and shyness), participants completed a battery of questionnaires, recalled a social situation, and then rated state post-event processing. Self-compassion negatively correlated with post-event processing, with some differences depending on situation type. Even after controlling for self-esteem, self-compassion remained significantly correlated with state post-event processing. Given these findings, self-compassion may serve as a buffer against post-event processing. Future studies should experimentally examine whether increasing self-compassion leads to reduced post-event processing.
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Affiliation(s)
| | - Nancy L. Kocovski
- Department of Psychology, Wilfrid Laurier University, Waterloo, Canada
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65
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Becker MPI, Simon D, Miltner WHR, Straube T. Altered activation of the ventral striatum under performance-related observation in social anxiety disorder. Psychol Med 2017; 47:2502-2512. [PMID: 28464974 DOI: 10.1017/s0033291717001076] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Social anxiety disorder (SAD) is characterized by fear of social and performance situations. The consequence of scrutiny by others for the neural processing of performance feedback in SAD is unknown. METHODS We used event-related functional magnetic resonance imaging to investigate brain activation to positive, negative, and uninformative performance feedback in patients diagnosed with SAD and age-, gender-, and education-matched healthy control subjects who performed a time estimation task during a social observation condition and a non-social control condition: while either being monitored or unmonitored by a body camera, subjects received performance feedback after performing a time estimation that they could not fully evaluate without external feedback. RESULTS We found that brain activation in ventral striatum (VS) and midcingulate cortex was modulated by an interaction of social context and feedback type. SAD patients showed a lack of social-context-dependent variation of feedback processing, while control participants showed an enhancement of brain responses specifically to positive feedback in VS during observation. CONCLUSIONS The present findings emphasize the importance of social-context processing in SAD by showing that scrutiny prevents appropriate reward-processing-related signatures in response to positive performances in SAD.
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Affiliation(s)
- M P I Becker
- Department of Biological and Clinical Psychology,Friedrich Schiller University,D-07743 Jena,Germany
| | - D Simon
- Department of Biological and Clinical Psychology,Friedrich Schiller University,D-07743 Jena,Germany
| | - W H R Miltner
- Department of Biological and Clinical Psychology,Friedrich Schiller University,D-07743 Jena,Germany
| | - T Straube
- Department of Biological and Clinical Psychology,Friedrich Schiller University,D-07743 Jena,Germany
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Hearn CS, Donovan CL, Spence SH, March S, Holmes MC. What's the Worry with Social Anxiety? Comparing Cognitive Processes in Children with Generalized Anxiety Disorder and Social Anxiety Disorder. Child Psychiatry Hum Dev 2017; 48:786-795. [PMID: 27917455 DOI: 10.1007/s10578-016-0703-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Social anxiety disorder (SAD) in children is often comorbid with generalized anxiety disorder (GAD). We investigated whether worry, intolerance of uncertainty, beliefs about worry, negative problem orientation and cognitive avoidance, that are typically associated with GAD, are present in children with SAD. Participants included 60 children (8-12 years), matched on age and gender. Groups included children: with primary GAD and without SAD (GAD); with primary SAD and without GAD (SAD); and without an anxiety disorder (NAD). GAD and SAD groups scored significantly higher than the NAD group on worry, intolerance of uncertainty, negative beliefs about worry and negative problem orientation, however, they did not score differently from each other. Only the GAD group scored significantly higher than the NAD group on cognitive avoidance. These findings further understanding of the structure of SAD and suggest that the high comorbidity between SAD and GAD may be due to similar underlying processes within the disorders.
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Affiliation(s)
- Cate S Hearn
- School of Applied Psychology and the Menzies Health Institute Queensland, Griffith University, Mount Gravatt Campus, 176 Messines Ridge Rd, M24 4th Floor Reception, Mount Gravatt, QLD, 4122, Australia.
| | - Caroline L Donovan
- School of Applied Psychology and the Menzies Health Institute Queensland, Griffith University, Mount Gravatt Campus, 176 Messines Ridge Rd, M24 4th Floor Reception, Mount Gravatt, QLD, 4122, Australia
| | - Susan H Spence
- School of Applied Psychology and the Menzies Health Institute Queensland, Griffith University, Mount Gravatt Campus, 176 Messines Ridge Rd, M24 4th Floor Reception, Mount Gravatt, QLD, 4122, Australia
| | - Sonja March
- Institute for Resilient Regions & School of Psychology and Counselling, University of Southern Queensland, Springfield, QLD, 4300, Australia
| | - Monique C Holmes
- School of Applied Psychology and the Menzies Health Institute Queensland, Griffith University, Mount Gravatt Campus, 176 Messines Ridge Rd, M24 4th Floor Reception, Mount Gravatt, QLD, 4122, Australia
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67
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Halldorsson B, Creswell C. Social anxiety in pre-adolescent children: What do we know about maintenance? Behav Res Ther 2017; 99:19-36. [PMID: 28881221 DOI: 10.1016/j.brat.2017.08.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 08/18/2017] [Accepted: 08/28/2017] [Indexed: 10/18/2022]
Abstract
The cognitive theory of social anxiety disorder (SAD) is one of the most widely accepted accounts of the maintenance of the disorder in adults, yet it remains unknown if, or to what extent, the same cognitive and behavioral maintenance mechanisms that occur in adult SAD also apply to SAD among pre-adolescent children. In contrast to the adult literature, current models of SAD in children mostly account for etiology and maintenance processes are given limited attention. Consequently, their clinical utility for the treatment of SAD in children may be limited. This narrative review, first, critically examines the different theoretical conceptualizations of the maintenance of social anxiety in the child and adult literature and illustrates how these have resulted in different treatment approaches and clinical understanding. Second, it reviews the available evidence relating to hypotheses about the maintenance of SAD in children as derived from adult cognitive and etiological models. Third, it highlights the need to attend directly to child specific maintenance mechanisms in SAD, to draw on cognitive theory, and to account for the influence of childhood-specific contextual (e.g. family and school-based interactions) and developmental factors on children's social experiences.
