The effect of rumination and reappraisal on social anxiety symptoms during cognitive-behavioral therapy for social anxiety disorder

Upward social comparison and social anxiety among Chinese college students: a chain-mediation model of relative deprivation and rumination

Background

Social anxiety has consistently emerged as a prominent manifestation of mental health issues among college students. Though the relationship between upward social comparison and social anxiety has been extensively addressed in previous literature, little attention has been paid to the underlying mechanisms at play.

Objective

The present study used a questionnaire survey to test whether upward social comparison may be associated with social anxiety in Chinese college students. The mediating role of relative deprivation and rumination was also examined.

Methods

In total, 463 college students were recruited to complete four scales, including the Upward Social Comparison Scale, the Relative Deprivation Scale, the Ruminative Thinking Scale, and the Social Anxiety Scale.

Results

The results show that upward social comparison was significantly positively correlated with relative deprivation, rumination, and social anxiety (r = 0.30, 0.31, and 0.27, respectively; p < 0.01). Second, relative deprivation was positively correlated with rumination and social anxiety (r = 0.40 and 0.17, respectively; p < 0.01). Finally, rumination was positively correlated with social anxiety (r = 0.47, p < 0.01). Moreover, upward social comparison positively predicts social anxiety, with an effect value of 0.12, while rumination plays a mediating role between upward social comparison and social anxiety, with an effect value of 0.07, and the 95% confidence interval for the indirect effect is 0.04-0.11. Separately, the chain mediation of relative deprivation and rumination had an effect value of 0.03, and the 95% confidence interval for the indirect effect is 0.02-0.05.

Conclusion

This research highlights the relationship between upward social comparison and social anxiety in Chinese society and revealed the mediating mechanisms between them, deepening our understanding of how upward social comparison increases social anxiety.

Fluctuations in emotion regulation as a mechanism linking stress and internalizing psychopathology among adolescents: An intensive longitudinal study

Stressful life events (SLEs) are tightly coupled with the emergence of anxiety and depression symptoms among adolescents, but the mechanisms underlying this relationship remain poorly understood. We investigated within-person fluctuations in emotion regulation as a mechanism linking SLEs and internalizing psychopathology in an intensive longitudinal study. We examined how monthly fluctuations in SLEs were related to engagement in three emotion regulation strategies-acceptance, reappraisal, and rumination-and whether these strategies were associated with changes in internalizing symptoms in adolescents followed for one year (N = 30; n = 355 monthly observations). Bayesian hierarchical models revealed that on months when adolescents experienced more SLEs than was typical for them, they also engaged in more rumination, which, in turn, was associated with higher anxiety and depression symptoms and mediated the prospective relationship between SLEs and internalizing symptoms. In contrast, greater use of acceptance and reappraisal selectively moderated the association between stressors and internalizing symptoms, resulting in stronger links between SLEs and symptoms. These results suggest that emotion regulation strategies play different roles in the stress-psychopathology relationship. Understanding how changes in emotion regulation contribute to increases in internalizing symptoms following experiences of stress may provide novel targets for interventions aimed at reducing stress-related psychopathology.

Brain activity during reappraisal and associations with psychotherapy response in social anxiety and major depression: a randomized trial

BACKGROUND

Cognitive behavioral therapy (CBT) is an effective treatment for patients with social anxiety disorder (SAD) or major depressive disorder (MDD), yet there is variability in clinical improvement. Though prior research suggests pre-treatment engagement of brain regions supporting cognitive reappraisal (e.g. dorsolateral prefrontal cortex [dlPFC]) foretells CBT response in SAD, it remains unknown if this extends to MDD or is specific to CBT. The current study examined associations between pre-treatment neural activity during reappraisal and clinical improvement in patients with SAD or MDD following a trial of CBT or supportive therapy (ST), a common-factors comparator arm.

METHODS

Participants were 75 treatment-seeking patients with SAD (n = 34) or MDD (n = 41) randomized to CBT (n = 40) or ST (n = 35). Before randomization, patients completed a cognitive reappraisal task during functional magnetic resonance imaging. Additionally, patients completed clinician-administered symptom measures and a self-report cognitive reappraisal measure before treatment and every 2 weeks throughout treatment.

