Post-event processing and memory bias for performance feedback in social anxiety

Toward a mechanistic understanding of the role of error monitoring and memory in social anxiety

Cognitive models state that social anxiety (SA) involves biased cognitive processing that impacts what is learned and remembered within social situations, leading to the maintenance of SA. Neuroscience work links SA to enhanced error monitoring, reflected in error-related neural responses arising from mediofrontal cortex (MFC). Yet, the role of error monitoring in SA remains unclear, as it is unknown whether error monitoring can drive changes in memory, biasing what is learned or remembered about social situations. Motivated by the longer-term goal of identifying mechanisms implicated in SA, in the current study we developed and validated a novel paradigm for probing the role of error-related MFC theta oscillations (associated with error monitoring) and incidental memory biases in SA. Electroencephalography (EEG) data were collected while participants completed a novel Face-Flanker task, involving presentation of task-unrelated, trial-unique faces behind target/flanker arrows on each trial. A subsequent incidental memory assessment evaluated memory biases for error events. Severity of SA symptoms were associated with greater error-related theta synchrony over MFC, as well as between MFC and sensory cortex. Social anxiety also was positively associated with incidental memory biases for error events. Moreover, greater error-related MFC-sensory theta synchrony during the Face-Flanker predicted subsequent incidental memory biases for error events. Collectively, the results demonstrate the potential of a novel paradigm to elucidate mechanisms underlying relations between error monitoring and SA.

Post-event rumination and social anxiety: a systematic review and meta-analysis

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.

Social feedback biases emerge during recall but not prediction and shift across the development of social anxiety

Memory is a reconstructive process that can result in events being recalled as more positive or negative than they actually were. While positive recall biases may contribute to well-being, negative recall biases may promote internalizing symptoms, such as social anxiety. Adolescence is characterized by increased salience of peers and peak incidence of social anxiety. Symptoms often wax and wane before becoming more intractable during adulthood. Open questions remain regarding how and when biases for social feedback are expressed and how individual differences in biases may contribute to social anxiety across development. Two studies used a social feedback and cued response task to assess biases about being liked or disliked when retrieving memories vs. making predictions. Findings revealed a robust positivity bias about memories for social feedback, regardless of whether memories were true or false. Moreover, memory bias was associated with social anxiety in a developmentally sensitive way. Among adults (study 1), more severe symptoms of social anxiety were associated with a negativity bias. During the transition from adolescence to adulthood (study 2), age strengthened the positivity bias in those with less severe symptoms and strengthened the negativity bias in those with more severe symptoms. These patterns of bias were isolated to perceived memory retrieval and did not generalize to predictions about social feedback. These results provide initial support for a model by which schemas may infiltrate perceptions of memory for past, but not predictions of future, social events, shaping susceptibility for social anxiety, particularly during the transition into adulthood.

Induced interpretation bias affects free recall and episodic memory bias in social anxiety

The combined effect of each cognitive bias, interpretation, attention, and memory bias, is known to play a causal role in the etiology and maintenance of social anxiety. However, little is known about how each type of bias (i.e., interpretation, memory bias) acts during social anxiety. The present study aimed to investigate whether experimentally induced interpretation bias using the cognitive bias modification (CBM) paradigm would influence free recall and episodic memory biases in a Korean sample. A total of 61 participants were randomly assigned to either a positive (n = 30) or negative (n = 31) CBM group. The study used CBM scenarios that were auditory-specific and focused on social anxiety symptoms. The results showed that interpretation biases could be induced, and they resulted in training congruent state mood and memory biases on both free-recall memory and autobiographical memory, which partly confirmed the combined cognitive biases hypothesis proposed by Hirsch, Clark (1).

Neurocognitive Model of Schema-Congruent and -Incongruent Learning in Clinical Disorders: Application to Social Anxiety and Beyond

Negative schemas lie at the core of many common and debilitating mental disorders. Thus, intervention scientists and clinicians have long recognized the importance of designing effective interventions that target schema change. Here, we suggest that the optimal development and administration of such interventions can benefit from a framework outlining how schema change occurs in the brain. Guided by basic neuroscientific findings, we provide a memory-based neurocognitive framework for conceptualizing how schemas emerge and change over time and how they can be modified during psychological treatment of clinical disorders. We highlight the critical roles of the hippocampus, ventromedial prefrontal cortex, amygdala, and posterior neocortex in directing schema-congruent and -incongruent learning (SCIL) in the interactive neural network that comprises the autobiographical memory system. We then use this framework, which we call the SCIL model, to derive new insights about the optimal design features of clinical interventions that aim to strengthen or weaken schema-based knowledge through the core processes of episodic mental simulation and prediction error. Finally, we examine clinical applications of the SCIL model to schema-change interventions in psychotherapy and provide cognitive-behavior therapy for social anxiety disorder as an illustrative example.

