Post-event processing in social anxiety

Post-event processing and autobiographical memory in social anxiety: the influence of negative feedback and rumination

Two experiments investigated the extent to which the content of feedback and the style of post-event processing are associated with a bias in the retrieval of autobiographical memories by individuals high in social anxiety. In each experiment high and low socially anxious individuals responded to questions about autobiographical experiences, participated in a task involving real or imagined social encounters, and then recalled autobiographical memories. In Experiment 1 (n=50) participants focused on positive or negative feedback following the social task, while in Experiment 2 (n=59) participants engaged in either a ruminative or reflective response style following the social task. Experiment 1 showed that negative feedback led to the recall of memories with a significantly greater average anxiety rating only in the high social anxiety group. Experiment 2 demonstrated that the high social anxiety group who engaged in a ruminative response style recalled memories with the highest average anxiety rating. Implications of these findings for understanding the role of post-event processing as a maintaining factor in social anxiety are discussed.

The functional theory of counterfactual thinking

Counterfactuals are thoughts about alternatives to past events, that is, thoughts of what might have been. This article provides an updated account of the functional theory of counterfactual thinking, suggesting that such thoughts are best explained in terms of their role in behavior regulation and performance improvement. The article reviews a wide range of cognitive experiments indicating that counterfactual thoughts may influence behavior by either of two routes: a content-specific pathway (which involves specific informational effects on behavioral intentions, which then influence behavior) and a content-neutral pathway (which involves indirect effects via affect, mind-sets, or motivation). The functional theory is particularly useful in organizing recent findings regarding counterfactual thinking and mental health. The article concludes by considering the connections to other theoretical conceptions, especially recent advances in goal cognition.

Entwicklungspsychopathologie Sozialer Angststörungen

Die Soziale Phobie (oder Soziale Angststörung) stellt eine häufige psychische Störung dar, die insbesondere aufgrund ihres chronischen Verlaufs mit umfassenden Beeinträchtigungen einhergeht. Voraussetzung für die langfristig wirksame Behandlung oder Prävention der Störung ist ein umfassendes Verständnis bedingender und aufrecht erhaltender Faktoren. Mittlerweile liegen neben einer Reihe deskriptiver Störungsmodelle zur Entstehung und Aufrechterhaltung eine Vielfalt empirischer Ergebnisse zu Risikofaktoren sozialer Ängste vor. Neben einem Überblick über Phänomenologie und Epidemiologie Sozialer Angststörungen liegt der Schwerpunkt der Arbeit auf der Diskussion möglicher Einflussfaktoren in einer Entwicklungspsychopathologie der Sozialen Phobie. Dabei werden internale Faktoren, wie Familiengenetik, Temperament, kognitive Stile und soziale Fertigkeiten, sowie externe Faktoren, wie Erziehungsverhalten der Eltern und Erfahrungen mit der sozialen Umwelt, berücksichtigt. Zur Integration dieser Befunde werden differenzierte Modelle zur Ausbildung und zu differenziellen Entwicklungsverläufen generalisierter und isolierter sozialer Ängste vorgeschlagen.

Can Clark and Wells' (1995) Cognitive Model of Social Phobia be Applied to Young People?

Social phobia is a common and disabling condition for both children and adults. In recent years Clark and Wells' (1995) cognitive model of social phobia has given rise to an effective treatment protocol for the condition in adults (e.g. Clark et al., 2003, 2006). The current study investigates the applicability of this model to younger people. One hundred and seventy-one 11–14 year-old participants completed questionnaires measuring social anxiety, depression, and the variables hypothesized to maintain social phobia in Clark and Wells' (1995) cognitive model: negative social cognitions, safety behaviours, self-focused attention, and pre- and post-event processing. High socially anxious children scored significantly higher than low socially anxious children on all of the variables in Clark and Wells' model. Negative social cognitions, self-focused attention, safety behaviours, and pre- and post-event processing were all significant predictors of social anxiety, accounting for 48% of the variance in social anxiety. Furthermore, these variables showed specificity to social anxiety, predicting significantly more variance in social anxiety than in depression. Findings suggest that although Clark and Wells' (1995) model of social phobia was developed from research on adult populations, it may be equally applicable to younger people with social phobia.

