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Edgar EV, Richards A, Castagna PJ, Bloch MH, Crowley MJ. Post-event rumination and social anxiety: a systematic review and meta-analysis. J Psychiatr Res 2024; 173:87-97. [PMID: 38518572 PMCID: PMC11018455 DOI: 10.1016/j.jpsychires.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 02/03/2024] [Accepted: 03/12/2024] [Indexed: 03/24/2024]
Abstract
Post-event rumination, the extent to which one engages in persistent, detailed, and negative thinking following social situations, serves as a risk process in the pathophysiology of social anxiety. Although a substantial body of research has assessed post-event rumination and social anxiety, this literature has produced inconsistent results. We conducted a systematic review and meta-analysis to examine whether the magnitude of the association between post-event rumination and social anxiety varied as a function of questionnaire and/or task utilized. We included all studies reporting a correlation between post-event rumination and social anxiety symptomatology. Fisher's z correlation coefficients were calculated through random-effect meta-analyses. Results indicated a moderate association between post-event rumination and social anxiety symptomatology (r = 0.45, p < 0.001, 95%CI [0.40-0.50]). Subgroup meta-analyses indicated that the type of questionnaire used to assess post-event rumination (Q = 44.36, df = 3, p < 0.001) and social anxiety (Q = 26.44, df = 8, p < 0.001), as well as the task conducted prior to assessing post-event rumination (Q = 14.31, df = 2, p < 0.001), influenced the effect size. This study demonstrates a moderate relation between post-event rumination and social anxiety across the anxiety spectrum, illustrating the importance of treatments specifically targeting post-event rumination. Moreover, we highlight the importance of taking care when designing studies to explore relations between post-event rumination and social anxiety.
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Affiliation(s)
- Elizabeth V Edgar
- Yale Child Study Center, Yale School of Medicine, New Haven, CT, USA.
| | - Ashlyn Richards
- Department of Psychology, Sewanee the University of the South, Sewanee, TN, USA
| | - Peter J Castagna
- Department of Psychology, The University of Alabama, Tuscaloosa, AL, USA
| | - Michael H Bloch
- Yale Child Study Center, Yale School of Medicine, New Haven, CT, USA
| | - Michael J Crowley
- Yale Child Study Center, Yale School of Medicine, New Haven, CT, USA
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Donohue HE, Modini M, Abbott MJ. Psychological interventions for pre-event and post-event rumination in social anxiety: A systematic review and meta-analysis. J Anxiety Disord 2024; 102:102823. [PMID: 38142483 DOI: 10.1016/j.janxdis.2023.102823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 12/04/2023] [Accepted: 12/18/2023] [Indexed: 12/26/2023]
Abstract
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.
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Affiliation(s)
| | - Matthew Modini
- School of Psychology, The University of Sydney, Australia; Concord Centre for Mental Health, Sydney Local Health District, Australia
| | - Maree J Abbott
- School of Psychology, The University of Sydney, Australia.
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3
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Wong QJJ, Hamrick HC, Clague CA, Judah MR. Understanding the Dimensions of Post-Event Processing: Applying a Bifactor Modeling Approach to the EPEPQ-15. Assessment 2023; 30:1836-1847. [PMID: 36176182 DOI: 10.1177/10731911221127911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Social anxiety disorder is maintained in part by rumination about past social experiences, known as post-event processing. The Extended Post-Event Processing Questionnaire (EPEPQ-15) assesses post-event processing as three correlated factors. Competing against this structure is a bifactor model that has not yet been evaluated for the EPEPQ-15. These models were tested for the conventional state version of the EPEPQ-15 and a new trait version in two separate samples (Ns = 327 and 351). In both samples, the fit of the bifactor model was better than that of correlated factor models. Moreover, the results did not support the group factors, indicating that a unidimensional interpretation of the EPEPQ-15 is most appropriate. The general dimension of the EPEPQ-15 was highly correlated with social interaction anxiety, beliefs related to social anxiety, anticipatory processing, and safety behaviors. These results overall suggest post-event processing is best conceptualized as a unitary construct.
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Gavric D, Cameron D, Waechter S, Moscovitch DA, McCabe RE, Rowa K. Just do something: An experimental investigation of brief interventions for reducing the negative impact of post-event processing in social anxiety disorder. J Anxiety Disord 2023; 98:102744. [PMID: 37478698 DOI: 10.1016/j.janxdis.2023.102744] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 06/02/2023] [Accepted: 07/12/2023] [Indexed: 07/23/2023]
Abstract
Post-Event Processing (PEP) is prevalent and problematic in Social Anxiety Disorder (SAD) but is typically not a direct target in evidence-based treatments such as cognitive behavioural therapy (CBT) for SAD. The primary aim of the current study was to examine the impact of several theoretically and empirically derived interventions for PEP in SAD, including concrete thinking, abstract thinking, and distraction in comparison to a control (i.e., do nothing) condition. Based on prior research, we hypothesized that the concrete and distract conditions would be associated with positive benefits, including reductions in PEP and improvements in self-perception, whereas the abstract and control conditions would not. The second aim of the study was to identify baseline variables that predict the trajectory of change in PEP over time. Participants (N=92) with a principal diagnosis of SAD completed a social stress task and were randomly assigned to one of four conditions. Participants completed measures at baseline, post-intervention/control, and at 1-week, and 1-month follow-up. Contrary to hypotheses, all three active conditions were similarly effective at reducing PEP and improving self-perceptions relative to the control condition. In the absence of an intervention, engagement in PEP remained high up to a month following the social stress task. Higher levels of baseline state anxiety, intolerance of uncertainty, and use of safety behaviours predicted greater PEP, even in the presence of an intervention. These results highlight the benefits of relatively brief interventions that disrupt the course of PEP for people with SAD. Such interventions can be easily incorporated into CBT protocols for SAD to enhance their effects.
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Affiliation(s)
- Dubravka Gavric
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 3K7, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L8S 4L8, Canada.
| | - Duncan Cameron
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 3K7, Canada
| | - Stephanie Waechter
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 3K7, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - David A Moscovitch
- Department of Psychology and Centre for Mental Health Research and Treatment, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Randi E McCabe
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 3K7, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Karen Rowa
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 3K7, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L8S 4L8, Canada
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Vishwanathan A, Kashyap H, Reddy RP, Philip M, Thippeswamy H, Desai G. Neurocognition and Metacognition in Anxiety Disorders. Indian J Psychol Med 2022; 44:558-566. [PMID: 36339691 PMCID: PMC9615456 DOI: 10.1177/02537176211072408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Neurocognitive deficits are noted in anxiety disorders (ADs), albeit with several inconsistencies. The relationship between neurocognition and metacognition may have potential implications for understanding cognitive dysfunction but is poorly understood in ADs. This study aimed to examine the relationship between neurocognition and metacognition in ADs, with a cross-sectional design. METHODS The sample included ADs (n = 25) and nonclinical (n = 25) groups matched on age, gender, and education. Neurocognition was assessed using tests for intelligence, attention, working memory, fluency, flexibility, set-shifting, inhibition, planning, and memory; and metacognition using Metacognition Questionnaire-30 (MCQ-30) and Metacognitive Awareness and Regulation Scale (MARS). RESULTS Compared to comparison/normative scores, the anxiety group showed significantly poorer performance on zoo map test (low demand trial; P = 0.007), rule shift cards 1 (P ≤ 0.001), rule shift cards 2 (P ≤ 0.001), and logical memory immediate recall (P ≤ 0.001) and delayed recall (P ≤ 0.001); greater negative beliefs about worry (P = 0.005), and poorer metacognitive awareness and regulation (P = 0.01). Greater cognitive self-consciousness was correlated with better planning (Spearman's rho = -0.509, P = 0.009). CONCLUSIONS Individuals with ADs show neurocognitive difficulties in planning, set-shifting, and logical memory, dysfunctional metacognition, and reduced metacognitive awareness and regulation. Cognitive self-consciousness is linked to better planning. The interrelationships between neurocognition and metacognition may have potential implications for clarifying inconsistent findings and designing novel cognitive interventions in ADs.