Towards a mechanistic understanding of the role of error monitoring and memory in social anxiety

Cognitive models state social anxiety (SA) involves biased cognitive processing that impacts what is learned and remembered within social situations, leading to the maintenance of SA. Neuroscience work links SA to enhanced error monitoring, reflected in error-related neural responses arising from mediofrontal cortex (MFC). Yet, the role of error monitoring in SA remains unclear, as it is unknown whether error monitoring can drive changes in memory, biasing what is learned or remembered about social situations. Thus, we developed a novel paradigm to investigate the role of error-related MFC theta oscillations (associated with error monitoring) and memory biases in SA. EEG was collected while participants completed a novel Face-Flanker task, involving presentation of task-unrelated, trial-unique faces behind target/flanker arrows on each trial. A subsequent incidental memory assessment evaluated memory biases for error events. Severity of SA symptoms were associated with greater error-related theta synchrony over MFC, as well as between MFC and sensory cortex. SA was positively associated with memory biases for error events. Consistent with a mechanistic role in biased cognitive processing, greater error-related MFC-sensory theta synchrony during the Face-Flanker predicted subsequent memory biases for error events. Our findings suggest high SA individuals exhibit memory biases for error events, and that this behavioral phenomenon may be driven by error-related MFC-sensory theta synchrony associated with error monitoring. Moreover, results demonstrate the potential of a novel paradigm to elucidate mechanisms underlying relations between error monitoring and SA.

Changes in Learning From Social Feedback After Web-Based Interpretation Bias Modification: Secondary Analysis of a Digital Mental Health Intervention Among Individuals With High Social Anxiety Symptoms

BACKGROUND

Biases in social reinforcement learning, or the process of learning to predict and optimize behavior based on rewards and punishments in the social environment, may underlie and maintain some negative cognitive biases that are characteristic of social anxiety. However, little is known about how cognitive and behavioral interventions may change social reinforcement learning in individuals who are anxious.

OBJECTIVE

This study assessed whether a scalable, web-based cognitive bias modification for interpretations (CBM-I) intervention changed social reinforcement learning biases in participants with high social anxiety symptoms. This study focused on 2 types of social reinforcement learning relevant to social anxiety: learning about other people and learning about one's own social performance.

METHODS

Participants (N=106) completed 2 laboratory sessions, separated by 5 weeks of ecological momentary assessment tracking emotion regulation strategy use and affect. Approximately half (n=51, 48.1%) of the participants completed up to 6 brief daily sessions of CBM-I in week 3. Participants completed a task that assessed social reinforcement learning about other people in both laboratory sessions and a task that assessed social reinforcement learning about one's own social performance in the second session. Behavioral data from these tasks were computationally modeled using Q-learning and analyzed using mixed effects models.

RESULTS

After the CBM-I intervention, participants updated their beliefs about others more slowly (P=.04; Cohen d=-0.29) but used what they learned to make more accurate decisions (P=.005; Cohen d=0.20), choosing rewarding faces more frequently. These effects were not observed among participants who did not complete the CBM-I intervention. Participants who completed the CBM-I intervention also showed less-biased updating about their social performance than participants who did not complete the CBM-I intervention, learning similarly from positive and negative feedback and from feedback on items related to poor versus good social performance. Regardless of the intervention condition, participants at session 2 versus session 1 updated their expectancies about others more from rewarding (P=.003; Cohen d=0.43) and less from punishing outcomes (P=.001; Cohen d=-0.47), and they became more accurate at learning to avoid punishing faces (P=.001; Cohen d=0.20).

CONCLUSIONS

Taken together, our results provide initial evidence that there may be some beneficial effects of both the CBM-I intervention and self-tracking of emotion regulation on social reinforcement learning in individuals who are socially anxious, although replication will be important.

Just do something: An experimental investigation of brief interventions for reducing the negative impact of post-event processing in social anxiety disorder

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.

A corticostriatal pathway mediating self-efficacy enhancement

Forming positive beliefs about one's ability to perform challenging tasks, often termed self-efficacy, is fundamental to motivation and emotional well-being. Self-efficacy crucially depends on positive social feedback, yet people differ in the degree to which they integrate such feedback into self-beliefs (i.e., positive bias). While diminished positive bias of this sort is linked to mood and anxiety, the neural processes by which positive feedback on public performance enhances self-efficacy remain unclear. To address this, we conducted a behavioral and fMRI study wherein participants delivered a public speech and received fictitious positive and neutral feedback on their performance in the MRI scanner. Before and after receiving feedback, participants evaluated their actual and expected performance. We found that reduced positive bias in updating self-efficacy based on positive social feedback associated with a psychopathological dimension reflecting symptoms of anxiety, depression, and low self-esteem. Analysis of brain encoding of social feedback showed that a positive self-efficacy update bias associated with a stronger reward-related response in the ventral striatum (VS) and stronger coupling of the VS with a temporoparietal region involved in self-processing. Together, our findings demarcate a corticostriatal circuit that promotes positive bias in self-efficacy updating based on social feedback, and highlight the centrality of such bias to emotional well-being.

Neural effects of a short-term virtual reality self-training program to reduce social anxiety

BACKGROUND

Social anxiety disorder (SAD) is characterized by anxiety regarding social situations, avoidance of external social stimuli, and negative self-beliefs. Virtual reality self-training (VRS) at home may be a good interim modality for reducing social fears before formal treatment. This study aimed to find neurobiological evidence for the therapeutic effect of VRS.