RESULTS

Results indicated that pre-treatment neural activity during reappraisal differentially predicted CBT and ST response. Specifically, greater trajectories of symptom improvement throughout treatment were associated with less ventrolateral prefrontal cortex (vlPFC) activity for CBT patients, but more vlPFC activity for ST patients. Also, less baseline dlPFC activity corresponded with greater trajectories of self-reported reappraisal improvement, regardless of treatment arm.

CONCLUSIONS

If replicated, findings suggest individual differences in brain response during reappraisal may be transdiagnostically associated with treatment-dependent improvement in symptom severity, but improvement in subjective reappraisal following psychotherapy, more broadly.

Trajectories and influencing factors of social anxiety in postoperative breast cancer patients

BACKGROUND

Social anxiety among postoperative breast cancer patients is a prevalent concern, with its intensity fluctuating throughout the course of treatment. The study aims to describe the trajectory of social anxiety in postoperative breast cancer patients, explore the influencing factors, and provide theoretical support for the construction of future intervention programs.

METHODS

This study was conducted from June 2022 to January 2023, encompassing 213 breast cancer patients from three first-class hospitals in China. Data collection occurred at four distinct time points. A growth mixture model was employed to identify latent categories representing the trajectories of social anxiety changes among patients. A multiple regression analysis was utilized to explore predictive factors associated with different latent trajectory categories.

RESULTS

The trajectory of social anxiety changes in postoperative breast cancer patients includes five potential categories: maintaining mild social anxiety group, changing from mild to moderate social anxiety group, maintaining moderate social anxiety group, changing from moderate to severe social anxiety group, and maintaining severe social anxiety group. Cluster analysis results indicated three types: positive, negative, and low. Logistic regression analysis revealed that younger age, spouses concerned about postoperative appearance, chemotherapy with taxol-based drugs, opting for modified radical surgery or radical mastectomy surgical approaches, and breast cancer patients with negative rumination were factors that influenced patients' social anxiety (P < 0.05).

CONCLUSION

The trajectory of social anxiety in postoperative breast cancer patients comprises five potential categories. In clinical practice, it is essential to strengthen the management of high-risk populations susceptible to experiencing social anxiety emotions, including younger age, spouses concerned about postoperative appearance, chemotherapy with taxol-based drugs, opting for modified radical surgery or radical mastectomy surgical approaches, and breast cancer patients with negative rumination.

Psychological interventions for pre-event and post-event rumination in social anxiety: A systematic review and meta-analysis

Pre-event and post-event rumination have been consistently identified by cognitive models as important maintaining factors in Social Anxiety Disorder (SAD). This systematic review and meta-analysis aimed to investigate the effectiveness of psychological treatment in reducing pre-event and post-event rumination in adults with social anxiety. A comprehensive literature search identified 26 eligible studies, with 1524 total participants. Psychological treatments demonstrated large significant within-group effect sizes (from pre- to post-treatment) in reducing pre-event rumination (g = 0.86) and post-event rumination (g = 0.83). Subgroups analysed showed CBT to have large significant effect sizes in reducing pre-event rumination (g = 0.97) and post-event rumination (g = 0.85). Interventions that specifically addressed rumination were found to be significantly more effective in reducing pre-event rumination than those that did not (p = .006). Both individual and group treatment formats were equally effective in reducing pre-event rumination and post-event rumination. Meta-regressions revealed that pre-event rumination treatment effects were significantly larger in individuals with higher baseline social anxiety, meanwhile post-event rumination treatment effects were larger for those with higher baseline depression. Overall findings show that pre-event and post-event rumination are effectively reduced through psychological treatment, and clinical implications for the enhancement of evidence-based treatment protocols are discussed.

Reducing Test Anxiety During the COVID-19 Pandemic: A Comparison of the Effectiveness of Cognitive Behavioral Therapy and Acceptance and Commitment Therapy

Educational assessments can affect students' mental health, particularly during a pandemic. Acceptance and Commitment Therapy (ACT) and Cognitive Behavioral Therapy (CBT) are widely efficacious for reducing test anxiety, as well as general anxiety and rumination. However, the effectiveness of these two therapies for students during COVID-19 is unclear. We measured the effectiveness of ACT and CBT for managing test anxiety, general anxiety, and rumination during COVID-19 for 77 students taking Türkiye's national university entrance exam, assigned to either the ACT or CBT psychoeducation programs. Both programs reduced test anxiety, general anxiety, and rumination, and showed similar levels of effectiveness. This suggests that ACT and CBT are both important for improving students' mental health during COVID-19 and either may be beneficial.