Rumination and cortisol responses to laboratory stressors

OBJECTIVE

For some, a stressor's psychological and physiological influence ceases on removal; for others, the effects may persist through rumination. These repetitive, intrusive thoughts might prolong physiological stress responses. Previous studies produced mixed results, indicating a need to clarify the relationship between rumination and cortisol responses. The current study investigated whether a laboratory speech task is sufficient to elicit rumination and whether those who ruminated in response to the speech task have elevated cortis of responses. Additionally, whether trait depressive rumination follows a similar pattern was examined. It was hypothesized that those delivering speeches in a social-evaluative context would experience more posttask rumination and that greater posttask rumination would predict elevated cortisol responses.

METHODS

Eighty-nine participants performed a speech in front of an evaluative panel (SET) or in one of two nonexplicitly evaluative conditions. Participants indicated the frequency of the thoughts they experienced during a 10-minute rest period after the speech as a measure of posttask rumination. Salivary cortisol was collected at five time points throughout the session.

RESULTS

The SET condition elicited more posttask rumination than the nonexplicitly evaluative conditions. Posttask rumination was associated with amplified and prolonged elevations in cortisol across all conditions. Trait depressive rumination was associated with blunted cortisol responses in the SET condition. There was no association between trait depressive rumination and cortisol responses in the nonexplicitly evaluative conditions.

CONCLUSION

Results suggest that the nature of the relationship between cortisol activation and rumination may be contingent on how rumination is conceptualized and measured.

Social anxiety and ruminative self-focus

Studies of rumination have supported the differentiation of self-focus into distinct modes of self-attention with distinct functional effects. Given that self-focused attention and rumination have been implicated in the maintenance of social anxiety, the present study investigated the effects of these two distinct forms of self-focused attention on mood and cognition in social anxiety. High and low socially anxious individuals (n=29 in each group) either thought analytically about, or focused on their momentary experience of, identical symptom-focused induction items from [Nolen-Hoeksema, S., & Morrow, J. (1993). Effects of rumination and distraction on naturally occurring depressed mood. Cognition and Emotion, 7, 561-570] rumination task. As predicted, in high socially anxious individuals, the experiential (low analysis) self-focus condition decreased ratings of anxious mood pre- to post-manipulation and was associated with more positive thoughts on a thought-listing exercise, whereas the analytical (high analysis) self-focus condition resulted in no significant effects on mood and cognition. Theoretical and clinical implications of these findings are discussed.

Measurement of ambivalent and purposeful engagement after aversive social experiences

We describe two ways that participants may react to their internal experiences subsequent to stressful interpersonal interactions: Ambivalent engagement, consisting of attempts to avoid or dismiss the experiences arising from memories of the situation, and purposeful engagement, consisting of effortful attempts to approach the memories and internal experiences associated with the event. In a series of studies employing undergraduate samples, we evaluate a self-report method of measuring these trait-like constructs. The measure shows promising psychometric properties, including adequate to good factorial validity, good internal consistency, good test-retest reliability, and strong convergent and discriminant validity across a variety of theoretically related measures. This method of measuring ambivalent and purposeful engagement should be useful in investigating whether these constructs are related to the development of such disorders as social anxiety disorder and generalized anxiety disorder, as well as whether purposeful engagement is related to therapeutic change.

Constructive and unconstructive repetitive thought

The author reviews research showing that repetitive thought (RT) can have constructive or unconstructive consequences. The main unconstructive consequences of RT are (a) depression, (b) anxiety, and (c) difficulties in physical health. The main constructive consequences of RT are (a) recovery from upsetting and traumatic events, (b) adaptive preparation and anticipatory planning, (c) recovery from depression, and (d) uptake of health-promoting behaviors. Several potential principles accounting for these distinct consequences of RT are identified within this review: (a) the valence of thought content, (b) the intrapersonal and situational context in which RT occurs, and (c) the level of construal (abstract vs. concrete processing) adopted during RT. Of the existing models of RT, it is proposed that an elaborated version of the control theory account provides the best theoretical framework to account for its distinct consequences.