METHODS

Fifty-two patients with SAD were randomly assigned to a VRS or waiting list (WL) group. The VRS group received an eight-session VRS program for 2 weeks, whereas the WL group received no intervention. Clinical assessments and functional magnetic resonance imaging scanning with the distress and speech evaluation tasks were repeatedly performed at baseline and after 3 weeks.

RESULTS

The post-VRS assessment showed significantly decreased anxiety and avoidance scores, distress index, and negative evaluation index for 'self', but no change in the negative evaluation index for 'other'. Patients showed significant responses to the distress task in various regions, including both sides of the prefrontal regions, occipital regions, insula, and thalamus, and to the speech evaluation task in the bilateral anterior cingulate cortex. Among these, significant neuronal changes after VRS were observed only in the right lingual gyrus and left thalamus.

CONCLUSIONS

VRS-induced improvements in the ability to pay attention to social stimuli without avoidance and even positively modulate emotional cues are based on functional changes in the visual cortices and thalamus. Based on these short-term neuronal changes, VRS can be a first intervention option for individuals with SAD who avoid society or are reluctant to receive formal treatment.

The effect of distraction versus post-event processing on cortisol recovery in individuals with elevated social anxiety

There are preliminary findings that repetitive thinking on social situations (post-event processing; PEP) is associated with impaired cortisol recovery after experiencing social evaluative stressors. However, no studies have examined the effect of experimental manipulation of PEP on cortisol recovery among socially anxious individuals. The aim of the present study was to examine the effect of distraction on cortisol recovery following a social-evaluative stressor in individuals with subclinical social anxiety symptoms. A total of 40 participants, who scored >30 on the Liebowitz Social Anxiety Scale, completed a standardized stress test (the Trier Social Stress Test; TSST). They were then randomized to complete either a 10-min distraction or PEP induction task. Subjective anxiety and salivary cortisol levels were assessed at −20, −10, 0, +10, +20, +30, +40, and +50 min, with respect to the TSST offset. Contrary to the hypothesis, no difference in cortisol recovery was observed between distraction induction and PEP induction. These findings suggest that short-term distraction induction may not be sufficient to promote cortisol recovery in individuals with elevated social anxiety.

•

Effect of distraction on cortisol recovery was tested in individuals with elevated social anxiety.

•

No effect of distraction on cortisol recovery in comparison to post-event processing induction.

•

Short-term distraction induction may not be sufficient for individuals with social anxiety to promote cortisol recovery.

The Effect of Anonymous Computer-Mediated Communication on State Anxiety: An Experimental Study

This study examined the effect of anonymous computer-mediated communication (CMC) on state anxiety, specifically focusing on whether the valence of the interaction affected state anxiety before completing an anxiety-inducing task. Sixty-two female participants aged 18-25 were randomly assigned to one of three conditions: positive CMC, negative CMC, and blog. Self-report measures of state anxiety were taken at baseline; after participants had been given instructions about the anxiety-inducing task; after 10 minutes of CMC/blog writing; and after the anxiety-inducing task had been completed. Results showed that participants in the positive CMC condition showed a significant and moderate decrease in anxiety following the CMC, whereas those in the negative CMC condition showed a nonsignificant but moderate increase in anxiety following the CMC. Anxiety remained relatively unaffected by the blog condition. After completing the anxiety-inducing task, there were no differences in anxiety scores between groups. The findings show that CMC can be beneficial for relieving state anxiety, but the valence of the communication is crucial. This has implications for advice and training given to those participating in and supporting CMC where mental health issues might be discussed.

Retrieval-induced forgetting in a social task

Clinical researchers suggest that post-event thinking functions to negatively bias event recall for socially anxious participants. We used a repeated retrieval paradigm to examine the effects of post-event retrieval on memory for social information. Undergraduate participants (n = 214) engaged in an impromptu public speaking task and received a standardised mixture of positive and negative feedback on their speech. Participants in the experimental condition were instructed to repeatedly retrieve the negative feedback items whereas participants in the control condition completed a control task. Both groups were asked to recall the feedback after five minutes and after one week. Results indicated that the experimental group displayed the hypothesised retrieval-induced forgetting effect. In addition, repeated retrieval predicted valence change in that participants recalled the non-retrieved positive feedback items less positively over time. The retrieval-practice effects were distinct from self-reported post-event processing. Contrary to clinical theories, social anxiety did not moderate retrieval-induced forgetting or recall bias. Instead, all participants displayed retrieval-related negatively biased recall.

Social anxiety and dynamic social reinforcement learning in a volatile environment

Adaptive social behavior requires learning probabilities of social reward and punishment, and updating these probabilities when they change. Given prior research on aberrant reinforcement learning in affective disorders, this study examines how social anxiety affects probabilistic social reinforcement learning and dynamic updating of learned probabilities in a volatile environment. N=222 online participants completed questionnaires and a computerized ball-catching game with changing probabilities of reward and punishment. Dynamic learning rates were estimated to assess the relative importance ascribed to new information in response to volatility. Mixed-effects regression was used to analyze throw patterns as a function of social anxiety symptoms. Higher social anxiety predicted fewer throws to the previously punishing avatar and different learning rates after certain role changes, suggesting that social anxiety may be characterized by difficulty updating learned social probabilities. Socially anxious individuals may miss the chance to learn that a once-punishing situation no longer poses a threat.