Linking Cognitive Reappraisal and Expressive Suppression to Mindfulness: A Three-Level Meta-Analysis

Cognitive reappraisal and expressive suppression have long been considered the two most important emotion regulation strategies. Increasingly, studies have found that mindfulness has a relationship with them. However, the magnitude and direction of the relationship between them have yet to reach a consistent conclusion. To this end, a three-level meta-analysis was used to explore the relationship between mindfulness, cognitive reappraisal, and expressive suppression. Thirty-six studies were included in the meta-analysis through a literature search, including 36 samples with 83 effect sizes and a total of 12,026 subjects. The three-level random effects model showed that mindfulness was positively correlated with cognitive reappraisal to a low to moderate degree but was not correlated with expressive suppression. The moderating effect analysis showed that the relationship between mindfulness and cognitive reappraisal was slightly closer in males than in females. The study found a relatively stable positive relationship between mindfulness and cognitive reappraisal, an adaptive emotion regulation mode, while the relationship with expressive suppression was insignificant. The finding supported the affect regulation training model and also shed light on potential areas for future studies.

Effect of rejection sensitivity on the development of anxious-depressive attack in Japanese outpatients: The mediating roles of rumination, social anxiety, and depressive symptoms

OBJECTIVE

Anxious-depressive attack (ADA) is a cluster of symptoms, including sudden and intense anxiety or depression, intrusive rumination about negative memories or future worries, prominent agitation, impatient behavior, and/or loneliness; in some cases, symptoms include a wide range of violent coping behaviors to manage emotional distress. Four characteristics-rejection sensitivity, rumination, social anxiety symptoms, and depressive symptoms-are thought to be associated with the development of ADA. However, the complex relationships among these factors have not been clarified. In this study, we aimed to examine the mechanism by which these four characteristics influence the development of ADA.

METHODS

We conducted a structured interview about ADA with 332 outpatients, who completed several self-report measures, to assess rejection sensitivity, rumination, social anxiety symptoms, and depressive symptoms.

RESULTS

A structural equation model showed goodness-of-fit with the data. These findings suggest that rejection sensitivity may demonstrate a direct effect on the occurrence of ADA. Furthermore, rejection sensitivity might affect depressive symptoms through rumination and social anxiety symptoms and consequently contribute to the development of ADA.

CONCLUSION

These results provide preliminary evidence that rejection sensitivity contributes to the development of ADA.

Emotion regulation strategies and difficulties in older adults: A systematic review

OBJECTIVES

The purpose of this systematic review was to assess the types of emotion regulation (ER) strategies used and difficulties in emotion regulation experienced by older adults, within the theoretical frameworks proposed by Gross, and by Gratz and Roemer, respectively.

METHODS

A systematic search was conducted using principal electronic scientific databases (PubMed, Scopus, and Web of Science). The systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines.

RESULTS

The final number of articles included was 44. Older adults reported a higher use of adaptive ER strategies, as well as fewer difficulties in ER, compared with younger adults. Findings from this review also suggest that the use of maladaptive ER strategies can also expose older adults to psychological distress, and may affect their adaptation to negative disease-related outcomes more common in later life.

CONCLUSIONS

Older adults generally showed a greater emotional control compared with younger subjects. Adaptive control strategies, rather than maladaptive control strategies, were correlated with more positive outcomes for psychological distress and adaptation to chronic diseases.

CLINICAL IMPLICATIONS

Understanding the nature of ER processes in older adults may contribute to implement tailored interventions aimed at reinforcing adaptive ER processes.

Sequential multiple mediation of cognitive fusion and experiential avoidance in the relationship between rumination and social anxiety among Chinese adolescents

BACKGROUND AND OBJECTIVES

The potential mechanism by which rumination influences social anxiety through cognitive fusion and experiential avoidance proposed by the Acceptance and Commitment Therapy model has not been well-documented. This study, therefore, aimed to examine the sequential multiple mediation of the two processes.