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Affiliation(s)
- Brynjar Halldorsson
- School of Psychology and Clinical Language Sciences, University of Reading, UK.
| | - Cathy Creswell
- School of Psychology and Clinical Language Sciences, University of Reading, UK
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The Development and Evaluation of the Psychometric Properties of the Negative Beliefs about Post-Event Processing Scale. Behav Cogn Psychother 2017; 45:590-599. [PMID: 28593830 DOI: 10.1017/s1352465817000340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Although negative beliefs have been found to be associated with worry symptoms and depressive rumination, negative beliefs have yet to be examined in relation to post-event processing and social anxiety symptoms. AIMS The purpose of the current study was to examine the psychometric properties of the Negative Beliefs about Post-Event Processing Questionnaire (NB-PEPQ). METHOD A large, non-referred undergraduate sample completed the NB-PEPQ along with validation measures, including a measure of post-event processing and social anxiety symptoms. RESULTS Based on factor analysis, a single-factor model was obtained, and the NB-PEPQ was found to exhibit good validity, including positive associations with measures of post-event processing and social anxiety symptoms. CONCLUSIONS These findings add to the literature on the metacognitive variables that may lead to the development and maintenance of post-event processing and social anxiety symptoms, and have relevant clinical applications.
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69
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Klemanski DH, Curtiss J, McLaughlin KA, Nolen-Hoeksema S. Emotion Regulation and the Transdiagnostic Role of Repetitive Negative Thinking in Adolescents with Social Anxiety and Depression. COGNITIVE THERAPY AND RESEARCH 2017; 41:206-219. [PMID: 28579659 PMCID: PMC5455341 DOI: 10.1007/s10608-016-9817-6] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Social anxiety and depression are common mental health problems among adolescents and are frequently comorbid. Primary aims of this study were to (1) elucidate the nature of individual differences in specific emotion regulation deficits among adolescents with symptoms of social anxiety and depression, and (2) determine whether repetitive negative thinking (RNT) functions as a transdiagnostic factor. A diverse sample of adolescents (N = 1065) completed measures assessing emotion regulation and symptoms of social anxiety and depression. Results indicated that adolescents with high levels of social anxiety and depression symptoms reported decreased emotional awareness, dysregulated emotion expression, and reduced use of emotion management strategies. The hypothesized structural model in which RNT functions as a transdiagnostic factor exhibited a better fit than an alternative model in which worry and rumination function as separate predictors of symptomatology. Findings implicate emotion regulation deficits and RNT in the developmental psychopathology of youth anxiety and mood disorders.
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Affiliation(s)
- David H Klemanski
- Department of Psychology, Yale University, New Haven, CT, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032, USA
| | - Joshua Curtiss
- Department of Psychology, Yale University, New Haven, CT, USA
- Department of Psychology, Boston University, Boston, MA, USA
| | - Katie A McLaughlin
- Department of Psychology, Yale University, New Haven, CT, USA
- Department of Psychology, University of Washington, Seattle, WA, USA
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Gavric D, Moscovitch DA, Rowa K, McCabe RE. Post-event processing in social anxiety disorder: Examining the mediating roles of positive metacognitive beliefs and perceptions of performance. Behav Res Ther 2017; 91:1-12. [DOI: 10.1016/j.brat.2017.01.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 12/22/2016] [Accepted: 01/03/2017] [Indexed: 11/17/2022]
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Cheng J, Craske MG, Niles AN. Exposure reduces negative bias in self-rated performance in public speaking fearful participants. J Behav Ther Exp Psychiatry 2017; 54:101-107. [PMID: 27459691 DOI: 10.1016/j.jbtep.2016.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 06/27/2016] [Accepted: 07/07/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Individuals with public speaking anxiety (PSA) under-rate their performance compared to objective observers. The present study examined whether exposure reduces the discrepancy between self and observer performance ratings and improved observer-rated performance in individuals with PSA. METHODS PSA participants gave a speech in front of a small audience and rated their performance using a questionnaire before and after completing repeated exposures to public speaking. Non-anxious control participants gave a speech and completed the questionnaire one time only. Objective observers watched videos of the speeches and rated performance using the same questionnaire. RESULTS PSA participants underrated their performance to a greater degree than did controls prior to exposure, but also performed significantly more poorly than did controls when rated objectively. Bias significantly decreased and objective-rated performance significantly increased following completion of exposure in PSA participants, and on one performance measure, anxious participants no longer showed a greater discrepancy between self and observer performance ratings compared to controls. LIMITATIONS The study employed non-clinical student sample, but the results should be replicated in clinical anxiety samples. CONCLUSIONS These findings indicate that exposure alone significantly reduces negative performance bias among PSA individuals, but additional exposure or additional interventions may be necessary to fully correct bias and performance deficits.