How badly will I feel if you don't like me?: Social anxiety and predictions of future affect

The current study investigated whether high and low socially anxious individuals would show differences in affective forecasting accuracy (i.e., the prediction of emotional states in response to future events) to positive versus negative social evaluation. High (n=94) and low (n=98) socially anxious participants gave a speech and were randomly assigned to receive a positive or negative evaluation. For affective forecasts made proximally (moments before the speech), those low in social anxiety overpredicted their affect to a greater extent to a negative evaluation versus a positive evaluation. In contrast, those high in social anxiety overpredicted their affect to positive and negative evaluations comparably, and failed to adjust their prediction for a future hypothetical negative evaluation - in effect, not learning from their prior forecasting error. Results suggest that affective forecasting biases deserve further study as a maintaining factor for social anxiety symptoms.

Modulation of feedback processing by social context in social anxiety disorder (SAD)-an event-related potentials (ERPs) study

The ability to learn from feedback, especially under social scrutiny, is an essential prerequisite for successful interaction with the environment. Patients suffering from social anxiety disorder (SAD) have been proposed to show altered processing of and learning from feedback, especially depending on social context. However, the neural basis and behavioral consequences of altered reinforcement learning in SAD are not clear yet. In the present event-related potentials (ERPs) study, 34 SAD patients and 30 healthy control subjects (HC) performed an adapted version of a probabilistic feedback learning task in two distinct social conditions. In the observation condition, participants were observed by a confederate; in the control condition, they performed the task without being observed. Patients as compared to healthy controls experienced more subjective discomfort under social observation. Moreover, they showed better learning from negative feedback in the control condition, but reduced learning from negative feedback in the observation condition. This effect correlated with reduced differentiation of positive and negative feedback in the time range of the feedback-related negativity (FRN) under high action-feedback contingency. In addition, SAD patients demonstrated increased FRN amplitudes in the first half of the observation condition, in particular to positive feedback. The present results demonstrate that processing of and learning from feedback are altered in SAD, especially under social scrutiny. In particular, it appears that SAD patients do not process positive information adequately on the neural level, which may impair their ability to differentiate between negative and positive outcomes.

The mediating role of state maladaptive emotion regulation in the relation between social anxiety symptoms and self-evaluation bias

Although social anxiety symptoms are robustly linked to biased self-evaluations across time, the mechanisms of this relation remain unclear. The present study tested three maladaptive emotion regulation strategies - state post-event processing, state experiential avoidance, and state expressive suppression - as potential mediators of this relation. Undergraduate participants (N = 88; 61.4% Female) rated their social skill in an impromptu conversation task and then returned to the laboratory approximately two days later to evaluate their social skill in the conversation again. Consistent with expectations, state post-event processing and state experiential avoidance mediated the relation between social anxiety symptoms and worsening self-evaluations of social skill (controlling for research assistant evaluations), particularly for positive qualities (e.g. appeared confident, demonstrated social skill). State expressive suppression did not mediate the relation between social anxiety symptoms and changes in self-evaluation bias across time. These findings highlight the role that spontaneous, state experiential avoidance and state post-event processing may play in the relation between social anxiety symptoms and worsening self-evaluation biases of social skill across time.

Negative Event Recall as a Vulnerability for Depression: Relationship between Momentary Stress-Reactive Rumination and Memory for Daily Life Stress

The current research utilized ecological momentary assessment (EMA) methodology to test the hypotheses that: 1) engaging in greater rumination following stress (stress-reactive rumination; SRR) would lead to improved stressor recall, and 2) this improved memory for stress would predict increases in depressive symptoms. One hundred twenty-one participants received smartphone alerts in which they reported on their experience of negative life events (NLEs) as well as SRR and depressed mood after event occurrence. NLEs followed by increased SRR were more likely to be recalled two weeks later. Furthermore, individuals who endorsed and recalled more stressors displayed increased depressive symptoms. Contrary to hypotheses, no evidence was found for a mediational effect in which SRR predicted depressive symptoms and was mediated by memory for NLEs. Current findings demonstrate a relationship between rumination following stress and the subsequent recall of those stressors, and support the role of negative event recall as a vulnerability factor for depression.

Social Anxiety and Biased Recall of Positive Information: It's Not the Content, It's the Valence

Cognitive theorists hypothesize that individuals with social anxiety are prone to memory biases such that event recall becomes more negative over time. With few exceptions, studies have focused primarily on changes in negative self-judgments. The current study examined whether memory for positive social events is also subject to recall bias. Undergraduate participants (N = 138) engaged in an unexpected public speaking task and received standardized positive or neutral feedback on their performance. They rated their memory of the received feedback following a 5-minute delay and again 1 week later. Results revealed that higher scores on social anxiety symptoms predicted significant reductions in the recalled valence of positive feedback over time, whereas no changes were observed for neutral feedback. The results suggest that social anxiety may lead to erosion in memory of positive events.