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Affiliation(s)
| | - Himani Kashyap
- Dept. of Clinical Psychology, NIMHANS, Bengaluru, Karnataka, India
| | | | - Mariamma Philip
- Dept. of Biostatistics, NIMHANS, Bengaluru, Karnataka, India
| | | | - Geetha Desai
- Dept. of Psychiatry, NIMHANS, Bengaluru, Karnataka, India
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Do Metacognitions of Children and Adolescents with Anxiety Disorders Change after Intensified Exposure Therapy? CHILDREN 2022; 9:children9020168. [PMID: 35204889 PMCID: PMC8869889 DOI: 10.3390/children9020168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 11/17/2022]
Abstract
Metacognitive beliefs have repeatedly proven to play a role in anxiety disorders in children and adolescents, but few studies have investigated whether they change after cognitive behavioral therapy. This longitudinal intervention study explores whether positive and negative metacognitive beliefs in particular change after exposure-focused treatment, and if metacognitive changes predict reductions in anxiety symptoms. A sample of 27 children between 8 and 16 years of age with a primary diagnosis of specific phobia, separation-anxiety disorder or social phobia completed assessments of anxiety symptoms, metacognitive beliefs, worry and repetitive negative thoughts before and after 11 sessions of intensified exposure treatment. Metacognitive beliefs did not change significantly after intensified exposure, but post-hoc power analysis revealed a lack of power here. Change in negative metacognitive beliefs correlated with a change in anxiety symptoms, but did not independently contribute as a predictor variable. Differences between subsamples showed that patients with separation-anxiety disorder scored higher on negative metacognitive beliefs than those with specific or social phobia. Consideration of metacognition, and negative metacognitive beliefs in particular could help us further improve the understanding and treatment of anxiety disorders in children and adolescents and should therefore receive more attention in psychotherapy research.
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Positive Beliefs about Post-Event Processing in Social Anxiety Disorder. BEHAVIOUR CHANGE 2021. [DOI: 10.1017/bec.2021.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Background: Post-event processing (PEP) is an important maintenance factor of social anxiety disorder (SAD). This study examined psychometric properties of the Positive Beliefs about Post-Event Processing Questionnaire (PB-PEPQ; Fisak & Hammond, 2013), which measures metacognitive beliefs about PEP. Method: Participants receiving treatment for SAD (n = 71) and other anxiety and related disorders (n = 266) completed self-report questionnaires at several timepoints. Results: Confirmatory factor analysis did not support the PB-PEPQ's proposed unidimensional model. Subsequent exploratory factor analysis yielded a three-factor structure consisting of engaging in PEP to (1) review negative events (Negative scale), (2) review positive events (Positive scale), and (3) better understand one's social anxiety (Understand scale). Within the SAD subsample, PB-PEPQ scales demonstrated good internal consistency (α = 0.83–0.85) and test–retest reliability (r = 0.65–0.78). Convergent and criterion validity of the PB-PEPQ Negative scale were supported. PB-PEPQ scale scores were significantly higher within the SAD group, as compared with the other groups (generalised anxiety disorder, panic disorder and agoraphobia, posttraumatic stress disorder, and obsessive-compulsive disorder), supporting the scales’ discriminative validity. Conclusion: Findings support the reliability and validity of the PB-PEPQ in a clinical sample and reveal the measure's multifactorial structure.
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Rozen N, Aderka IM. The effect of depression on treatment outcome in social anxiety disorder: an individual-level meta-analysis. Cogn Behav Ther 2021; 51:185-216. [PMID: 34617874 DOI: 10.1080/16506073.2021.1966089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Social anxiety disorder (SAD) is highly comorbid with depression. In the present meta-analysis, we conducted the first individual-level examination of the association between pre-treatment depression and improvement in social anxiety symptoms during treatment. We identified eligible studies on cognitive behavior therapy (CBT) and pharmacotherapy for SAD and contacted authors to obtain individual-level data. We obtained these data from 41 studies, including 46 treatment conditions (n = 4,381). Our results showed that individuals who had high levels of depression at pre-treatment experienced greater decreases in social anxiety symptoms from pre- to post-treatment, but not at follow-up. When analyzing treatment modalities (individual CBT, group CBT, internet-delivered CBT, and pharmacotherapy), we found that depressive symptoms were associated with better post-treatment outcomes for individual CBT and internet-delivered CBT, but not for pharmacotherapy or group CBT. Our findings suggest that depression does not negatively affect treatment outcome in SAD and may even lead to improved outcomes in some treatment formats. Clinical implications of these findings are discussed.
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Affiliation(s)
- Naama Rozen
- School of Psychological Sciences, University of Haifa, Haifa, Israel
| | - Idan M Aderka
- School of Psychological Sciences, University of Haifa, Haifa, Israel
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9
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Lewis EM, Gilroy SP, Buckner JD, Heimberg RG. The Impact of Brief Mindfulness Training on Postevent Processing Among Individuals With Clinically Elevated Social Anxiety. Behav Ther 2021; 52:785-796. [PMID: 34134820 DOI: 10.1016/j.beth.2020.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 10/02/2020] [Accepted: 10/08/2020] [Indexed: 11/17/2022]
Abstract
Postevent processing (PEP), the engagement in detailed and repetitive self-focused review of one's performance in social situations, is theorized to maintain pathological social anxiety. However, little is known about interventions that may impact this maintenance factor. The current study examined the impact of brief mindfulness training (BMT) on PEP among socially anxious individuals. There were 77 participants (75.32% female, 63.64% non-Hispanic/Latinx White) with clinically elevated social anxiety who attended one appointment in the laboratory during which they were randomized to receive a brief mindfulness-based training (n = 37) or no training (i.e., thinking as usual control group; n = 40). After the training period, participants underwent a 3-minute social anxiety induction task, after which they were instructed to apply their thinking strategy. Participants were then asked to complete 2 weeks of daily online surveys that included a PEP induction task, instructions to use their thinking strategy following PEP induction, and a measure of state PEP. Individuals in the BMT condition reported a significant reduction in state anxiety posttraining compared to individuals in the control condition. Conditions did not differ on state PEP after the social anxiety induction task. However, compared to those in the control condition, participants in the BMT condition reported significantly greater decreases in state PEP over the 14-day follow-up period. Thus, this brief mindfulness-based strategy may be useful for individuals with clinically elevated social anxiety who engage in PEP, a cognitive vulnerability factor implicated in the maintenance of social anxiety.