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Affiliation(s)
- Joyce Cheng
- University of California, Los Angeles, Department of Psychology, 1285 Franz Hall, Box 951563, Los Angeles, CA 90095-1563, United States.
| | - Michelle G Craske
- University of California, Los Angeles, Department of Psychology, 1285 Franz Hall, Box 951563, Los Angeles, CA 90095-1563, United States.
| | - Andrea N Niles
- University of California, Los Angeles, Department of Psychology, 1285 Franz Hall, Box 951563, Los Angeles, CA 90095-1563, United States.
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Hearn CS, Donovan CL, Spence SH, March S. A worrying trend in Social Anxiety: To what degree are worry and its cognitive factors associated with youth Social Anxiety Disorder? J Affect Disord 2017; 208:33-40. [PMID: 27744124 DOI: 10.1016/j.jad.2016.09.052] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 09/27/2016] [Accepted: 09/30/2016] [Indexed: 01/04/2023]
Abstract
BACKGROUND Comorbidity between Social Anxiety Disorder (SAD) and Generalized Anxiety Disorder (GAD) is extremely common. This study investigated whether factors commonly associated with GAD, including worry, intolerance of uncertainty (IU), positive and negative beliefs about worry (PBW, NBW), negative problem orientation (NPO) and cognitive avoidance (CA) were associated with SAD severity, symptoms and overall functioning. METHOD Participants included 126 youth aged 8-17 years (M=11.29, SD=2.67, Males n=50) with a primary diagnosis of SAD. Participants and a parent underwent a diagnostic interview and completed questionnaires at pre- and 12-week post assessment, and 6-month follow-up. Correlations and hierarchical multiple regression analyses were conducted. RESULTS Each of the cognitive variables, with the exception of PBW, was found to correlate with SAD symptoms, SAD severity and overall functioning. NPO emerged as an important predictor of SAD severity, self-reported ratings of SAD symptoms, and poorer levels of overall functioning. IU and worry also predicted self-rated SAD symptoms. LIMITATIONS Measures were chosen on the basis of their sound psychometrics however some were yet to undergo rigorous testing with youth populations. The study design is cross-sectional, which restricts firm conclusions regarding causal and temporal associations between the variables. CONCLUSIONS Findings from this study have implications for the specificity of GAD and SAD in youth. Further research is required to understand whether these cognitive variables play a maintaining role in youth SAD and the extent to which they might influence treatment.
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Affiliation(s)
- Cate S Hearn
- School of Applied Psychology and the Menzies Health Institute Queensland, Griffith University, Mount Gravatt Campus, Mount Gravatt, QLD 4122, Australia.
| | - Caroline L Donovan
- School of Applied Psychology and the Menzies Health Institute Queensland, Griffith University, Mount Gravatt Campus, Mount Gravatt, QLD 4122, Australia.
| | - Susan H Spence
- School of Applied Psychology and the Menzies Health Institute Queensland, Griffith University, Mount Gravatt Campus, Mount Gravatt, QLD 4122, Australia.
| | - Sonja March
- School of Psychology, Institute for Resilient Regions & School of Psychology and Counselling, University of Southern Queensland, Springfield, QLD 4300, Australia.
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van Niekerk RE, Klein AM, Allart-van Dam E, Hudson JL, Rinck M, Hutschemaekers GJM, Becker ES. The Role of Cognitive Factors in Childhood Social Anxiety: Social Threat Thoughts and Social Skills Perception. COGNITIVE THERAPY AND RESEARCH 2016; 41:489-497. [PMID: 28515542 PMCID: PMC5410201 DOI: 10.1007/s10608-016-9821-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Models of cognitive processing in anxiety disorders state that socially anxious children display several distorted cognitive processes that maintain their anxiety. The present study investigated the role of social threat thoughts and social skills perception in relation to childhood trait and state social anxiety. In total, 141 children varying in their levels of social anxiety performed a short speech task in front of a camera and filled out self-reports about their trait social anxiety, state anxiety, social skills perception and social threat thoughts. Results showed that social threat thoughts mediated the relationship between trait social anxiety and state anxiety after the speech task, even when controlling for baseline state anxiety. Furthermore, we found that children with higher trait anxiety and more social threat thoughts had a lower perception of their social skills, but did not display a social skills deficit. These results provide evidence for the applicability of the cognitive social anxiety model to children.