Using Advances From Cognitive Behavioral Models of Anxiety to Guide Treatment for Social Anxiety Disorder

This case features an adult male with moderate social anxiety disorder and mild depressive symptoms who showed an initial positive response to an earlier experience of cognitive behavior therapy, but then relapsed when he started avoiding social situations again because of continuing beliefs that experiencing anxiety was unacceptable. His treatment at our clinic focused on shifting unhelpful thinking about the likelihood and consequences of becoming anxious and reengaging in avoided social situations so he could learn to tolerate negative affect and uncertainty. The treatment approach draws from cognitive behavioral models of social anxiety and highlights advances in clinical science, especially recent work on the causal role of interpretation biases (the tendency to assign negative or threatening meaning to ambiguous situations) in the maintenance and reduction of anxiety.

Social anxiety is characterized by biased learning about performance and the self

People learn about their self from social information, and recent work suggests that healthy adults show a positive bias for learning self-related information. In contrast, social anxiety disorder (SAD) is characterized by a negative view of the self, yet what causes and maintains this negative self-view is not well understood. Here the authors use a novel experimental paradigm and computational model to test the hypothesis that biased social learning regarding self-evaluation and self-feelings represents a core feature that distinguishes adults with SAD from healthy controls. Twenty-one adults with SAD and 35 healthy controls (HCs) performed a speech in front of 3 judges. They subsequently evaluated themselves and received performance feedback from the judges and then rated how they felt about themselves and the judges. Affective updating (i.e., change in feelings about the self over time, in response to feedback from the judges) was modeled using an adapted Rescorla-Wagner learning model. HCs demonstrated a positivity bias in affective updating, which was absent in SAD. Further, self-performance ratings revealed group differences in learning from positive feedback-a difference that endured at an average of 1 year follow up. These findings demonstrate the presence and long-term endurance of positively biased social learning about the self among healthy adults, a bias that is absent or reversed among socially anxious adults. (PsycINFO Database Record

Social Anxiety and Relationship Formation During the College Transition: Self-Verification, Self-Image, and Victimization

This study tested a self-verification model of social anxiety in the context of relationship formation during the transition to college. Incoming college freshmen (N = 68) completed measures of social anxiety and social self-esteem at the beginning of college and 10 weeks later. Using sociometric ratings completed 10 weeks later, relational victimization appeared to be a unitary construct and not distinct from physical victimization. Participants with low social self-esteem at Time 1 were subsequently seen as victimized, reported disliking spending time at Time 2 with peers who reported liking them, and reported high social anxiety at Time 2 even in the absence of subsequent victimization. The implications of these results for understanding the role of self-verification processes in the maintenance of self-image and social anxiety are discussed.

Self-focused attention affects subsequent processing of positive (but not negative) performance appraisals

BACKGROUND AND OBJECTIVES

Cognitive-behavioral models highlight the conjoint roles of self-focused attention (SFA), post-event processing (PEP), and performance appraisals in the maintenance of social anxiety. SFA, PEP, and biased performance appraisals are related to social anxiety; however, limited research has examined how SFA affects information-processing following social events. The current study examined whether SFA affects the relationships between performance appraisals and PEP following a social event..

METHODS

137 participants with high (n = 72) or low (n = 65) social anxiety were randomly assigned to conditions of high SFA or low SFA while engaging in a standardized social performance. Subsequent performance appraisals and PEP were measured.

RESULTS

Immediate performance appraisals were not affected by SFA. High levels of SFA led to a stronger, inverse relationship between immediate positive performance appraisals and subsequent negative PEP. High levels of SFA also led to a stronger, inverse relationship between negative PEP and changes in positive performance appraisals..

LIMITATIONS

Future research should examine whether the current findings, which involved a standardized social performance event, extend to interaction events as well as in a clinical sample.

CONCLUSIONS

These findings suggest that SFA affects the processing of positive information following a social performance event. SFA is particularly important for understanding how negative PEP undermines positive performance appraisals..

Can I Really Do This? An Examination of Anticipatory Event Processing in Social Anxiety Disorder

Clark and Wells (1995) posit that anticipatory processing before a social situation serves to maintain social anxiety. More specifically, ruminative processes similar to post-event processing (PEP) may occur in anticipation of anxiety provoking social events, and in this article, we have labelled this type of anticipatory rumination anticipatory event processing (AnEP). Participants (n = 75) with social anxiety disorder (SAD) completed measures of anticipatory event processing, trait anxious rumination, social anxiety, state anxiety, and PEP, in the context of completing videotaped exposures twice as part of manual-based group cognitive behavioral therapy. AnEP was significantly positively associated with trait anxious rumination and social anxiety and was associated with state anxiety during the first videotaping. AnEP at the two time points was significantly correlated and decreased across the two taped exposures. Greater AnEP at the first taping was associated with greater PEP the following week. PEP after the first videotaped exposure then significantly related to AnEP for the second videotaped exposure several weeks later. Discussion focuses on the similarities between PEP and AnEP as well as implications for cognitive models and treatment of SAD.

Is post-event processing a social anxiety specific or transdiagnostic cognitive process in the anxiety spectrum?

BACKGROUND

Research on post-event processing (PEP), where individuals conduct a post-mortem evaluation of a social situation, has focused primarily on its relationship with social anxiety.

AIMS

The current study examined: 1) levels of PEP for a standardized event in different anxiety disorders; 2) the relationship between peak anxiety levels during this event and subsequent PEP; and 3) the relationship between PEP and disorder-specific symptom severity.