DESIGN

A cross-sectional survey was conducted.

METHOD

A total of 233 Chinese adolescents (42.06% girls) completed a set of printed self-report questionnaires measuring rumination, cognitive fusion, experiential avoidance, and social anxiety. The SPSS macro PROCESS (model 6) was used to test a sequential mediating model. A 95% confidence interval (CI) was calculated with 5000 bootstrapping re-samples.

RESULTS

Bootstrap analyses indicated that there were indirect effects of rumination on social anxiety mediated by cognitive fusion together with experiential avoidance (B = 0.098, BootSE = 0.032, CI = 0.045 to 0.170), or solely by experiential avoidance (B = 0.048, BootSE = 0.020, CI = 0.014 to 0.093). The mediation of cognitive fusion alone was not significant (B = 0.065, BootSE = 0.038, CI = -0.006 to 0.144).

CONCLUSIONS

The results indicated the sequential mediating role of cognitive fusion and experiential avoidance, and the relative prominence of the latter in the association between rumination and social anxiety.

Pretreatment levels of rumination predict cognitive-behavioral therapy outcomes in a transdiagnostic sample of adults with anxiety-related disorders

Increasing research has implicated rumination in the development and maintenance of many types of psychopathology, including anxiety-related disorders. A few studies have explored the impact of rumination during cognitive-behavioral therapy (CBT) for anxiety-related disorders (which relies heavily on exposure-based interventions), with mixed results. The present study assessed levels of (trait) rumination before starting treatment for predicting outcomes in 147 adults seeking CBT for anxiety-related disorders in an open treatment clinic. Results revealed that pretreatment levels of rumination significantly predicted (lower) quality of life at the end of treatment, after accounting for baseline variance in quality of life. This finding remained robust when also accounting for demographics, depression, general anxiety, and diagnosis. This result was not observed for self-reflection (a construct related to, but distinguishable from, rumination). Nevertheless, a follow-up (receiver-operator characteristic) analysis showed that pretreatment rumination did not reliably distinguish participants who showed clinically meaningful gains in quality of life during treatment from those who did not. Theoretical and clinical implications of these findings are discussed. We propose that rumination may impede emotional processing during CBT for anxiety, and warrants further attention and treatment. However, more advanced methods (e.g., multivariate modeling) are needed to improve the prognostic utility of rumination.

Experience Versus Report: Where Are Changes Seen After Exposure-Based Cognitive-Behavioral Therapy? A Randomized Controlled Group Treatment of Childhood Social Anxiety Disorder

A considerable number of children and adolescents with social anxiety disorder (SAD) do not benefit from treatment as much as expected. However, treatment success should not be measured with social anxiety reports alone; the cognitive, behavioral, and physiological components of social stress should also be assessed. The authors examined an exposure-based SAD-specific group cognitive behavioral therapy (CBT) in a randomized controlled trial (N = 67, age 9-13 years, blind randomized allocation to treatment [CBT; n = 31] and waitlist control [WLC; n = 36] groups). Success was operationalized as a clinically significant reduction of symptoms measured with SAD-specific questionnaires, structured interviews, and changes in response to the Trier Social Stress Test (TSST). In the CBT group, there was a trend toward a significant increase in positive cognitions in the TSST after treatment (d = 0.37), whereas these positive cognitions decreased in the WLC group (d = 0.40). No significant results involving group appeared for negative cognitions, behavior and physiology. Children in the CBT group, but not parents, further reported less social anxiety in one questionnaire from pre- to post-treatment (d = 0.89). A structured interview confirmed a decrease in severity of SAD in the CBT group. While the gold standard of a blind interview showed efficacy of treatment, not all trait and state measures demonstrated similar success patterns.Trial registration Eligibility criteria and some of the dependent variables (cognitions, physiology) for treatment success were registered with the German Research Foundation (TU 78/5-2, HE 3342/4-2) prior to recruitment. Clinical assessment of diagnosis and behavioral data were not a priori planned as outcome measures for this trial and therefore analyzed in a post-hoc approach.