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10
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Wong QJ. Anticipatory Processing and Post‐Event Processing in Social Anxiety Disorder: An Update on the Literature. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12189] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Quincy Jj Wong
- Centre for Emotional Health, Department of Psychology, Macquarie University,
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11
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Asbrand J, Schmitz J, Krämer M, Nitschke K, Heinrichs N, Tuschen-Caffier B. Effects of Group-Based CBT on Post-Event Processing in Children with Social Anxiety Disorder Following an Experimental Social Stressor. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 47:1945-1956. [PMID: 31073879 DOI: 10.1007/s10802-019-00558-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Theoretical models and previous research suggest that post-event processing (PEP) after social situations maintains social anxiety disorder (SAD). To date, little is known about PEP in childhood, a critical period for disorder development, or about possible positive effects of cognitive behavioral therapy (CBT) on PEP in children. Children with SAD (n = 71; aged 9-13 years) and healthy controls (n = 55) participated in a social stress task (Trier Social Stress Test for Children, TSST-C), which was repeated in children with SAD after either 12 sessions of CBT or a waiting period. PEP was assessed daily with regard to both valence and frequency, as well as in more detail regarding specific negative and positive ruminative thoughts 1 week after each TSST-C. Daily PEP after the TSST-C was more frequent and more negative in children with SAD compared to healthy controls, in particular during the first 2 days after the TSST-C. After CBT treatment, children with SAD reported more positive PEP but not less negative PEP compared to children in the waitlist control group. The current study suggests that negative PEP in children with SAD is most pronounced in the first days following social stress. Group-based CBT seems to be effective in building up positive cognitions after social stress in children, but developing specific interventions targeting negative PEP immediately after a social stressor may be necessary to further increase treatment efficacy.
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Affiliation(s)
- Julia Asbrand
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg im Breisgau, Germany.
| | - Julian Schmitz
- Department for Clinical Child and Adolescent Psychology, Leipzig University, Leipzig, Germany.,Leipzig Research Center for Early Child Development, Leipzig University, Leipzig, Germany
| | - Martina Krämer
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg im Breisgau, Germany
| | - Kai Nitschke
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg im Breisgau, Germany
| | - Nina Heinrichs
- Institute of Psychology, University of Braunschweig, Braunschweig, Germany
| | - Brunna Tuschen-Caffier
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg im Breisgau, Germany
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12
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Im S, Kahler J. Evaluating the empirical evidence for three transdiagnostic mechanisms in anxiety and mood disorders. THE JOURNAL OF GENERAL PSYCHOLOGY 2020; 149:232-257. [PMID: 33030123 DOI: 10.1080/00221309.2020.1828252] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
High co-morbidity among mental disorders indicates that common transdiagnostic mechanisms underlie various psychopathology, yet there has been little research effort to empirically explicate transdiagnostic processes. A few existing studies are limited in the number of transdiagnostic mechanisms and mental disorder categories explored. The current study addresses these limitations by examining the relationship between three transdiagnostic processes (experiential avoidance, rumination, and emotion dysregulation) and symptom severity of five mental disorders (generalized anxiety disorder, panic disorder, social anxiety disorder, specific phobia, and depression) in a college sample (N = 266). Applying Structural Equation Modeling (SEM), three transdiagnostic models were evaluated, with the five latent variables of mental disorder regressed onto each transdiagnostic process. The results showed that all transdiagnostic models-except the emotion dysregulation model-generally fit the data well. Among the tested models, the strongest evidence was found for experiential avoidance as a transdiagnostic mechanism underlying multiple disorders, suggesting the need for further research effort to reduce experiential avoidance in diverse clinical populations.
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13
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Self-Focused Attention as a Predictor of Post-event and Anticipatory Processing: Examination of a Moderation Model. Int J Cogn Ther 2020. [DOI: 10.1007/s41811-020-00072-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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14
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Rozen N, Aderka IM. Do depressive symptoms affect the outcome of treatments for SAD? A meta analysis of randomized controlled trials. Clin Psychol Rev 2020; 80:101874. [PMID: 32653699 DOI: 10.1016/j.cpr.2020.101874] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/17/2020] [Accepted: 05/30/2020] [Indexed: 01/05/2023]
Abstract
Individuals with social anxiety disorder (SAD) typically have elevated depressive symptoms. In the present meta-analysis, we reviewed the treatment outcome literature in SAD and examined whether depressive symptoms predict treatment outcome. We focused on randomized controlled trials of cognitive behavior therapy (individual face-to-face, group format, and internet-delivered format) and randomized controlled trials of pharmacotherapy. After implementing exclusion criteria, 108 studies with 133 treatment conditions (n = 12,913 participants) were included in the meta-analysis. Our findings indicated that treatments for SAD were efficacious and significantly reduced social anxiety symptoms across all treatment modalities. Exclusion of individuals with MDD or high levels of depression did not affect outcome at post-treatment or at follow-up. However, we found that elevated depressive symptoms were associated with greater reductions in social anxiety symptoms from pre-treatment to post-treatment. Importantly, this effect was above and beyond pre-treatment levels of social anxiety. Finally, analyzing treatment modalities separately, we found that depressive symptoms were associated with better post-treatment outcomes in individual face-to-face CBT but not in other modalities. Clinical and research implications of these findings are discussed.
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Affiliation(s)
- Naama Rozen
- School of Psychological Sciences, University of Haifa, Israel
| | - Idan M Aderka
- School of Psychological Sciences, University of Haifa, Israel.
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15
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Processes in cognitive behavior therapy for social anxiety disorder: Predicting subsequent symptom change. J Anxiety Disord 2019; 67:102118. [PMID: 31487573 DOI: 10.1016/j.janxdis.2019.102118] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 06/27/2019] [Accepted: 07/24/2019] [Indexed: 11/22/2022]
Abstract
Although cognitive behavior therapy (CBT) is an effective treatment for social anxiety disorder, little is known about the processes during treatment that bring about change. The aim of this study was to investigate whether the proposed processes of change according to the cognitive model of social anxiety disorder predicted subsequent symptom reduction in CBT delivered as therapist-guided bibliotherapy. We analyzed data from patients with social anxiety disorder (N = 61) who participated in an effectiveness trial of CBT in primary care. Seven putative processes and outcome (i.e., social anxiety) were assessed on a weekly basis throughout treatment. We used linear mixed models to analyze within-person relations between processes and outcome. The results showed a unidirectional effect of reduced avoidance on subsequent decrease in social anxiety. Further, we found support for reciprocal influences between four of the proposed processes (i.e., estimated probability and cost of adverse outcome, self-focused attention, and safety behaviors) and social anxiety. The remaining two processes, (i.e., anticipatory and post-event processing) did not predict subsequent social anxiety, but were predicted by prior symptom reduction. The findings support that several of the change processes according to the cognitive model of social anxiety disorder are involved in symptom improvement.