Constructive and unconstructive repetitive thought

The author reviews research showing that repetitive thought (RT) can have constructive or unconstructive consequences. The main unconstructive consequences of RT are (a) depression, (b) anxiety, and (c) difficulties in physical health. The main constructive consequences of RT are (a) recovery from upsetting and traumatic events, (b) adaptive preparation and anticipatory planning, (c) recovery from depression, and (d) uptake of health-promoting behaviors. Several potential principles accounting for these distinct consequences of RT are identified within this review: (a) the valence of thought content, (b) the intrapersonal and situational context in which RT occurs, and (c) the level of construal (abstract vs. concrete processing) adopted during RT. Of the existing models of RT, it is proposed that an elaborated version of the control theory account provides the best theoretical framework to account for its distinct consequences.

Constructive and unconstructive repetitive thought

The author reviews research showing that repetitive thought (RT) can have constructive or unconstructive consequences. The main unconstructive consequences of RT are (a) depression, (b) anxiety, and (c) difficulties in physical health. The main constructive consequences of RT are (a) recovery from upsetting and traumatic events, (b) adaptive preparation and anticipatory planning, (c) recovery from depression, and (d) uptake of health-promoting behaviors. Several potential principles accounting for these distinct consequences of RT are identified within this review: (a) the valence of thought content, (b) the intrapersonal and situational context in which RT occurs, and (c) the level of construal (abstract vs. concrete processing) adopted during RT. Of the existing models of RT, it is proposed that an elaborated version of the control theory account provides the best theoretical framework to account for its distinct consequences.

Cognitive factors that maintain social anxiety disorder: a comprehensive model and its treatment implications

Social anxiety disorder (SAD) is a common, distressing and persistent mental illness. Recent studies have identified a number of psychological factors that could explain the maintenance of the disorder. These factors are presented here as part of a comprehensive psychological maintenance model of SAD. This model assumes that social apprehension is associated with unrealistic social standards and a deficiency in selecting attainable social goals. When confronted with challenging social situations, individuals with SAD shift their attention toward their anxiety, view themselves negatively as a social object, overestimate the negative consequences of a social encounter, believe that they have little control over their emotional response, and view their social skills as inadequate to effectively cope with the social situation. In order to avoid social mishaps, individuals with SAD revert to maladaptive coping strategies, including avoidance and safety behaviors, followed by post-event rumination, which leads to further social apprehension in the future. Possible disorder-specific intervention strategies are discussed.

Acceptance and mindfulness-based therapy: new wave or old hat?

Some contemporary theorists and clinicians champion acceptance and mindfulness-based interventions, such as Acceptance and Commitment Therapy (ACT), over cognitive-behavioral therapy (CBT) for the treatment of emotional disorders. The objective of this article is to juxtapose these two treatment approaches, synthesize, and clarify the differences between them. The two treatment modalities can be placed within a larger context of the emotion regulation literature. Accordingly, emotions can be regulated either by manipulating the evaluation of the external or internal emotion cues (antecedent-focused emotion regulation) or by manipulating the emotional responses (response-focused emotion regulation). CBT and ACT both encourage adaptive emotion regulation strategies but target different stages of the generative emotion process: CBT promotes adaptive antecedent-focused emotion regulation strategies, whereas acceptance strategies of ACT counteract maladaptive response-focused emotion regulation strategies, such as suppression. Although there are fundamental differences in the philosophical foundation, ACT techniques are fully compatible with CBT and may lead to improved interventions for some disorders. Areas of future treatment research are discussed.