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Affiliation(s)
- Rianne E. van Niekerk
- Behavioural Science Institute, Radboud University Nijmegen, P.O. Box 9104, 6500 HE Nijmegen, The Netherlands
- Pro Persona, Centre for Anxiety Disorders Overwaal, Nijmegen, The Netherlands
| | - Anke M. Klein
- Behavioural Science Institute, Radboud University Nijmegen, P.O. Box 9104, 6500 HE Nijmegen, The Netherlands
| | | | | | - Mike Rinck
- Behavioural Science Institute, Radboud University Nijmegen, P.O. Box 9104, 6500 HE Nijmegen, The Netherlands
| | - Giel J. M. Hutschemaekers
- Behavioural Science Institute, Radboud University Nijmegen, P.O. Box 9104, 6500 HE Nijmegen, The Netherlands
| | - Eni S. Becker
- Behavioural Science Institute, Radboud University Nijmegen, P.O. Box 9104, 6500 HE Nijmegen, The Netherlands
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Stein JE, Modini M, Hunt C, Abbott MJ. A Systematic Review of the Psychometric Properties of Trait Cognitive Self-Report Measures in Social Anxiety. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2016. [DOI: 10.1007/s10862-016-9573-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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75
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Blackie RA, Kocovski NL. Development and validation of the trait and state versions of the Post-Event Processing Inventory. ANXIETY STRESS AND COPING 2016; 30:202-218. [DOI: 10.1080/10615806.2016.1230668] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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76
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Piccirillo ML, Taylor Dryman M, Heimberg RG. Safety Behaviors in Adults With Social Anxiety: Review and Future Directions. Behav Ther 2016; 47:675-687. [PMID: 27816080 DOI: 10.1016/j.beth.2015.11.005] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Revised: 11/23/2015] [Accepted: 11/24/2015] [Indexed: 11/28/2022]
Abstract
Safety behaviors are considered an important factor in the maintenance of social anxiety disorder (SAD). Safety behaviors are typically employed by socially anxious individuals to reduce anxiety in feared social situations. However, by preventing individuals with social anxiety from gathering evidence that would disconfirm their maladaptive beliefs about social situations, the use of safety behaviors ultimately maintains social anxiety over time. Twenty years ago, Wells and colleagues (1995) demonstrated that use of safety behaviors diminishes the efficacy of exposure treatment for SAD, suggesting that reduction in the use of safety behaviors during exposure can enhance treatment response. Research on safety behaviors has expanded considerably since Wells et al.'s seminal publication, and our understanding of the role safety behaviors may play in the maintenance of social anxiety has grown in breadth and depth. In this paper, we present a detailed review of the published research on safety behaviors relevant to social anxiety and social-anxiety-related processes. Finally, we evaluate the impact of safety behaviors on the outcome of treatment for SAD, and we look to the literature on safety behaviors in other anxiety disorders to inform our understanding of use of safety behaviors during exposure and to facilitate future research in SAD.
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77
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Buckner JD, Dean KE. Social anxiety and post-event processing among African-American individuals. ANXIETY STRESS AND COPING 2016; 30:219-227. [PMID: 27576610 DOI: 10.1080/10615806.2016.1220549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Social anxiety is among the most prevalent psychiatric conditions, yet little attention has been paid to whether putative cognitive vulnerability factors related to social anxiety in predominantly White samples are related to social anxiety among historically underrepresented groups. DESIGN We tested whether one such vulnerability factor, post-event processing (PEP; detailed review of social event that can increase state social anxiety) was related to social anxiety among African-American (AA; n = 127) persons, who comprise one of the largest underrepresented racial groups in the U.S. Secondarily, we tested whether AA participants differed from non-Hispanic White participants (n = 127) on PEP and social anxiety and whether race moderated the relation between PEP and social anxiety. METHOD Data were collected online among undergraduates. RESULTS PEP was positively correlated with social anxiety among AA participants, even after controlling for depression and income, pr = .30, p = .001. AA and White participants did not differ on social anxiety or PEP, β = -1.57, 95% CI: -5.11, 1.96. The relation of PEP to social anxiety did not vary as a function of race, β = 0.00, 95% CI: -0.02, 0.02. CONCLUSIONS PEP may be an important cognitive vulnerability factor related to social anxiety among AA persons suffering from social anxiety.
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Affiliation(s)
- Julia D Buckner
- a Department of Psychology , Louisiana State University , Baton Rouge , LA , USA
| | - Kimberlye E Dean
- a Department of Psychology , Louisiana State University , Baton Rouge , LA , USA
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Badra M, Schulze L, Becker ES, Vrijsen JN, Renneberg B, Zetsche U. The association between ruminative thinking and negative interpretation bias in social anxiety. Cogn Emot 2016; 31:1234-1242. [DOI: 10.1080/02699931.2016.1193477] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Marcel Badra
- Department of Clinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany
| | - Lars Schulze
- Department of Clinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany
| | - Eni S. Becker
- Clinical Psychology, Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Janna Nonja Vrijsen
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Babette Renneberg
- Department of Clinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany
| | - Ulrike Zetsche
- Department of Clinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany
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79
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Wong QJJ, Gregory B, McLellan LF. A Review of Scales to Measure Social Anxiety Disorder in Clinical and Epidemiological Studies. Curr Psychiatry Rep 2016; 18:38. [PMID: 26893236 DOI: 10.1007/s11920-016-0677-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
To advance research into social anxiety disorder (SAD) and provide efficacious treatments for individuals with SAD, researchers and clinicians must have effective assessment instruments for identifying the disorder in terms of its diagnostic criteria, symptoms, and the presence of specific maintaining factors. This review highlights the main lines of existing adult and youth research on scales that form part of diagnostic instruments that assess SAD, scales that measure social anxiety symptoms, and scales that measure theory-based psychological maintaining factors associated with SAD. The review also highlights methodological issues that impact on the use of the aforementioned scales. The continued refinement and comparative evaluation of measures for SAD, culminating in the ascertainment of optimal measures, will improve the assessment and identification of the disorder. Improved identification of the disorder will contribute to the advancement of SAD research and treatment.