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16
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Katz DE, Cassin S, Weerasinghe R, Rector NA. Changes in post-event processing during cognitive behavioural therapy for social anxiety disorder: A longitudinal analysis using post-session measurement and experience sampling methodology. J Anxiety Disord 2019; 66:102107. [PMID: 31284123 DOI: 10.1016/j.janxdis.2019.102107] [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: 03/20/2019] [Revised: 05/24/2019] [Accepted: 06/07/2019] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Danielle E Katz
- Frederick W. Thompson Anxiety Disorders Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Stephanie Cassin
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | - Rashmi Weerasinghe
- Frederick W. Thompson Anxiety Disorders Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Neil A Rector
- Frederick W. Thompson Anxiety Disorders Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
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17
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Yeung RC, Fernandes MA. Social anxiety enhances recognition of task-irrelevant threat words. Acta Psychol (Amst) 2019; 194:69-76. [PMID: 30779989 DOI: 10.1016/j.actpsy.2019.01.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 09/22/2018] [Accepted: 01/31/2019] [Indexed: 11/24/2022] Open
Abstract
Past research is mixed regarding the conditions under which memory biases emerge in individuals with high levels of social anxiety. The current study examined whether high social anxiety would be associated with a memory bias for threatening, but task-irrelevant information, or whether it creates a memory bias for both threatening as well as neutral distractors. 60 undergraduate students were recruited, half classified as having high social anxiety and half as having low social anxiety according to the Social Phobia Inventory. Participants memorized a series of sequentially and visually presented target words that were either all neutral (e.g., patient) or all socially threatening (e.g., embarrassed). Simultaneously during encoding, participants also saw a distractor word on each trial that was either neutral or socially threatening. Memory for targets was then assessed using a recall and recognition test. Incidental recall and recognition tests for the distractors were also administered. There were no group differences in memory for threat versus neutral targets. However, recognition of socially threatening distractors was significantly enhanced in those with high relative to low levels of social anxiety, but only when targets were also socially threatening. Memory biases in high social anxiety were shown to be specific for threat-related distractors rather than general, for all distractors. This specific bias for threat emerged only when the to-be-remembered target information was also threatening. Findings suggest that when social anxiety is primed, attention to irrelevant, but socially threatening, information is heightened.
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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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19
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Bright M, Parker S, French P, Morrison AP, Tully S, Stewart SLK, Wells A. Assessment of metacognitive beliefs in an at risk mental state for psychosis: A validation study of the Metacognitions Questionnaire-30. Clin Psychol Psychother 2018; 25:710-720. [PMID: 29882228 PMCID: PMC6221013 DOI: 10.1002/cpp.2301] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 04/17/2018] [Accepted: 05/07/2018] [Indexed: 11/10/2022]
Abstract
AIM The Metacognitions Questionnaire-30 (MCQ-30) has been used to assess metacognitive beliefs in a range of mental health problems. The aim of this study is to assess the validity of the MCQ-30 in people at risk for psychosis. METHODS One hundred eighty-five participants meeting criteria for an at risk mental state completed the MCQ-30 as part of their involvement in a randomized controlled trial. Confirmatory and exploratory factor analyses were conducted to assess factor structure and construct validity. RESULTS Confirmatory factor analyses confirmed the original five-factor structure of the MCQ-30. Examination of principal component analysis and parallel analysis outputs also suggested a five-factor structure. Correlation analyses including measures of depression, social anxiety, and beliefs about paranoia showed evidence of convergent validity. Discriminant validity was supported using the normalizing subscale of the beliefs about paranoia tool. CONCLUSIONS The MCQ-30 demonstrated good fit using the original five-factor model, acceptable to very good internal consistency of items was evident and clinical usefulness in those at risk for psychosis was demonstrated.
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Affiliation(s)
- Measha Bright
- School of Health Sciences, Division of Psychology & Mental Health, The University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Sophie Parker
- School of Health Sciences, Division of Psychology & Mental Health, The University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Paul French
- School of Health Sciences, Division of Psychology & Mental Health, The University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Anthony P Morrison
- School of Health Sciences, Division of Psychology & Mental Health, The University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Sarah Tully
- School of Health Sciences, Division of Psychology & Mental Health, The University of Manchester, Manchester, UK
| | | | - Adrian Wells
- School of Health Sciences, Division of Psychology & Mental Health, The University of Manchester, Manchester, UK
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20
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Wenn J, O'Connor M, Breen LJ, Rees CS. Exploratory study of metacognitive beliefs about coping processes in prolonged grief symptomatology. DEATH STUDIES 2018; 43:143-153. [PMID: 29474138 DOI: 10.1080/07481187.2018.1440032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Despite research examining the role of metacognitive beliefs about coping processes in maintaining psychological disorders, to date, no studies have explored their role in the maintenance of prolonged grief. Twelve semistructured interviews were conducted with bereavement specialists and bereaved people with elevated grief to identify metacognitive beliefs about coping processes relevant to prolonged grief. Analysis revealed several metacognitive beliefs potentially driving maladaptive coping processes used by people with prolonged grief symptomatology. Findings may underpin the development of interventions that aim to modify unhelpful metacognitive beliefs that perpetuate maladaptive coping processes.
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Affiliation(s)
- Jenine Wenn
- a School of Psychology, Faculty of Health Sciences , Curtin University , Perth , Western Australia , Australia
| | - Moira O'Connor
- a School of Psychology, Faculty of Health Sciences , Curtin University , Perth , Western Australia , Australia
| | - Lauren J Breen
- a School of Psychology, Faculty of Health Sciences , Curtin University , Perth , Western Australia , Australia
| | - Clare S Rees
- a School of Psychology, Faculty of Health Sciences , Curtin University , Perth , Western Australia , Australia
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21
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Nordahl H, Nordahl HM, Vogel PA, Wells A. Explaining depression symptoms in patients with social anxiety disorder: Do maladaptive metacognitive beliefs play a role? Clin Psychol Psychother 2018; 25:457-464. [PMID: 29493054 DOI: 10.1002/cpp.2181] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 01/03/2018] [Accepted: 01/16/2018] [Indexed: 01/04/2023]
Abstract
Social anxiety disorder (SAD) is a major risk factor for developing symptoms of depression. Severity of social anxiety has previously been identified as a risk factor, and cognitive models emphasize dysfunctional schemas and self-processing as the key vulnerability factors underlying general distress in SAD. However, in the metacognitive model, depressive and other symptoms are related to metacognitive beliefs. The aim of this study was therefore to test the relative contribution of metacognitions when controlling for SAD severity and factors postulated in cognitive models. In a cross-sectional design, 102 patients diagnosed with primary SAD were included. We found that negative metacognitive beliefs concerning uncontrollability and danger and low confidence in memory emerged as the only factors explaining depressive symptoms in the regression model, suggesting that metacognitive beliefs are associated with increased depressive symptoms in SAD patients.