Interrelations Among Biologically Relevant Personality Traits, Emotion Regulation Strategies, and Clinical Symptoms

Biologically relevant personality traits of weak inhibitory control (disinhibition) and threat sensitivity confer vulnerability to various clinical problems. Difficulties with emotion regulation have also been studied extensively in relation to risk for and maintenance of psychopathology. However, it remains unclear how emotion regulation strategies interface with dispositional vulnerabilities in affecting clinical symptomatology. The current study provided an initial examination of the roles of disinhibition, threat sensitivity, and use of key emotion regulation strategies (cognitive reappraisal, expressive suppression) in the occurrence of distress-related symptoms (i.e., depressivity, anxiousness, and borderline personality features). Analyses revealed that trait disinhibition and lowered use of cognitive reappraisal were related to each form of distress symptomatology, with the predictive relationship for disinhibition accounting entirely for that of reappraisal. This finding suggests that deficient top-down control capacity (i.e., disinhibition) is integral to failures in the use of an adaptive but cognitively demanding regulation strategy (i.e., reappraisal). By contrast, threat sensitivity was related both to anxiousness and use of expressive suppression, with the latter two variables unrelated to one another. Anxious individuals may avoid emotionally evocative situations, negating the downstream need to engage in the maladaptive strategy of expressive suppression. Despite certain study limitations (a cross-sectional, self-report design; modest sample size), the current study yielded evidence in line with study hypotheses, indicating a pivotal role for dispositional traits in associations between cognitive-behavioral processes and clinical problems.

Changes in post-event processing during cognitive behavioural therapy for social anxiety disorder: A longitudinal analysis using post-session measurement and experience sampling methodology

PURPOSE

Post-event processing (PEP) is posited to be an important factor in the maintenance of social anxiety symptoms. Previous research has demonstrated that general PEP tendencies are sensitive to treatment. However, it remains unclear how momentary PEP following social interactions changes over the course of treatment for social anxiety disorder. The purpose of the present study was to examine how both momentary and general PEP change over the course of treatment, and how such changes predict treatment outcome.

METHOD

Participants (N = 60) with social anxiety disorder were enrolled in group cognitive behavioural therapy. All participants completed measures of PEP and social anxiety symptom severity at five time points over treatment. A subset (N = 33) also completed repeated experience sampling measurements of PEP following social interactions across the course of treatment.

RESULTS

Both general and momentary PEP decreased over the course of treatment. Decreases in both types of PEP predicted lower social anxiety symptom severity following treatment.

CONCLUSION

The results of the study demonstrate that momentary experiences of PEP can be influenced by treatment, and can in turn impact treatment outcome. The findings have significant clinical and theoretical implications.

Comparing cognitive styles in social anxiety and major depressive disorders: An examination of rumination, worry, and reappraisal

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.

Social anxiety questionnaire (SAQ): Development and preliminary validation

BACKGROUND

The Social Anxiety Questionnaire (SAQ) was designed to assess five dimensions of social anxiety as posited by the Clark and Wells' (1995; Clark, 2001) cognitive model.

METHODS

The development of the SAQ involved generation of an item pool, followed by a verification of content validity and the theorized factor structure (Study 1). The final version of the SAQ was then assessed for reliability, temporal stability (test re-test reliability), and construct, criterion-related, and contrasted-group validity (Study 2, 3, and 4).

RESULTS

Following a systematic process, the results provide support for the SAQ as reliable, and both theoretically and empirically valid measure. A five-factor structure of the SAQ verified and replicated through confirmatory factor analyses reflect five dimensions of social anxiety: negative self-processing; self-focused attention and self-monitoring; safety behaviours; somatic and cognitive symptoms; and anticipatory and post-event rumination.

LIMITATIONS

Results suggest that the SAQ possesses good psychometric properties, while recognizing that additional validation is a required future research direction. It is important to replicate these findings in diverse populations, including a large clinical sample.

CONCLUSIONS

The SAQ is a promising measure that supports social anxiety as a multidimensional construct, and the foundational role of self-focused cognitive processes in generation and maintenance of social anxiety symptoms. The findings make a significant contribution to the literature, moreover, the SAQ is a first instrument that offers to assess all, proposed by the Clark-Wells model, specific cognitive-affective, physiological, attitudinal, and attention processes related to social anxiety.