METHOD

Participants with primary DSM-IV diagnoses of social anxiety disorder (SAD), obsessive compulsive disorder (OCD), panic disorder with/without agoraphobia (PD/A), or generalized anxiety disorder (GAD) completed diagnosis specific symptom measures before attending group cognitive behavioural therapy (CBT) specific to their diagnosis. Participants rated their peak anxiety level during the first group therapy session, and one week later rated PEP in the context of CBT.

RESULTS

The results indicated that all anxiety disorder groups showed heightened and equivalent PEP ratings. Peak state anxiety during the first CBT session predicted subsequent level of PEP, irrespective of diagnostic group. PEP ratings were found to be associated with disorder-specific symptom severity in SAD, GAD, and PD/A, but not in OCD.

CONCLUSIONS

PEP may be a transdiagnostic process with relevance to a broad range of anxiety disorders, not just SAD.

Expectancy bias mediates the link between social anxiety and memory bias for social evaluation

Social anxiety (SA) involves a multitude of cognitive symptoms related to fear of evaluation, including expectancy and memory biases. We examined whether memory biases are influenced by expectancy biases for social feedback in SA. We hypothesised that, faced with a socially evaluative event, people with higher SA would show a negative expectancy bias for future feedback. Furthermore, we predicted that memory bias for feedback in SA would be mediated by expectancy bias. Ninety-four undergraduate students (55 women, mean age = 19.76 years) underwent a two-visit task that measured expectations about (Visit 1) and memory of (Visit 2) feedback from unknown peers. Results showed that higher levels of SA were associated with negative expectancy bias. An indirect relationship was found between SA and memory bias that was mediated by expectancy bias. The results suggest that expectancy biases are in the causal path from SA to negative memory biases for social evaluation.

Trajectories of functioning after remission from anxiety disorders: 2-year course and outcome predictors

BACKGROUND

Anxiety disorders are associated with substantial functional limitations but the course of functioning following symptom remission remains largely unknown.

METHOD

Using data from the Netherlands Study of Depression and Anxiety (NESDA), we examined the 2-year trajectories of functioning in participants with chronic (n = 586) or remitting anxiety disorders (n = 385) and in healthy controls (n = 585). In participants with remitting anxiety disorders, we identified predictors of functioning from among sociodemographic, clinical and vulnerability variables. Data were analysed using linear mixed models (LMMs). Functioning was assessed with the World Health Organization Disability Assessment Schedule II (WHO DAS II).

RESULTS

At baseline, participants with remitting anxiety disorders functioned significantly better than those with chronic anxiety disorders, but significantly worse than controls. In both anxiety disorder groups, most impairment was reported in social functioning, occupational functioning and cognition. During the follow-up, functioning improved in both groups, probably due to treatments received. Participants who achieved symptom remission experienced moderate improvements in social functioning and cognition but not in occupational functioning. Of those who remitted, 45.8% reported functioning scores similar to healthy controls whereas 28.5% still functioned at the level of those with chronic anxiety disorders. Worse functioning was predicted by severe anxiety disorders, use of psychological treatment, co-morbid depressive disorders and maladaptive personality traits.

CONCLUSIONS

In anxiety disorders, symptom remission is accompanied by improvements in functioning but significant functional impairments may persist because of co-morbid disorders, lower functioning prior to the onset of the anxiety disorder or residual subthreshold anxiety symptoms.

Self-Focused Attention and Post-Event Processing: Relevance to Social Performance Anxiety and Social Interaction Anxiety

This study examined the roles of self-focused attention and post-event processing in social performance anxiety and social interaction anxiety. College students (N = 101) completed measures of social performance anxiety, social interaction anxiety, self-focused attention, post-event processing, and beliefs related to social anxiety. Interoceptive self-focused attention and post-event processing predicted social performance anxiety after controlling for social interaction anxiety. The associations with social interaction anxiety were not significant after controlling for social performance anxiety. Associations of behavioral self-focused attention with social performance anxiety and social interaction anxiety were not significant after controlling for interoceptive self-focused attention. No evidence of an interaction between self-focused attention and post-event processing in the prediction of social anxiety was found. This study found no evidence that the associations of interoceptive self-focused attention and post-event processing with social performance anxiety were statistically mediated by high standards, conditional beliefs about self, and unconditional beliefs about self. These results and their theoretical implications are discussed.

Mental imagery and post-event processing in anticipation of a speech performance among socially anxious individuals

The present study investigated whether post-event processing (PEP) involving mental imagery about a past speech is particularly detrimental for socially anxious individuals who are currently anticipating giving a speech. One hundred fourteen high and low socially anxious participants were told they would give a 5 min impromptu speech at the end of the experimental session. They were randomly assigned to one of three manipulation conditions: post-event processing about a past speech incorporating imagery (PEP-Imagery), semantic post-event processing about a past speech (PEP-Semantic), or a control condition, (n=19 per experimental group, per condition [high vs low socially anxious]). After the condition inductions, individuals' anxiety, their predictions of performance in the anticipated speech, and their interpretations of other ambiguous social events were measured. Consistent with predictions, high socially anxious individuals in the PEP-Imagery condition displayed greater anxiety than individuals in the other conditions immediately following the induction and before the anticipated speech task. They also interpreted ambiguous social scenarios in a more socially anxious manner than socially anxious individuals in the control condition. High socially anxious individuals made more negative predictions about their upcoming speech performance than low anxious participants in all conditions. The impact of imagery during post-event processing in social anxiety and its implications are discussed.