Social anxiety, depressive symptoms, and post-event rumination: affective consequences and social contextual influences

Using a self-presentation perspective, we hypothesized that during social interactions in which social attractiveness could be easily appraised by others, more socially anxious individuals would be more prone to ruminate and rumination would have more adverse emotional consequences. After assessing social anxiety and depressive symptoms, unacquainted college students participated in 45-min structured social interactions manipulated to induce personal self-disclosure or mimic superficial, small-talk. Affective experiences were assessed immediately after and 24h after social interactions. Results found that social anxiety was associated with negative post-event rumination more strongly among those with elevated depressive symptoms. Further, at higher levels of social anxiety, post-event rumination was associated with increases in NA following personal disclosure interactions and decreases in NA following small-talk interactions. Individuals with more depressive symptoms experienced increases in NA following small-talk interactions, but not personal disclosure interactions. Contrary to expectation, positive relations between social anxiety and rumination were not mediated by self-presentation concerns during interactions. Fitting with relevant theory, findings implicated symptom and social contextual variables that moderate the affective consequences of rumination.

Predictors of Post‐Event Rumination Related to Social Anxiety

Post-event processing is the cognitive rumination that follows social events in cognitive models of social anxiety. The aim of this study was to examine factors that may predict the extent to which individuals engage in post-event processing. Anxious rumination, social anxiety, anxiety sensitivity and post-event processing related to a recent anxiety-provoking social event were assessed in a college student sample (n = 439). Social anxiety and anxious rumination, but not anxiety sensitivity, significantly predicted the extent to which the participants engaged in post-event processing related to an anxiety-provoking social event. Factors that appear to impact on the post-event period include the nature of the social situation and the ethnicity of the participant. It appears that both general rumination over anxious symptoms, and specific rumination related to social events are relevant for cognitive models of social anxiety.

Post-event processing in social anxiety

Clark and Wells' [1995. A cognitive model of social phobia. In: R. Heimberg, M. Liebowitz, D.A. Hope, & F.R. Schneier (Eds.) Social phobia: Diagnosis, assessment and treatment (pp. 69-93). New York: Guildford Press.] cognitive model of social phobia proposes that following a social event, individuals with social phobia will engage in post-event processing, during which they conduct a detailed review of the event. This study investigated the relationship between self-appraisals of performance and post-event processing in individuals high and low in social anxiety. Participants appraised their performance immediately after a conversation with an unknown individual and prior to an anticipated second conversation task 1 week later. The frequency and valence of post-event processing during the week following the conversation was also assessed. The study also explored differences in the metacognitive processes of high and low socially anxious participants. The high socially anxious group experienced more anxiety, predicted worse performance, underestimated their actual performance, and engaged in more post-event processing than low socially anxious participants. The degree of negative post-event processing was linked to the extent of social anxiety and negative appraisals of performance, both immediately after the conversation task and 1 week later. Differences were also observed in some metacognitive processes. The results are discussed in relation to current theory and previous research.

Is post-event processing specific for social anxiety?

In their model of social phobia, Clark and Wells [1995. A cognitive model of social phobia. In R. G. Heimberg, M. Liebowitz, D. A. Hope & F. Schneier (Eds.), Social phobia: Diagnosis, assessment, and treatment (pp. 69-93). New York, London: The Guilford Press] introduced a process called "post-event processing" (PEP), which is characterized by prolonged rumination about past social situations. The present study examined to what extent PEP is specific for (a) social anxiety or (b) social situations. In a cross-sectional study, 217 participants reported about a social and a phobic event followed by negative thinking. PEP as well as its potential predictors such as social anxiety, general anxiety, and depression were measured by questionnaires. Results showed that social events were followed more often and by more intense PEP. Further confirming specificity, the fear of negative evaluation as an aspect of social anxiety was significantly associated with PEP for social but not for phobic situations, and vice versa; general anxiety predicted PEP only after phobic but not after social situations. Furthermore, PEP was elevated particularly for interaction (as opposed to performance) situations, indicating that the ambiguity of the situation may be an important predictor for prolonged processing.