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Affiliation(s)
- Henrik Nordahl
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway.,St. Olavs Hospital, Nidaros DPS, Trondheim University Hospital, Trondheim, Norway
| | - Hans M Nordahl
- St. Olavs Hospital, Nidaros DPS, Trondheim University Hospital, Trondheim, Norway.,Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Patrick A Vogel
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Adrian Wells
- School of Psychological Sciences, University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Prestwich, UK
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22
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Modelling the Relationship Between Changes in Social Anxiety and Rumination Before and After Treatment. COGNITIVE THERAPY AND RESEARCH 2018. [DOI: 10.1007/s10608-018-9895-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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23
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Wong QJJ, Gregory B, McLellan LF, Kangas M, Abbott MJ, Carpenter L, McEvoy PM, Peters L, Rapee RM. Anticipatory Processing, Maladaptive Attentional Focus, and Postevent Processing for Interactional and Performance Situations: Treatment Response and Relationships With Symptom Change for Individuals With Social Anxiety Disorder. Behav Ther 2017; 48:651-663. [PMID: 28711115 DOI: 10.1016/j.beth.2017.03.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 03/29/2017] [Accepted: 03/29/2017] [Indexed: 10/19/2022]
Abstract
Anticipatory processing, maladaptive attentional focus, and postevent processing are key cognitive constructs implicated in the maintenance of social anxiety disorder (SAD). The current study examined how treatment for SAD concurrently affects these three cognitive maintaining processes and how these processes are associated with each other as well as with symptom change from pre- to posttreatment. The sample consisted of 116 participants with SAD receiving group cognitive behavioral therapy. All three cognitive maintaining processes were measured relative to a speech task and again relative to a conversation task. Across both tasks, the three cognitive process variables demonstrated decreases from pre- to posttreatment. Within the same task, a slower rate of decrease in a specific cognitive process variable from pre- to posttreatment was predicted from higher pretreatment levels of either one or both of the other cognitive process variables. Additionally, higher levels of pretreatment conversation-related anticipatory processing and maladaptive attentional focus predicted a slower rate of decrease in social anxiety symptoms from pre- to posttreatment. Results are consistent with cognitive models of SAD and have important implications for enhancing existing treatments.
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Gkika S, Wittkowski A, Wells A. Social cognition and metacognition in social anxiety: A systematic review. Clin Psychol Psychother 2017; 25:10-30. [PMID: 28836318 DOI: 10.1002/cpp.2127] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 07/17/2017] [Accepted: 07/19/2017] [Indexed: 01/12/2023]
Abstract
Cognitive-behavioural and metacognitive approaches to emotional disorder implicate beliefs in social anxiety, but the types of beliefs differ across these perspectives. Cognitive models suggest that social beliefs about the self (i.e., high standards and conditional and unconditional beliefs) are central. In contrast, the metacognitive model gives centre stage to metacognitive beliefs (i.e., positive and negative beliefs about thinking) as main contributors to the maintenance of the disorder. Despite an expanding research interest in this area, the evidence for such contributions has not yet been reviewed. This study set out to systematically review relevant cross-sectional, longitudinal, and experimental investigations of the direct and indirect (through cognitive processes, such as anticipatory processing, self-focused attention, the post-mortem, and avoidance) relationships of social and metacognitive beliefs with social anxiety. Clinical and nonclinical samples were included, and correlation and regression coefficients as well as results from group comparisons (e.g., t tests and analyses of variance) were extracted. Overall, 23 papers were located, through PsycINFO, PubMed, and Web of Science, and reviewed using narrative synthesis. The results showed a robust positive relationship between social beliefs and social anxiety that appeared to be mediated by cognitive processes. Specific metacognitive beliefs were found to positively contribute to social anxiety both directly and indirectly, through cognitive processes. The study's findings are limited to 2 models of social anxiety and other minor limitations (e.g., grey literature was excluded). With these accounted for, the results are discussed in terms of the conceptualization and treatment of social anxiety and suggestions for future research are made.
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Affiliation(s)
- Styliani Gkika
- The University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Anja Wittkowski
- The University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Adrian Wells
- The University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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25
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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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26
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Burlingame GM, Jensen JL. Small Group Process and Outcome Research Highlights: A 25-Year Perspective. Int J Group Psychother 2017; 67:S194-S218. [PMID: 38449275 DOI: 10.1080/00207284.2016.1218287] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We summarize major research findings from the past 25 years within the larger evolution of group psychotherapy. Small group process findings are highlighted from a group-as-a-whole, interpersonal relation, subgroup, individual member characteristics, and leader perspective. Special emphasis is given to cohesion and the significant correlation between cohesion and outcome. We note that group therapy is an empirically well-supported treatment for a large number of psychiatric disorders and describe evidence supporting the outcome of various theoretical orientations. Key studies showing outcome equivalence for group and individual therapy are reviewed, followed by a high-level summary of group therapy's efficacy research for depression, bipolar, social phobia, panic disorder, obsessive compulsive, bulimia nervosa, binge-eating, substance-related, trauma-related, HIV/AIDS, breast cancer, chronic pain, schizophrenia, and borderline personality. We conclude with the promise of recent advances for moving the field forward over the next 25 years.
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Spence SH, Donovan CL, March S, Kenardy JA, Hearn CS. Generic versus disorder specific cognitive behavior therapy for social anxiety disorder in youth: A randomized controlled trial using internet delivery. Behav Res Ther 2016; 90:41-57. [PMID: 27988427 DOI: 10.1016/j.brat.2016.12.003] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 10/14/2016] [Accepted: 12/05/2016] [Indexed: 12/01/2022]
Abstract
The study examined whether the efficacy of cognitive behavioral treatment for Social Anxiety Disorder for children and adolescents is increased if intervention addresses specific cognitive and behavioral factors linked to the development and maintenance of SAD in young people, over and above the traditional generic CBT approach. Participants were 125 youth, aged 8-17 years, with a primary diagnosis of SAD, who were randomly assigned to generic CBT (CBT-GEN), social anxiety specific CBT (CBT-SAD) or a wait list control (WLC). Intervention was delivered using a therapist-supported online program. After 12-weeks, participants who received treatment (CBT-SAD or CBT-GEN) showed significantly greater reduction in social anxiety and post-event processing, and greater improvement in global functioning than the WLC but there was no significant difference between CBT-SAD and CBT-GEN on any outcome variable at 12-weeks or 6-month follow-up. Despite significant reductions in anxiety, the majority in both treatment conditions continued to meet diagnostic criteria for SAD at 6-month follow-up. Decreases in social anxiety were associated with decreases in post-event processing. Future research should continue to investigate disorder-specific interventions for SAD in young people, drawing on evidence regarding causal or maintaining factors, in order to enhance treatment outcomes for this debilitating condition.