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Affiliation(s)
- Quincy J J Wong
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW 2109, Australia.
| | - Bree Gregory
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW 2109, Australia
| | - Lauren F McLellan
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW 2109, Australia
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Helbig-Lang S, Poels V, Lincoln TM. Performance perceptions and self-focused attention predict post-event processing after a real-life social performance situation. ANXIETY STRESS AND COPING 2016; 29:708-15. [DOI: 10.1080/10615806.2016.1157168] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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81
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Self-Focused Cognition in Social Anxiety: A Review of the Theoretical and Empirical Literature. BEHAVIOUR CHANGE 2016. [DOI: 10.1017/bec.2016.2] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Social anxiety disorder (SAD) is characterised by a marked and persistent fear of social or performance situations. Cognitive models suggest that self-focused cognitive processes play a crucial role in generating and maintaining social anxiety, and that self-focused cognition occurs prior to, during, and following social situations (Clark & Wells, 1995; Rapee & Heimberg, 1997). There is a substantial body of empirical evidence demonstrating that socially anxious individuals engage in self-focused cognition during and following a social or performance situation. A smaller but growing body literature suggests that a similar process occurs prior to such situations, and that these three processes are interdependent. Furthermore, the vast majority of research to date indicates that self-focused cognitive processes are detrimental, and that they generate and maintain social anxiety in a variety of ways. However, there remains considerable scope for research to further explicate the role of these processes in the maintenance of SAD, and to enhance interventions designed to ameliorate their negative effects.
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82
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Kissell K, Rodriguez H, Lucas L, Fisak B. Examination of the Contribution of Ruminative Thinking and Maladaptive Self-Beliefs to Social Anxiety. J Cogn Psychother 2016; 30:253-262. [PMID: 32755928 DOI: 10.1891/0889-8391.30.4.253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to examine the relative contribution of 3 components of the Clark and Wells (1995) model to social anxiety symptoms. In particular, based on theory and previous research, it was hypothesized that the association between post-event processing and social anxiety and between anticipatory anxiety and social anxiety would be mediated by maladaptive self-beliefs. To test this hypothesis, a large, nonclinical sample of young adults completed a measure of anticipatory processing, post-event processing, maladaptive self-beliefs, and social anxiety. Based on a structural equation modeling approach, full mediation was found between post-event processing and social anxiety, and partial mediation was found between anticipatory processing and social anxiety. Overall, the results contribute to the literature by elucidating cognitive processes that may lead to the development and maintenance of social anxiety symptoms.
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83
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Can I Really Do This? An Examination of Anticipatory Event Processing in Social Anxiety Disorder. J Cogn Psychother 2016; 30:94-104. [PMID: 32755909 DOI: 10.1891/0889-8391.30.2.94] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Clark and Wells (1995) posit that anticipatory processing before a social situation serves to maintain social anxiety. More specifically, ruminative processes similar to post-event processing (PEP) may occur in anticipation of anxiety provoking social events, and in this article, we have labelled this type of anticipatory rumination anticipatory event processing (AnEP). Participants (n = 75) with social anxiety disorder (SAD) completed measures of anticipatory event processing, trait anxious rumination, social anxiety, state anxiety, and PEP, in the context of completing videotaped exposures twice as part of manual-based group cognitive behavioral therapy. AnEP was significantly positively associated with trait anxious rumination and social anxiety and was associated with state anxiety during the first videotaping. AnEP at the two time points was significantly correlated and decreased across the two taped exposures. Greater AnEP at the first taping was associated with greater PEP the following week. PEP after the first videotaped exposure then significantly related to AnEP for the second videotaped exposure several weeks later. Discussion focuses on the similarities between PEP and AnEP as well as implications for cognitive models and treatment of SAD.
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84
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Post-Event Processing across Multiple Anxiety Presentations: Is it Specific to Social Anxiety Disorder? Behav Cogn Psychother 2015; 44:568-79. [PMID: 26639672 DOI: 10.1017/s1352465815000697] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Post-event processing (PEP) occurs when individuals engage in cognitive rumination following an event or interaction. Although the relation between PEP and social anxiety has been clearly demonstrated, it remains unclear whether PEP is limited to individuals with elevated social anxiety, or if it is also problematic among people with other anxiety presentations. AIMS The present study assessed PEP after the first session of group cognitive behavioural therapy (CBT) in individuals with a variety of anxiety presentations. METHOD Participants with a principal diagnosis of SAD (N = 25), those diagnosed with a principal other anxiety disorder with comorbid SAD (N = 18), and those with principal other anxiety diagnoses with no SAD (N = 43) completed baseline measures of social anxiety severity and state anxiety at their first session of CBT and measures of PEP one week later. RESULTS Participants with a principal diagnosis of SAD experienced the most PEP in the week following the first CBT session, while those with no comorbid SAD experienced the least. Those with comorbid SAD experienced intermediate levels of PEP. The strongest predictor of PEP was state anxiety during the first session. CONCLUSIONS Results suggest that PEP is more problematic for clients with SAD as part of their clinical presentation. Clinical and theoretical implications are discussed.