Implicit Associations and Social Anxiety

The aim of this study was to test whether an Implicit Association Test (IAT) with self- and social anxiety-words is sensitive to differences in trait social anxiety, and to an experimental induction of social anxiety. This was performed in the context of a partial replication of a previous study, in which Mauss et al. (2004) compared high and low trait socially anxious individuals before and after a social anxiety induction (an impromptu speech). Mauss et al.'s findings were replicated; that is, (i) the social anxiety induction produced increases in self-rated anxiety, self-rated physiological responses, and actual physiological arousal; and (ii) higher trait social anxiety was associated with stronger self-rated anxiety and stronger self-rated physiological responses, but not with stronger actual physiological responses. In addition, the results showed higher IAT social anxiety scores, both (i) as a result of the social anxiety induction, and (ii) as a function of self-reported trait social anxiety. It is suggested that the IAT may be a useful method for the experimental study of automatic evaluational thought patterns.

The relationship between rumination, avoidance and depression in a non-clinical sample

Recent commentaries have proposed conceptualizations of rumination in terms of both cognitive and behavioral avoidance. This study examined the relationship between rumination, avoidance and depression using a newly developed self-report measure of avoidance in depression, the Cognitive-Behavioral Avoidance Scale (CBAS) [Ottenbreit, N.D., & Dobson, K.S. (2004). Avoidance and depression: The construction of the cognitive-behavioral avoidance scale. Behaviour Research and Therapy, 42, 293-313]. A non-clinical sample (N=104) of undergraduate students completed self-report measures of depression, anxiety, rumination and avoidance. Rumination, avoidance and depression were all significantly correlated. Rumination and behavioral avoidance remained intercorrelated when anxiety was controlled, confirming an association that is independent of anxiety. By contrast, the relationship between cognitive avoidance and rumination disappeared when anxiety was partialled out. Notably, avoidance predicted unique variance in depression scores, over and above anxiety and rumination. Consistent with the proposal of Ottenbreit and Dobson [Avoidance and depression: The construction of the cognitive-behavioral avoidance scale. Behaviour Research and Therapy, 42, 293-313], our findings support the value of clinicians and psychopathologists giving consideration to avoidance in their conceptualization of depression.

Traumatic and socially stressful life events among persons with social anxiety disorder

This study examined the frequency of reexperiencing, avoidance, and hyperarousal symptoms most often associated with posttraumatic stress disorder (PTSD) among 45 persons with social anxiety disorder and 30 nonanxious controls in response to an extremely stressful social event (which did not satisfy DSM-IV's PTSD Criterion A). Avoidance and hyperarousal in response to reminders of socially stressful events were common among patients; more than one-third would have met criteria for PTSD if these events satisfied DSM-IV PTSD Criterion A. Frequency of this PTSD-like symptom pattern did not differ among patients who did and did not experience another event that did satisfy PTSD Criterion A. Implications of these findings for the treatment of social anxiety disorder are discussed.

Phenomenal characteristics of autobiographical memories for social and non-social events in social phobia

Previous studies failed to show clear differences between people with social phobia and non-anxious individuals regarding the specificity and affective intensity of their autobiographical memories for social events. However, these studies did not assess the subjective experience associated with remembering. In this study, people with social phobia and non-anxious control participants recalled social and non-social events, and rated the phenomenal characteristics of their memories. The memories of people with social phobia for social events contained fewer sensorial details but more self-referential information than controls' memories. In addition, people with social phobia remembered social situations from an observer perspective, viewing themselves as if from outside, to a greater extent than controls. By contrast, the two groups did not differ concerning their memories for non-social events. These findings are discussed in relation to cognitive models of social phobia.

The post-event processing questionnaire in a clinical sample with social phobia

Post-event processing (PEP) involving rumination about perceived inadequacy in a past social situation has been proposed as an important maintaining factor in social phobia. The three aims of this study were to examine (a) the factor structure and internal reliability of a modified version of the Post-Event Processing Questionnaire [Rachman, S., Grüter-Andrew, J., & Shafran, R. (2000). Post-event processing in social anxiety. Behaviour Research and Therapy, 38, 611-617] in a clinical sample with social phobia (N=117), (b) the associations between PEP and symptoms of anxiety and depression, and (c) the relationship between perspective-taking ('field' and 'observer') and anxiety. Principal axis factor analysis yielded a highly reliable one-factor solution in our clinical sample, which generally replicated Rachman et al.'s findings with a sample of undergraduate students. PEP was most strongly and independently associated with state anxiety when depression, general anxiety and stress were controlled for. Contrary to expectations, PEP was not related to measures of social anxiety. The relationship between perspective-taking and anxiety was more complex than expected. Theoretical implications of these findings are discussed with reference to contemporary cognitive-behavioural models of social phobia.