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Affiliation(s)
- Susan H Spence
- Australian Institute of Suicide Research and Prevention (AISRAP) and School of Applied Psychology, 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, QLD, 4122, Australia
| | - Sonja March
- School of Psychology and Counselling & Institute for Resilient Regions, University of Southern Queensland, Springfield, QLD, Australia, 4300
| | - Justin A Kenardy
- School of Psychology, The University of Queensland, Brisbane, QLD, Australia
| | - Cate S Hearn
- School of Applied Psychology and the Menzies Health Institute Queensland, Griffith University, Mount Gravatt Campus, QLD, 4122, Australia
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28
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A Comprehensive Review of the Cognitive Determinants of Anxiety and Rumination in Social Anxiety Disorder. BEHAVIOUR CHANGE 2016. [DOI: 10.1017/bec.2016.10] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Social anxiety disorder (SAD) is characterised by an intense fear of social situations in which the individual believes they may be negatively evaluated (American Psychiatric Association, 2013). A number of cognitive models (Clark & Wells, 1995; Hofmann, 2007; Rapee & Heimberg, 1997) have been proposed that provide frameworks for understanding the key cognitive processes involved in SAD. Negative rumination, which can be divided into pre- and post-event rumination, appears to be a key maintaining factor in the cycle of social anxiety. However, there are mixed findings regarding the cognitive predictors of post-event rumination and a lack of research regarding the consequences and predictors of pre-event rumination. Furthermore, there has been little empirical research investigating the effects of targeting negative rumination and state anxiety in social anxiety treatment. If the cognitive predictors of negative rumination can be determined then they can be targeted when designing interventions that aim to break the vicious cycle of social anxiety. The state of research investigating the cognitive determinants of state anxiety and negative rumination is reviewed and suggestions are made for continuing research.
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Lakshmi J, Sudhir PM, Sharma MP, Math SB. Effectiveness of Metacognitive Therapy in Patients with Social Anxiety Disorder: A Pilot Investigation. Indian J Psychol Med 2016; 38:466-471. [PMID: 27833233 PMCID: PMC5052963 DOI: 10.4103/0253-7176.191385] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Metacognitive therapy (MCT) is a recent psychological intervention for emotional disorders. Its efficacy in social anxiety disorder (SAD) is yet to be established. AIMS We examined the effectiveness of an MCT in patients with SAD. A two group case-control design with baseline, post, and 3 months follow-up was adopted. The control group received training in applied relaxation (AR). Four patients with Diagnostic and Statistical Manual-IV diagnosis of social anxiety were sequentially allotted to receive either MCT or AR. Patients were assessed on postevent processing (PEP), social anxiety, depression, and fear on negative evaluation. Clinical significance was calculated. MCT was more effective than AR in reducing social avoidance, PEP, and self-consciousness. While overall both interventions were effective in reducing social anxiety, MCT was marginally more effective. MCT may be a promising therapeutic approach in the management of SAD.
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Affiliation(s)
- Jayasree Lakshmi
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Paulomi Matam Sudhir
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Mahendra Prakash Sharma
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
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30
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Johnson SB, Anderson PL. Don't ask, don't tell: a systematic review of the extent to which participant characteristics are reported in social anxiety treatment studies. ANXIETY STRESS AND COPING 2016; 29:589-605. [DOI: 10.1080/10615806.2016.1138289] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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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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33
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Wenn J, O'Connor M, Breen LJ, Kane RT, Rees CS. Efficacy of metacognitive therapy for prolonged grief disorder: protocol for a randomised controlled trial. BMJ Open 2015; 5:e007221. [PMID: 26646828 PMCID: PMC4680007 DOI: 10.1136/bmjopen-2014-007221] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Studies of effective psychotherapy for individuals suffering from the effects of prolonged grief disorder (PGD) are scarce. This paper describes the protocol for an evaluation of a metacognitive therapy programme designed specifically for PGD, to reduce the psychological distress and loss of functioning resulting from bereavement. METHODS AND ANALYSIS The proposed trial comprises three phases. Phase 1 consists of a review of the literature and semistructured interviews with key members of the target population to inform the development of a metacognitive therapy programme for Prolonged Grief. Phase 2 involves a randomised controlled trial to implement and evaluate the programme. Male and female adults (N=34) will be randomly assigned to either a wait list or an intervention group. Measures of PGD, anxiety, depression, rumination, metacognitions and quality of life will be taken pretreatment and posttreatment and at the 3-month and 6-month follow-up. The generalised linear mixed model will be used to assess treatment efficacy. Phase 3 will test the social validity of the programme. DISCUSSION This study is the first empirical investigation of the efficacy of a targeted metacognitive treatment programme for PGD. A focus on identifying and changing the metacognitive mechanisms underpinning the development and maintenance of prolonged grief is likely to be beneficial to theory and practice. ETHICS Ethics approval was obtained from Curtin University Human Research Ethics Committee (Approval number HR 41/2013.) TRIAL REGISTRATION NUMBER ACTRN12613001270707.
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Affiliation(s)
- Jenine Wenn
- School of Psychology and Speech Pathology, Curtin University, Perth, Western Australia, Australia
| | - Moira O'Connor
- School of Psychology and Speech Pathology, Curtin University, Perth, Western Australia, Australia
| | - Lauren J Breen
- School of Psychology and Speech Pathology, Curtin University, Perth, Western Australia, Australia
| | - Robert T Kane
- School of Psychology and Speech Pathology, Curtin University, Perth, Western Australia, Australia
| | - Clare S Rees
- School of Psychology and Speech Pathology, Curtin University, Perth, Western Australia, Australia
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34
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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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35
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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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36
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McEvoy PM, Erceg-Hurn DM, Anderson RA, Campbell BNC, Swan A, Saulsman LM, Summers M, Nathan PR. Group metacognitive therapy for repetitive negative thinking in primary and non-primary generalized anxiety disorder: an effectiveness trial. J Affect Disord 2015; 175:124-32. [PMID: 25601312 DOI: 10.1016/j.jad.2014.12.046] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 12/18/2014] [Accepted: 12/19/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Generalized anxiety disorder (GAD) is a common and highly comorbid anxiety disorder characterized by repetitive negative thinking (RNT). Treatment trials tend to exclude individuals with non-primary GAD, despite this being a common presentation in real world clinics. RNT is also associated with multiple emotional disorders, suggesting that it should be targeted regardless of the primary disorder. This study evaluated the acceptability and effectiveness of brief group metacognitive therapy (MCT) for primary or non-primary GAD within a community clinic. METHODS Patients referred to a specialist community clinic attended six, two-hour weekly sessions plus a one-month follow-up (N=52). Measures of metacognitive beliefs, RNT, symptoms, positive and negative affect, and quality of life were completed at the first, last, and follow-up sessions. RESULTS Attrition was low and large intent-to-treat effects were observed on most outcomes, particularly for negative metacognitive beliefs and RNT. Treatment gains increased further to follow-up. Benchmarking comparisons demonstrated that outcomes compared favorably to longer disorder-specific protocols for primary GAD. LIMITATIONS No control group or independent assessment of protocol adherence. CONCLUSIONS Brief metacognitive therapy is an acceptable and powerful treatment for patients with primary or non-primary GAD.