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85
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Blackie RA, Kocovski NL. Letting go of yesterday: Effect of distraction on post-event processing and anticipatory anxiety in a socially anxious sample. Cogn Behav Ther 2015; 45:60-72. [DOI: 10.1080/16506073.2015.1104383] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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86
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Blackhart GC, Williamson J, Nelson L. Social Anxiety in Relation to Self-Control Depletion Following Social Interactions. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2015. [DOI: 10.1521/jscp.2015.34.9.747] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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87
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Is post-event processing a social anxiety specific or transdiagnostic cognitive process in the anxiety spectrum? Behav Cogn Psychother 2015; 42:706-17. [PMID: 25413026 DOI: 10.1017/s135246581300074x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Research on post-event processing (PEP), where individuals conduct a post-mortem evaluation of a social situation, has focused primarily on its relationship with social anxiety. AIMS The current study examined: 1) levels of PEP for a standardized event in different anxiety disorders; 2) the relationship between peak anxiety levels during this event and subsequent PEP; and 3) the relationship between PEP and disorder-specific symptom severity. METHOD Participants with primary DSM-IV diagnoses of social anxiety disorder (SAD), obsessive compulsive disorder (OCD), panic disorder with/without agoraphobia (PD/A), or generalized anxiety disorder (GAD) completed diagnosis specific symptom measures before attending group cognitive behavioural therapy (CBT) specific to their diagnosis. Participants rated their peak anxiety level during the first group therapy session, and one week later rated PEP in the context of CBT. RESULTS The results indicated that all anxiety disorder groups showed heightened and equivalent PEP ratings. Peak state anxiety during the first CBT session predicted subsequent level of PEP, irrespective of diagnostic group. PEP ratings were found to be associated with disorder-specific symptom severity in SAD, GAD, and PD/A, but not in OCD. CONCLUSIONS PEP may be a transdiagnostic process with relevance to a broad range of anxiety disorders, not just SAD.
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Wong QJJ, McEvoy PM., Rapee RM. A Comparison of Repetitive Negative Thinking and Post-Event Processing in the Prediction of Maladaptive Social-Evaluative Beliefs: A Short-Term Prospective Study. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2015. [DOI: 10.1007/s10862-015-9506-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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89
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Vassilopoulos SP, Brouzos A, Moberly NJ, Tsorbatzoudis H, Tziouma O. Generalisation of the Clark and Wells cognitive model of social anxiety to children's athletic and sporting situations. BRITISH JOURNAL OF GUIDANCE & COUNSELLING 2015. [DOI: 10.1080/03069885.2015.1057474] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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90
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Abstract
Anticipatory processing (AP) is a repetitive thinking style associated with social anxiety that has been understudied relative to other similar constructs (e.g., rumination, worry). The primary goal of this study was the development and evaluation of the Positive Beliefs about Anticipatory Processing Questionnaire (PB-APQ) with a sample of 301 undergraduate students. Further, it was predicted that anticipatory processing would mediate the relationship between positive beliefs about anticipatory processing and social interaction anxiety. The findings from this study suggest that PB-APQ is a valid and reliable construct. Anticipatory processing was shown to partially mediate the relationship between positive beliefs about anticipatory processing and social interaction anxiety. The results provide initial evidence for the suggestion that individuals who tend to hold positive beliefs about anticipatory processing tend to engage in anticipatory processing, which may increase social interaction anxiety.
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91
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Niles AN, Craske MG, Lieberman MD, Hur C. Affect labeling enhances exposure effectiveness for public speaking anxiety. Behav Res Ther 2015; 68:27-36. [PMID: 25795524 DOI: 10.1016/j.brat.2015.03.004] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 01/22/2015] [Accepted: 03/10/2015] [Indexed: 11/25/2022]
Abstract
Exposure is an effective treatment for anxiety but many patients do not respond fully. Affect labeling (labeling emotional experience) attenuates emotional responding. The current project examined whether affect labeling enhances exposure effectiveness in participants with public speaking anxiety. Participants were randomized to exposure with or without affect labeling. Physiological arousal and self-reported fear were assessed before and after exposure and compared between groups. Consistent with hypotheses, participants assigned to Affect Labeling, especially those who used more labels during exposure, showed greater reduction in physiological activation than Control participants. No effect was found for self-report measures. Also, greater emotion regulation deficits at baseline predicted more benefit in physiological arousal from exposure combined with affect labeling than exposure alone. The current research provides evidence that behavioral strategies that target prefrontal-amygdala circuitry can improve treatment effectiveness for anxiety and these effects are particularly pronounced for patients with the greatest deficits in emotion regulation.
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Affiliation(s)
- Andrea N Niles
- University of California, Los Angeles, 1285 Franz Hall, Box 951563, Los Angeles, CA 90095-1563, USA.
| | - Michelle G Craske
- University of California, Los Angeles, 1285 Franz Hall, Box 951563, Los Angeles, CA 90095-1563, USA
| | - Matthew D Lieberman
- University of California, Los Angeles, 1285 Franz Hall, Box 951563, Los Angeles, CA 90095-1563, USA
| | - Christopher Hur
- University of California, Los Angeles, 1285 Franz Hall, Box 951563, Los Angeles, CA 90095-1563, USA
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92
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Lehman BJ, Cane AC, Tallon SJ, Smith SF. Physiological and emotional responses to subjective social evaluative threat in daily life. ANXIETY STRESS AND COPING 2014; 28:321-39. [PMID: 25264711 DOI: 10.1080/10615806.2014.968563] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND OBJECTIVES This study examined concurrent and delayed emotional and cardiovascular correlates of naturally occurring experiences with subjective social evaluative threat (SSET) and tested whether individual differences in social interaction anxiety moderated those associations. METHODS Sixty-eight participants wore ambulatory blood pressure monitors for three days. Following each blood pressure reading, participants reported on SSET and negative emotions, yielding 1770 momentary measures. RESULTS Multilevel modeling suggested that reports of greater SSET uniquely predicted elevations in anxiety and embarrassment, with elevations in anxiety, embarrassment, and shame extending to the hour following SSET. Reports of concurrent and previous-hour SSET also predicted cardiovascular elevations. Linkages between SSET and anxiety and shame, but not cardiovascular measures, were moderated by social interaction anxiety. Those higher in social interaction anxiety showed especially strong associations between SSET and both concurrent and delayed anxiety and greater delayed shame. CONCLUSIONS This research suggests an important role for anxiety, embarrassment, and shame as emotional consequences of naturally occurring evaluative threat, especially for those who are more socially anxious. Further, this work replicates other naturalistic studies that have documented increased blood pressure at times of SSET and extends that work by documenting cardiovascular responses into the following hour.