Social Self-Reappraisal Therapy for Social Phobia: Preliminary Findings

The recent psychopathology literature suggests that individuals with social phobia overestimate social standards and are deficient in setting and attaining social goals, have a negative perception of themselves as social objects, and show heightened self-focused attention when confronted with social threat. They further overestimate the potential cost of a social encounter, experience their anxiety as uncontrollable and visible to others, view their social skills as inadequate, rely on safety behaviors and avoidance strategies to control their anxiety, and engage in post-event rumination. Traditional cognitive-behavioral therapy does not adequately address all of these features of social phobia during treatment. We discuss here an enhanced version of cognitive-behavioral treatment for social phobia, which is expressly designed to address these factors. The results of an uncontrolled pilot study suggest that this new treatment may be more effective than traditional cognitive-behavioral therapy for social phobia.

Ruminative coping and post-event processing in social anxiety

Cognitive models of social anxiety implicate various factors in the initiation and maintenance of socially anxious states, including anticipatory processing, self-focused attention and post-event processing. The present study focused on post-event processing, which is a post-mortem analysis following a social event that is described as ruminative in nature and serves to maintain social anxiety. Participants (N=112; 64 women, 48 men) were presented with vignettes that involved making mistakes in public and were instructed to record their thoughts to allow for the examination of the content of post-event processing. Ruminative coping and distraction were assessed via self-report. Results indicated that participants high in social anxiety (n=55) were more likely to ruminate and less likely to distract when faced with socially anxious stressors compared to those low in social anxiety (n=57). Further, as hypothesized, participants high in social anxiety recorded more negative thoughts and more upward counterfactual thoughts ('if only' type thoughts on how things could have been better; associated with negative affect) compared to those low in social anxiety. These results are discussed in terms of cognitive models of social anxiety.

Post-event processing and the retrieval of autobiographical memories in socially anxious individuals

Individuals with social anxiety often report considerable ruminative thoughts following ambiguous social events (post-event processing). The purpose of this study was to determine whether post-event processing affects retrieval of autobiographical memories rated as negative, anxious and shameful in a sample of socially anxious individuals and controls. Results indicated that, compared to controls, socially anxious individuals recalled memories that were rated as significantly more negative and shameful regardless of the type of post-event processing engaged in. Unexpectedly, after negative post-event processing socially anxious individuals recalled memories that although anxious and shameful, were rated as significantly more calming than after other types of post-event processing. The results imply that post-event processing may have some adaptive benefit that could explain why it persists in socially anxious individuals.

Information-processing bias in social phobia

Social phobia is a persistent disorder that is unlikely to be maintained by avoidance alone. One reason for the enduring nature of social phobia may be the way individuals with the disorder process social information. It is important for those involved in social phobia to have an understanding of information-processing biases, because it has the potential to guide psychological interventions. In this review of social phobia, probability and cost estimates of social situations are examined, interpretive biases are evaluated and findings relating to memory and negative imagery are also reviewed. The clinical implications of social-phobia-related information-processing biases are discussed and possible avenues for future research are outlined.

Post-event rumination and negative self-appraisal in social phobia before and after treatment

This study investigated the relationship between self-appraisals of performance, symptom severity and post-event rumination in social phobia, and evaluated the effect of treatment on these variables. A socially phobic group and a nonanxious control group performed an impromptu speech and were told that their performance would be evaluated. Participants appraised their performance immediately after the speech and 1 week later, and the frequency of post-event rumination during the week following the speech was assessed. The socially phobic group maintained the negative appraisals of their speech over the week, whereas the nonclinical group showed increased positivity about their performance The socially phobic group also engaged in more negative rumination than controls. Treatment improved perceptions of performance and reduced negative rumination. These results are discussed in the light of cognitive models of social phobia.