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Affiliation(s)
- Peter M McEvoy
- Centre for Clinical Interventions, Perth, Australia; School of Psychology and Speech Pathology, Curtin University, GPO Box U1987, Perth, Western Australia 6845, Australia.
| | - David M Erceg-Hurn
- Centre for Clinical Interventions, Perth, Australia; University of Western Australia, Perth, Australia
| | - Rebecca A Anderson
- Centre for Clinical Interventions, Perth, Australia; School of Psychology and Speech Pathology, Curtin University, GPO Box U1987, Perth, Western Australia 6845, Australia
| | | | - Amanda Swan
- Centre for Clinical Interventions, Perth, Australia
| | | | - Mark Summers
- Centre for Clinical Interventions, Perth, Australia
| | - Paula R Nathan
- Centre for Clinical Interventions, Perth, Australia; University of Western Australia, Perth, Australia
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Hedman E, Mörtberg E, Hesser H, Clark DM, Lekander M, Andersson E, Ljótsson B. Mediators in psychological treatment of social anxiety disorder: individual cognitive therapy compared to cognitive behavioral group therapy. Behav Res Ther 2013; 51:696-705. [PMID: 23954724 DOI: 10.1016/j.brat.2013.07.006] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 05/28/2013] [Accepted: 07/08/2013] [Indexed: 11/28/2022]
Abstract
According to cognitive-behavioral models of social anxiety disorder (SAD), four of the important maintaining mechanisms are avoidance, self-focused attention, anticipatory processing and post-event cognitive processing. Individual cognitive therapy (ICT) and cognitive behavioral group therapy (CBGT) both have substantial empirical support. However, it is unclear whether they achieve their effects by similar or different mechanisms. The aim of this study was to investigate whether changes in the four maintenance processes mediate clinical improvement in ICT and CBGT for SAD. We analyzed data from participants (N = 94) who received either ICT or CBGT in two separate RCTs. The results showed that ICT had larger effects than CBGT on social anxiety and each of the four potential mediators. More pertinently, moderated mediation analyses revealed significant between-treatment differences. Whereas improvement in ICT was mainly mediated by reductions in avoidance and self-focused attention, improvement in CBGT was mediated by changes in self-focused attention and in anticipatory and post-event processing. These results support the importance of the putative mediators, but suggest that their relative weights are moderated by treatment type.
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Affiliation(s)
- Erik Hedman
- Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden.
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Abstract
Although positive metacognitive beliefs have been found to be associated with symptoms of depression and generalised anxiety disorder, surprisingly few studies have focused on the degree to which positive metacognitive beliefs are associated to social phobia symptoms. In response to this limitation, the primary goal of the current study was the development and validation of the Positive Beliefs about Post-Event Processing Questionnaire (PB-PEPQ). It was anticipated that the PB-PEPQ would exhibit adequate psychometric properties. Based on a non-referred sample of 300 undergraduate students, the PB-PEPQ was found to be positively associated with measures of post-event processing and social anxiety symptoms. Further, support was found for the incremental validity of the PB-PEPQ, as the measure predicted variance in social phobia symptoms after controlling for other metacognitive variables, including positive beliefs about worry and positive beliefs about rumination. Overall, the findings may have implications for cognitive models of social phobia. Further, the current findings have possible treatment implications, as individuals with social phobia may benefit from interventions focused on the identification and modification of positive metacognitive beliefs.
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Mechanisms driving pre- and post-stressor repetitive negative thinking: metacognitions, cognitive avoidance, and thought control. J Behav Ther Exp Psychiatry 2013; 44:84-93. [PMID: 22935546 DOI: 10.1016/j.jbtep.2012.07.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Revised: 07/27/2012] [Accepted: 07/31/2012] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Repetitive negative thinking (RNT) is common to multiple emotional disorders and occurs before, during, and following a stressor. One replicated difference between common forms of RNT such as worry and rumination is temporal orientation towards a stressor, with worry being more future-oriented and rumination more past-oriented. Different mechanisms may drive RNT at these different time points. The aim of Study 1 was to examine whether previously demonstrated relationships between post-stressor RNT and mechanisms theorized to drive engagement in RNT, including metacognitive beliefs, cognitive avoidance strategies, and thought control strategies, would be replicated with anticipatory (pre-stressor) RNT. The aim of Study 2 was to replicate these associations in a new sample that completed measures of both pre- and post-stressor RNT. METHOD Participants in Study 1 (N = 175) completed the RNT-L in anticipation of a stressor, along with measures of metacognitive beliefs, cognitive avoidance strategies, and thought control strategies. Participants in Study 2 (N = 91) completed the measures both before and after a stressor. RESULTS Pre- and post-stressor RNT were significantly correlated with all three mechanism measures. Metacognitive beliefs that RNT is uncontrollable and dangerous, and the thought control strategy of punishment, were most consistently and uniquely associated with RNT at both time-points. LIMITATIONS Replication with clinical samples and with reference to a broader array of stressors is required. The correlational design precluded causal conclusions. CONCLUSIONS Common and possibly some distinct mechanisms drive RNT before and after a stressor.
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Intolerance of uncertainty and negative metacognitive beliefs as transdiagnostic mediators of repetitive negative thinking in a clinical sample with anxiety disorders. J Anxiety Disord 2013; 27:216-24. [PMID: 23474912 DOI: 10.1016/j.janxdis.2013.01.006] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 01/21/2013] [Accepted: 01/22/2013] [Indexed: 11/20/2022]
Abstract
This study aimed to replicate and extend a hierarchical model of vulnerability to worry, with neuroticism and extraversion as higher-order factors and negative metacognitions and intolerance of uncertainty as second-order factors. The model also included a transdiagnostic measure of repetitive negative thinking (RNT) and depression symptoms as outcome variables to determine whether relationships would extend beyond worry, which has traditionally been studied within the context of generalized anxiety disorder (GAD). Participants (N=99) were referrals to a specialist anxiety disorders clinic with a principal anxiety disorder who completed a battery of self-report questionnaires assessing neuroticism, extraversion, metacognitions, intolerance of uncertainty, worry, RNT, and depression symptoms. Mediational analyses using bootstrapping provided support for transdiagnostic and diagnosis-specific mediation effects. Negative metacognitions fully mediated the relationship between neuroticism and RNT for the whole sample and for subsamples with and without GAD. Intolerance of uncertainty mediated the relationship between neuroticism and worry (for the whole sample and for those with GAD) and between neuroticism and RNT (for those with GAD). Implications for theory, treatment, and nosology are discussed.