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Affiliation(s)
- Barbara J Lehman
- a Department of Psychology , Western Washington University , Bellingham , WA , USA
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93
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Developmental pathways of social avoidance across adolescence: the role of social anxiety and negative cognition. J Anxiety Disord 2014; 28:787-94. [PMID: 25265547 DOI: 10.1016/j.janxdis.2014.09.008] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 08/26/2014] [Accepted: 09/01/2014] [Indexed: 01/01/2023]
Abstract
It is argued that the adolescent onset of social anxiety disorder (SAD) may be partly attributable to an increase in avoidance of social situations across this period. The current cohort-sequential study investigated developmental pathways of social avoidance in adolescence and examined the explanatory role of social anxiety and negative cognitive processes. A community sample of youth (9-21 years, N=331) participated in a four-wave study. Trajectory analyses revealed two pathways: an increased avoidance pathway and a low avoidance pathway. The pathways were hardly distinguishable at age 9 and they steadily diverged across adolescence. Logistic regression analyses showed that social anxiety and post-event rumination were significantly related to the increased avoidance pathway; anticipatory processing and self-focused attention were not. The findings suggest that adolescence is a key developmental period for the progression of social avoidance among youth who show relatively high levels of social anxiety and post-event rumination.
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94
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Brozovich FA, Goldin P, Lee I, Jazaieri H, Heimberg RG, Gross JJ. The effect of rumination and reappraisal on social anxiety symptoms during cognitive-behavioral therapy for social anxiety disorder. J Clin Psychol 2014; 71:208-18. [PMID: 25311952 DOI: 10.1002/jclp.22132] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE There is growing interest in the role of transdiagnostic processes in the onset, maintenance, and treatment of mental disorders (Nolen-Hoeksema & Watkins, 2011). Two such transdiagnostic processes-rumination and reappraisal-are the focus of the present study. The main objective was to examine the roles of rumination (thought to be harmful) and reappraisal (thought to be helpful) in adults with social anxiety disorder (SAD). METHOD We conducted a randomized controlled trial of cognitive-behavioral therapy (CBT) with 75 adults with SAD and examined pre- to post-CBT changes as well as weekly fluctuations in rumination, reappraisal, and social anxiety symptoms. RESULTS Socially anxious individuals' baseline rumination (brooding) scores predicted weekly levels of social anxiety, rumination, and reappraisal, whereas baseline reappraisal scores did not. Greater weekly rumination was associated with greater weekly social anxiety, but reappraisal was not related to social anxiety. CONCLUSION These findings suggest that rumination may have a more significant role than reappraisal in understanding fluctuations in social anxiety during CBT for SAD.
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95
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Munsch S. Study protocol: psychological and physiological consequences of exposure to mass media in young women - an experimental cross-sectional and longitudinal study and the role of moderators. BMC Psychol 2014; 2:37. [PMID: 25685353 PMCID: PMC4317137 DOI: 10.1186/s40359-014-0037-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 08/22/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Repeated exposure to thin beauty ideals is part of the daily routine. Exposure to thin ideals via mass media plays an important role in the development and maintenance of eating disorders (EDs), low self-esteem, depressive or anxious feelings in young females. It is important to elucidate the circumstances under which exposure to thin ideals develops its detrimental impact and to investigate whether these features are more pronounced in EDs than in other mental disorders also related to negative body image. METHODS/DESIGN We investigate the following key questions: (1) Does laboratory induced exposure to thin ideals (waiting room design) relate to impairments in terms of body image, affect and eating behavior and biological stress response (salivary alpha-amylase, salivary cortisol, heart rate and heart rate variability) in 18 to 35 year old female suffering from anorexia and bulimia nervosa (AN, BN) compared to female healthy controls and to a sample of females suffering from mixed mental disorders (depression, anxiety and somatic symptom disorder (SSD) disorders)? (2) How do moderators such as cognitive distortions ("Thought-Shape Fusion, TSF"), and correlates of emotion regulation (ER) moderate the influence of the exposure? (3) Are these characteristics amenable to change after treatment? Altogether 250 female participants including patients with AN, BN, depressive, anxiety and SSD disorders, and healthy women will be recruited in Switzerland and Germany. DISCUSSION The findings will provide knowledge about the role of moderators influencing the effects of exposure to thin ideals promoted by mass media in eating disorder (ED) patients, patients suffering from mixed mental disorders and healthy controls. Evaluating their differential susceptibility will contribute to a better understanding of the role of negative body image in the maintenance of not only symptoms of ED, but also of depression, anxiety and SSD. Additionally our results will shed light on the stability of effects in healthy controls as well as in the patient groups before and after treatment as usual. Findings foster the development of tailored interventions including a training in specific ER strategies as well as cognitive restructuring of distorted beliefs about the own body when confronted with thin ideals. TRIAL REGISTRATION German Clinical Trials Register: DRKS00005709. Date of registration: 6(th) of February, 2014.