Negative self-imagery blocks inferences

Previous research has shown that, unlike non-anxious individuals, people with social phobia fail to generate non-threatening inferences when ambiguous social information is first encountered (i.e. 'on-line'; Hirsch and Mathews Journal of Abnormal Psychology, 109 (2000) 705-712). Patients with social phobia also report negative self-imagery in social situations, while individuals without high social anxiety do not. The negative self-imagery in social phobia may prevent the generation of non-threatening inferences. If so, then training non-anxious individuals to hold in mind a negative self-image should remove the 'on-line' non-threat inferential bias normally evident in this population. In the present study, low anxious volunteers were allocated to negative image training or a control task that did not manipulate self-imagery. Following negative image training, or the control task, volunteers read descriptions of job interviews and at certain points during the text performed lexical decisions. Some decisions were made after ambiguous text that could have been interpreted in both a threatening and a non-threatening manner. In a baseline condition, decisions were made following the text for which there was only one possible inference (either threat or non-threat). The results for the control group replicated earlier findings of a non-threat inferential bias for non-anxious individuals. In contrast, and as predicted, non-anxious volunteers who were trained to hold a negative image in mind lacked any non-threatening inferential bias, and also experienced higher levels of state anxiety.

Clinical perfectionism: a cognitive-behavioural analysis

This paper reviews the characteristics of clinical perfectionism and proposes a new definition of the phenomenon. It is suggested that the defining feature of clinically significant perfectionism is the overdependence of self-evaluation on the determined pursuit (and achievement) of self-imposed personally demanding standards of performance in at least one salient domain, despite the occurrence of adverse consequences. It is suggested that such clinical perfectionism is maintained by the biased evaluation of the pursuit and achievement of personally demanding standards. Specifically, it is suggested that people with perfectionism react to failure to meet their standards with self-criticism. If they do meet their standards, the standards are re-evaluated as being insufficiently demanding. Anorexia nervosa and bulimia nervosa are considered to have a particular relationship to perfectionism, with both disorders often being direct expressions of perfectionism. Under these circumstances self-evaluation is dependent on the pursuit and attainment of personally demanding standards in the domain of control over eating, shape and weight. The implications of this analysis for research and practice are considered.

Information processing in social phobia

Cognitive theories suggest that information processing biases play a central role in the development and maintenance of emotional disorders. The present article reviews recent studies of information processing biases in social phobia and considers the significance of the findings for understanding the persistence of the condition. Taken together, the studies suggest that social phobia is characterized by biases in the following: interpretation of external social events; detection of negative responses from other people; the balance of attention between external and self-processing; the use of internal information to make inferences about how one appears to others; recall of negative information about one's perceived, observable self; and by a variety of problematic anticipatory and post-event types of processing. If such biases play a role in maintaining social anxiety, experimental manipulation of the biases should modulate anxiety responses. Several recent studies have confirmed this prediction, but further research is required. Methodological limitations of existing information processing studies are highlighted. Finally, possible neurobiological correlates are discussed and suggestions are made for future attempts to link neurobiology and cognitive psychology.

Brief cognitive therapy for social phobia: a case series

Social phobia is a common and disabling anxiety disorder. The most effective psychological treatments for social phobia are cognitive therapy and exposure. However, the degree of improvement across these treatments is variable, and their implementation is costly and time-consuming. This study aimed to conduct a preliminary clinical evaluation of the effectiveness of a brief, new form of cognitive therapy based on a recent cognitive model of social phobia. Six consecutively referred patients with social phobia were treated using established single case series methodology. Brief cognitive therapy was effective with all patients demonstrating clinically significant improvements in all measures. Treatment gains were maintained at follow-up. The mean number of treatment sessions delivered was 5.5 and improvements compare favourably with previous treatment studies. Brief cognitive therapy for social phobia appears promising and it is potentially cost-effective. Future randomised and controlled evaluations of this brief treatment are warranted.