Expecting the unexpected: predicting physiological and psychological wildfire preparedness from perceived risk, responsibility, and obstacles

People who live in wildfire-prone communities tend to form their own hazard-related expectations, which may influence their willingness to prepare for a fire. Past research has already identified two important expectancy-based factors associated with people's intentions to prepare for a natural hazard: Perceived risk (i.e., perceived threat likelihood and severity) and perceived protection responsibility. We expanded this research by differentiating the influence of these factors on different types of wildfire preparedness (e.g., preparations for evacuation vs. for defending the house) and measured actual rather than intended preparedness. In addition, we tested the relation between preparedness and two additional threat-related expectations: the expectation that one can rely on an official warning and the expectation of encountering obstacles (e.g., the loss of utilities) during a fire. A survey completed by 1,003 residents of wildfire-prone areas in Perth, Australia, revealed that perceived risk (especially risk severity) and perceived protection responsibility were both positively associated with all types of preparedness, but the latter did not significantly predict preparedness after controlling for other predictors and demographics. Also, the two new expectancy-based factors were significantly associated with all types of preparedness, and remained significant predictors of some types of preparedness after controlling for other predictors and demographics: the expectation of being able to rely on an official fire warning and expecting to lose electricity both still predicted less preparedness around house resilience, and expecting to lose water still predicted increased planning preparedness. We discuss public policy implications that follow from this research.

Gender differences in rumination: A meta-analysis

Starting in adolescence and continuing through adulthood, women are twice as likely as men to experience depression. According to the response styles theory (RST), gender differences in depression result, in part, from women's tendency to ruminate more than men. A meta-analysis was performed to evaluate gender differences in rumination in adults (k = 59; N = 14,321); additionally, an analysis of subtypes of rumination - brooding and reflection - was conducted (k = 23). Fixed effects analyses indicated that women scored higher than men in rumination (d = .24, p < .01, SEd = .02), brooding (d = .19, p < .01, SEd = .03) and reflection (d = .17, p < .01, SEd = .03); there was no evidence of heterogeneity or publication bias across studies for these effect sizes. Although statistically significant, the effect sizes for gender differences in rumination were small in magnitude. Results are discussed with respect to the RST and gender differences in depression.

Well that changes everything! The genesis of memory bias for threat with implications for delayed onset in anxiety disorders

BACKGROUND AND OBJECTIVES

A number of aetiological pathways have been proposed in the development of anxiety disorders, including those associated with stressful triggering situations. Life events can provide new meaning to past situations, potentially leading to the delayed onset of a disorder. Whether or not a disorder will emerge is theoretically related to one's appraisal and memory of prior events, and memory biases are proposed to exist for threat-related information in association with anxiety. Given that new events may change the meaning of past experiences, threatening information may change one's memory for once-neutral events.

METHODS

The current study aimed to examine the effect of threatening information on memory for previously encoded (neutral) stimuli. Undergraduate participants (n = 81) interacted with 30 neutral objects (displayed in two boxes) and completed a recall memory test for these objects. They were then randomly assigned to receive either new threatening or new neutral information about half (one box) of the already-learned objects; a second recall test was then administered.

RESULTS

Individuals given threatening information showed a greater proportion of memory for items that were manipulated to total items recalled than did individuals given new non-threatening information.

LIMITATIONS

A nonclinical sample reported relatively low ratings of disgust and anxiety. Additionally, the time between the two memory tests was brief, likely differing from the actual occurrence of delayed onset disorders.

CONCLUSIONS

Results showed the genesis of a memory bias for threat in the presumed absence of an attentional bias, and are discussed in terms of the delayed onset of anxiety disorders.

Constructive Effects of Engaging in Post-Event Processing in High and Low Socially Anxious Individuals

Post-event processing (PEP), the act of engaging in a detailed, self-focused, and negative analysis of a prior social situation, has been hypothesised to contribute to the maintenance of social phobia (Clark & Wells, 1995). In light of this proposal, the present study investigated whether deliberate engagement in PEP as opposed to distraction following a speech task elicits unhelpful effects on emotion, cognition, and behaviour in a subsequent speech task in high and low socially anxious participants. The PEP manipulation instructed participants to focus on the anxious thoughts, images, feelings, and somatic sensations relating to the first speech. Contrary to hypotheses, results demonstrated that engaging in PEP as opposed to distraction led to a number of constructive outcomes such as: increased willingness among low socially anxious participants to give the second speech, a reduction in negative performance appraisals and underestimation of performance among high socially anxious participants, and better self-perceived speech quality irrespective of social anxiety level. However, there were no effects of response condition on anxiety, performance appraisals, observable behaviour, and negative cognitions. The findings underscore the need for additional research identifying the precise contents, construals, and processing modes that distinguish between adaptive and maladaptive forms of PEP.