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Wong QJJ, Moulds ML. Processing mode during repetitive thinking in socially anxious individuals: evidence for a maladaptive experiential mode. J Behav Ther Exp Psychiatry 2012; 43:1064-73. [PMID: 22695223 DOI: 10.1016/j.jbtep.2012.05.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Revised: 05/08/2012] [Accepted: 05/11/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Evidence from the depression literature suggests that an analytical processing mode adopted during repetitive thinking leads to maladaptive outcomes relative to an experiential processing mode. To date, in socially anxious individuals, the impact of processing mode during repetitive thinking related to an actual social-evaluative situation has not been investigated. We thus tested whether an analytical processing mode would be maladaptive relative to an experiential processing mode during anticipatory processing and post-event rumination. METHODS High and low socially anxious participants were induced to engage in either an analytical or experiential processing mode during: (a) anticipatory processing before performing a speech (Experiment 1; N = 94), or (b) post-event rumination after performing a speech (Experiment 2; N = 74). Mood, cognition, and behavioural measures were employed to examine the effects of processing mode. RESULTS For high socially anxious participants, the modes had a similar effect on self-reported anxiety during both anticipatory processing and post-event rumination. Unexpectedly, relative to the analytical mode, the experiential mode led to stronger high standard and conditional beliefs during anticipatory processing, and stronger unconditional beliefs during post-event rumination. LIMITATIONS These experiments are the first to investigate processing mode during anticipatory processing and post-event rumination. Hence, these results are novel and will need to be replicated. CONCLUSIONS These findings suggest that an experiential processing mode is maladaptive relative to an analytical processing mode during repetitive thinking characteristic of socially anxious individuals.
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Affiliation(s)
- Quincy J J Wong
- The University of New South Wales, School of Psychology, Mathews Building, Sydney, NSW 2052, Australia
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Predicting post-event processing in social anxiety disorder following two prototypical social situations: State variables and dispositional determinants. Behav Res Ther 2012; 50:617-26. [DOI: 10.1016/j.brat.2012.06.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Revised: 04/03/2012] [Accepted: 06/12/2012] [Indexed: 02/05/2023]
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Mahoney AEJ, McEvoy PM. Changes in intolerance of uncertainty during cognitive behavior group therapy for social phobia. J Behav Ther Exp Psychiatry 2012; 43:849-54. [PMID: 22204898 DOI: 10.1016/j.jbtep.2011.12.004] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Revised: 12/07/2011] [Accepted: 12/07/2011] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Recent research suggests that intolerance of uncertainty (IU), most commonly associated with generalized anxiety disorder, also contributes to symptoms of social phobia. This study examines the relationship between IU and social anxiety symptoms across treatment. METHOD Changes in IU, social anxiety symptoms, and depression symptoms were examined following cognitive behavior group therapy (CBGT) for social phobia (N=32). RESULTS CBGT led to significant improvements in symptoms of social anxiety and depression, as well as reductions in IU. Reductions in IU were associated with reductions in social anxiety but were unrelated to improvements in depression symptoms. Reductions in IU were predictive of post-treatment social phobia symptoms after controlling for pre-treatment social phobia symptoms and changes in depression symptoms following treatment. LIMITATIONS The relationship between IU and social anxiety requires further examination within experimental and longitudinal designs, and needs to take into account additional constructs that are thought to maintain social phobia. CONCLUSIONS Current findings suggest that the enhancing tolerance of uncertainty may play a role in the optimal management of social phobia. Theoretical and clinical implications are discussed.
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Affiliation(s)
- Alison E J Mahoney
- Clinical Research Unit for Anxiety and Depression, University of New South Wales at St Vincent's Hospital, Level 4 O'Brien Centre, 394-404 Victoria Street, Darlinghurst, Sydney, New South Wales 2010, Australia.
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Wong QJ, Moulds ML. Do Socially Anxious Individuals Hold Positive Metacognitive Beliefs About Rumination? BEHAVIOUR CHANGE 2012. [DOI: 10.1375/bech.27.2.69] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractThe Self-Regulatory Executive Function (S-REF) model of affective dysfunction (Wells & Matthews, 1994) suggests that metacognitive beliefs are important for initiating and maintaining repetitive thought processes in emotional disorders. Rumination is reported by socially anxious individuals, yet it is not known whether this group endorse positive beliefs about the utility of rumination. We predicted that higher levels of social anxiety would be positively associated with stronger positive metacognitive beliefs about rumination. In Study 1 (N= 250 undergraduates), a measure of social anxiety was positively correlated with a measure of positive metacognitive beliefs about rumination, even when controlling for gender and level of depression. Given this result, we then attempted to replicate the finding in another sample, as well as test whether positive metacognitive beliefs about rumination would mediate the relationship between social anxiety and trait rumination. In Study 2 (N= 124 undergraduates), a social anxiety composite measure was positively correlated with a measure of positive metacognitive beliefs about rumination, even when controlling for gender, level of depression and level of rumination. Positive metacognitive beliefs about rumination were also shown to partially mediate the relationship between social anxiety and trait rumination. These results support the S-REF model and provide a potential account of why socially anxious individuals engage in rumination. Implications for the treatment of social anxiety are discussed.
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Gaydukevych D, Kocovski NL. Effect of self-focused attention on post-event processing in social anxiety. Behav Res Ther 2012; 50:47-55. [DOI: 10.1016/j.brat.2011.10.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 10/12/2011] [Accepted: 10/25/2011] [Indexed: 02/05/2023]
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Impact of anticipatory processing versus distraction on multiple indices of anxiety in socially anxious individuals. Behav Res Ther 2011; 49:700-6. [DOI: 10.1016/j.brat.2011.07.007] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Revised: 07/08/2011] [Accepted: 07/13/2011] [Indexed: 11/21/2022]
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Price M, Anderson PL. The impact of cognitive behavioral therapy on post event processing among those with social anxiety disorder. Behav Res Ther 2010; 49:132-7. [PMID: 21159328 DOI: 10.1016/j.brat.2010.11.006] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2010] [Revised: 11/09/2010] [Accepted: 11/19/2010] [Indexed: 11/15/2022]
Abstract
Individuals with social anxiety are prone to engage in post event processing (PEP), a post mortem review of a social interaction that focuses on negative elements. The extent that PEP is impacted by cognitive behavioral therapy (CBT) and the relation between PEP and change during treatment has yet to be evaluated in a controlled study. The current study used multilevel modeling to determine if PEP decreased as a result of treatment and if PEP limits treatment response for two types of cognitive behavioral treatments, a group-based cognitive behavioral intervention and individually based virtual reality exposure. These hypotheses were evaluated using 91 participants diagnosed with social anxiety disorder. The findings suggested that PEP decreased as a result of treatment, and that social anxiety symptoms for individuals reporting greater levels of PEP improved at a slower rate than those with lower levels of PEP. Further research is needed to understand why PEP attenuates response to treatment.
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Affiliation(s)
- Matthew Price
- Anxiety Research & Treatment Laboratory, Georgia State University Psychology Department, 140 East Decatur Street, Atlanta, GA 30302, USA
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Improving prevention of depression and anxiety disorders: Repetitive negative thinking as a promising target. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.appsy.2012.03.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Does Rumination Predict the Strength of Maladaptive Self-Beliefs Characteristic of Social Anxiety Over Time? COGNITIVE THERAPY AND RESEARCH 2010. [DOI: 10.1007/s10608-010-9316-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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