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Affiliation(s)
- Simone Munsch
- Department of Psychology, Clinical Psychology and Psychtherapy, University of Fribourg, Fribourg, Switzerland
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96
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Penney ES, Abbott MJ. The Impact of Perceived Standards on State Anxiety, Appraisal Processes, and Negative Pre- and Post-event Rumination in Social Anxiety Disorder. COGNITIVE THERAPY AND RESEARCH 2014. [DOI: 10.1007/s10608-014-9639-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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97
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Wong QJ. Psychometric evaluation of the English version of the Extended Post-event Processing Questionnaire. ANXIETY STRESS AND COPING 2014; 28:215-25. [DOI: 10.1080/10615806.2014.925546] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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98
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Anticipatory and Post-Event Rumination in Social Anxiety Disorder: A Review of the Theoretical and Empirical Literature. BEHAVIOUR CHANGE 2014. [DOI: 10.1017/bec.2014.3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Social anxiety disorder (SAD) is a psychological disorder characterised by an excessive and persistent fear of social or performance situations, which interferes with daily functioning. Cognitive models of SAD (Clark & Wells, 1995; Hofmann, 2007; Rapee & Heimberg, 1997) emphasise the importance of negative pre- and post-event rumination as a maintaining factor in the cycle of SAD. While the link between negative rumination and SAD is well supported by empirical research, little is understood about this cognitively important process; thus, research investigating the predictors of negative rumination in SAD is important to consider. Within the current literature, performance appraisal appears to be the most likely unique cognitive predictor of post-event rumination. There is limited research into cognitive predictors of pre-event rumination. Treatments targeting this maintaining factor are important to consider. Suggestions for future research examining the cognitive models of SAD by experimentally manipulating perceived social standards in order to examine the impact of high and low perceived social standard on appraisal processes (i.e., threat appraisal and performance appraisal), state social anxiety, and negative pre-event and post-event rumination, are proposed. Implications for theoretical models and efficacious treatments for SAD are discussed.
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99
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Cummings CM, Caporino NE, Kendall PC. Comorbidity of anxiety and depression in children and adolescents: 20 years after. Psychol Bull 2014; 140:816-45. [PMID: 24219155 PMCID: PMC4006306 DOI: 10.1037/a0034733] [Citation(s) in RCA: 506] [Impact Index Per Article: 50.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Brady and Kendall (1992) concluded that although anxiety and depression in youths are meaningfully linked, there are important distinctions, and additional research is needed. Since then, studies of anxiety-depression comorbidity in youths have increased exponentially. Following a discussion of comorbidity, we review existing conceptual models and propose a multiple pathways model to anxiety-depression comorbidity. Pathway 1 describes youths with a diathesis for anxiety, with subsequent comorbid depression resulting from anxiety-related impairment. Pathway 2 refers to youths with a shared diathesis for anxiety and depression, who may experience both disorders simultaneously. Pathway 3 describes youths with a diathesis for depression, with subsequent comorbid anxiety resulting from depression-related impairment. Additionally, shared and stratified risk factors contribute to the development of the comorbid disorder, either by interacting with disorder-related impairment or by predicting the simultaneous development of the disorders. Our review addresses descriptive and developmental factors, gender differences, suicidality, assessments, and treatment-outcome research as they relate to comorbid anxiety and depression and to our proposed pathways. Research since 1992 indicates that comorbidity varies depending on the specific anxiety disorder, with Pathway 1 describing youths with either social phobia or separation anxiety disorder and subsequent depression, Pathway 2 applying to youths with coprimary generalized anxiety disorder and depression, and Pathway 3 including depressed youths with subsequent social phobia. The need to test the proposed multiple pathways model and to examine (a) developmental change and (b) specific anxiety disorders is highlighted.
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100
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Kollei I, Martin A. Body-related cognitions, affect and post-event processing in body dysmorphic disorder. J Behav Ther Exp Psychiatry 2014; 45:144-51. [PMID: 24158009 DOI: 10.1016/j.jbtep.2013.09.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 07/30/2013] [Accepted: 09/17/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND OBJECTIVES Cognitive behavioural models postulate that individuals with BDD engage in negative appearance-related appraisals and affect. External representations of one's appearance are thought to activate a specific mode of processing characterized by increased self-focused attention and an activation of negative appraisals and affect. METHODS The present study used a think-aloud approach including an in vivo body exposure to examine body-related cognitions and affect in individuals with BDD (n = 30), as compared to individuals with major depression (n = 30) and healthy controls (n = 30). Participants were instructed to think aloud during baseline, exposure and follow-up trials. RESULTS Individuals with BDD verbalized more body-related and more negative body-related cognitions during all trials and reported higher degrees of negative affect than both control groups. A weaker increase of positive body-related cognitions during exposure, a stronger increase of sadness and anger after exposure and higher levels of post-event processing, were specific processes in individuals with BDD. LIMITATIONS Individuals with major depression were not excluded from the BDD group. This is associated with a reduction of internal validity, as the two clinical groups are somewhat interwoven. Key findings need to be replicated. CONCLUSION The findings indicate that outcomes such as negative appearance-related cognitions and affect are specific to individuals with BDD. An external representation of one's appearance activates a specific mode of processing in BDD, manifesting itself in the absence of positive body-related cognitions, increased anger and sadness, and high levels of post-event processing. These specific processes may contribute toward maintenance of BDD psychopathology.
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Affiliation(s)
- Ines Kollei
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, University of Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany.
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