Emotion regulation strategies moderate the relationship of fatigue with depersonalization and derealization symptoms

BACKGROUND

The aim of the present study was to investigate the relationships of common emotion regulation strategies (suppression and reappraisal) to self-reported fatigue and depersonalization/derealization symptoms. Specifically, we tested the moderating effect of suppression and reappraisal on the link of fatigue with depersonalization and derealization symptoms. Opposite effects were expected for both emotion regulation strategies assuming that cognitive reappraisal has an adaptive buffering effect, while suppression intensifies the association of fatigue and depersonalization/derealization experiences.

METHODS

In a representative study (N = 2524) we assessed emotion regulation strategies, fatigue, depersonalization/derealization, distress, and demographic variables via questionnaires. 55.5% of the participants were female, mean age was 49.4 (SD = 18.2) years with age groups represented in comparable proportions.

RESULTS

In line with the assumptions, moderated regression analyses revealed an interaction effect of emotion regulation strategies and fatigue. Simple slope analyses indicated a buffering effect of cognitive reappraisal on the positive relation of fatigue with depersonalization and derealization symptoms. In contrast, suppression fosters the positive correlation of fatigue and depersonalization and derealization experiences.

LIMITATIONS

Our study is limited to these two habitual emotion regulation strategies employing a cross sectional design.

CONCLUSION

Our findings provide comprehensive empirical data investigating depersonalization/derealization symptoms from the perspective of emotion regulation research. Cognitive reappraisal might help people suffering from fatigue to prevent depersonalization and derealization tendencies.

Group CBT versus MBSR for social anxiety disorder: A randomized controlled trial

OBJECTIVE

The goal of this study was to investigate treatment outcome and mediators of cognitive-behavioral group therapy (CBGT) versus mindfulness-based stress reduction (MBSR) versus waitlist (WL) in patients with generalized social anxiety disorder (SAD).

METHOD

One hundred eight unmedicated patients (55.6% female; mean age = 32.7 years, SD = 8.0; 43.5% Caucasian, 39% Asian, 9.3% Hispanic, 8.3% other) were randomized to CBGT versus MBSR versus WL and completed assessments at baseline, posttreatment/WL, and at 1-year follow-up, including the Liebowitz Social Anxiety Scale-Self-Report (primary outcome; Liebowitz, 1987) as well as measures of treatment-related processes.

RESULTS

Linear mixed model analysis showed that CBGT and MBSR both produced greater improvements on most measures compared with WL. Both treatments yielded similar improvements in social anxiety symptoms, cognitive reappraisal frequency and self-efficacy, cognitive distortions, mindfulness skills, attention focusing, and rumination. There were greater decreases in subtle avoidance behaviors following CBGT than MBSR. Mediation analyses revealed that increases in reappraisal frequency, mindfulness skills, attention focusing, and attention shifting, and decreases in subtle avoidance behaviors and cognitive distortions, mediated the impact of both CBGT and MBSR on social anxiety symptoms. However, increases in reappraisal self-efficacy and decreases in avoidance behaviors mediated the impact of CBGT (vs. MBSR) on social anxiety symptoms.

CONCLUSIONS

CBGT and MBSR both appear to be efficacious for SAD. However, their effects may be a result of both shared and unique changes in underlying psychological processes.

A Validation Study of the Korean-Ruminative Response Scale in Korean Adolescents

OBJECTIVE

We aimed to evaluate the psychometric properties of Korean version of Ruminative Response Scale (K-RRS) for Korean adolescents.

METHODS

A community sample of 1220 adolescents was recruited from middle schools and high schools. Exploratory factor analyses and confirmatory factor analyses were conducted, and additional analyses were performed to assess the reliability and validity of the K-RRS.

RESULTS

An exploratory factor analysis of a sample of adolescents (n=550) yielded a three factor structure: 'depressive rumination', 'reflective pondering', and 'brooding'. Confirmatory factor analyses of another sample of adolescents (n=530) supported the three-factor model for the K-RRS. The K-RRS was found to have good internal consistency and construct validity.

CONCLUSION

Our results suggest that K-RRS is a valid measurement to assess rumination in adolescents, as well as in adults.