It was as big as my head, I swear! Biased spider size estimation in spider phobia

The current study tested the association between fear and perception in spider phobic individuals (n=57) within the context of a treatment outcome study. Participants completed 5 post-treatment Behavioral Approach Tasks (BATs) in which they encountered a live spider and were asked to provide spider size estimates. Consistent with predictions, results indicated that high levels of fear were associated with magnified perception of phobic stimuli. Specifically, we found a significant positive correlation between size estimates and self-reported fear while encountering spiders. Together with previous findings, these results further support the notion that fear is involved in the encoding and processing of perceptual information.

Global and local evaluations of public speaking performance in social anxiety

Differences in the relative use of global and local information (seeing the forest vs. the trees) may explain why people with social anxiety often do not benefit from corrective feedback, even though they pay close attention to details in social situations. In the current study, participants high (n=43) or low (n=47) in social anxiety symptoms gave a series of brief speeches, and then self-rated their speaking performance on items reflecting global and local performance indicators (self-assessment) and also received standardized performance feedback from an experimenter. Participants then completed a questionnaire asking how they thought the experimenter would rate their performance based on the feedback provided (experimenter assessment). Participants completed the self- and experimenter assessments again after 3 days, in addition to a measure of postevent processing (repetitive negative thinking) about their speech performance. Results showed that, as hypothesized, the High SA group rated their performance more negatively than the Low SA group. Moreover, the High SA group's ratings of global aspects of their performance became relatively more negative over time, compared to their ratings of local aspects and the Low SA group's ratings. As expected, postevent processing mediated the relationship between social anxiety group status and worsening global performance evaluations. These findings point to a pattern of progressively more negative global evaluations over time for persons high in social anxiety.

Negative post-event processing and decreased self-appraisals of performance following social stress in childhood social anxiety: an experimental study

Cognitive models of social phobia (SP) assume that following social evaluative stress, individuals with SP engage into dysfunctional post-event processing (PEP), a detailed negative review of the past event. While previous research has already shown, that children with high levels of social fears suffer from more frequent negative PEP, it remains unclear how stable PEP is across time in this age group and whether it leads to degraded self-appraisals of performance. Therefore in the present study we exposed a group of high (HSA) and low socially anxious children (LSA; both n = 20), aged 10-12 years, to a social evaluative situation and assessed negative and positive PEP as well as self-rated performance at 2.5 h and one week after the task. Our results revealed that HSA children reported more negative PEP than LSA children, independent of levels of depression. Moreover, negative PEP was related to measures of social anxiety and performance ratings within the tasks. Only the performance ratings in HSA children worsened over the course of the following week and were related to more negative PEP. Thus, these results speak for the high clinical relevance dysfunctional PEP may have for the maintenance of social fears already in childhood.

A prospective examination of predictors of post-event processing following videotaped exposures in group cognitive behavioural therapy for individuals with social phobia

Following social events, individuals with social phobia engage in post-event processing (PEP), namely a post-mortem detailed analysis of a social situation. This study aimed to examine cognitive and symptom correlates of PEP, as well as stability of PEP, in the context of videotaped exposures that occurred during treatment at sessions four and eight. Before treatment, 75 individuals with DSM-IV diagnosed social phobia completed measures of social anxiety, anxious rumination, fear of causing discomfort to others, and negative interpretation of positive social events. They rated their peak anxiety during the taped exposure. Then, they completed a measure of PEP one week after each videotaped exposure exercise. Results revealed that baseline social anxiety symptoms, state anxiety during the videotaping, anxious rumination, fear of causing discomfort to others, and negative interpretation of positive social events were all positively associated with PEP for the first taped exposure. Regression analyses demonstrated that unique predictors of PEP over and above baseline social anxiety were state social anxiety during the exposure, and anxious coping-focused rumination. This was largely replicated in the second taped exposure. In addition, PEP following two videotaped exposures separated by four weeks showed a moderate-to-large positive correlation. These findings highlight symptom and cognitive correlates of PEP, and underscore importance of state anxiety in social situations, as well as general anxiety focused rumination in social phobia.

Current research on cognitive aspects of anxiety disorders

PURPOSE OF REVIEW

Cognitive dysfunction is frequently reported in anxiety disorders. Our aim is to describe recent advances concerning these cognitive aspects.

RECENT FINDINGS

Cognitive dysfunction in anxiety disorders can be classified into four domains. The first concerns executive functions, mainly attentional processes. The second concerns memory, including deficits in working, episodic, and autobiographical memory. The third encompasses maladaptive cognitions, or thoughts and beliefs. Finally, a burgeoning area of research (mainly in obsessive-compulsive disorder and posttraumatic stress disorder) concerns metacognitions, or thoughts and beliefs about one's own thoughts and beliefs. All of these dysfunctions may contribute to maintain or aggravate anxiety disorders. When developing and implementing interventions, researchers and clinicians alike must consider these cognitive aspects, and may need to tailor their approaches accordingly.

SUMMARY

Advances have clearly been made in the elucidation of the cognitive functioning associated with anxiety disorders. It remains unclear if particular cognitive profiles can help to distinguish anxiety disorders from one another, although emerging evidence suggests this may be the case. Further clarification will add to our understanding of the development and maintenance of these disorders, and may provide targets for future therapy and endophenotypes.