Development and validation of the trait and state versions of the Post-Event Processing Inventory

Clinical and Psychosocial Predictors of Post-Event Processing in Adults Who Stutter

PURPOSE

Post-event processing, defined by self-critical rumination following a stressful communication event, is significantly associated with reduced quality of life. However, despite its relevance to the stuttering experience, to date, only a few studies have investigated post-event processing among adults who stutter, and no study has identified clinical and psychosocial predictors of post-event processing. The purpose of this study was to determine the contributions of clinical markers of stuttering and psychosocial variables to post-event processing.

METHOD

Adults who stutter (N = 96) participated in two virtual sessions. After completing the Trier Social Stress Test, a standardized social stress task in Session 1, participants completed measures of post-event processing, clinical markers of stuttering (i.e., the experience of stuttering, self- and observer-rated stuttering severity), and psychosocial characteristics (i.e., self-perceived performance, self-esteem, social anxiety, trait, and state self-compassion) in Session 2.

RESULTS

Hierarchical linear regression models indicated that a more negative experience of stuttering, higher self-rated stuttering severity, and greater social anxiety predicted more post-event processing. Greater self-perceived performance and state self-compassion predicted less rumination. Observer-rated severity, self-esteem, and trait self-compassion were not significantly associated with post-event processing behavior.

CONCLUSION

Findings reveal clinical and psychosocial variables to consider in the assessment and mitigation of post-event processing behavior in adults who stutter, and to bolster resiliency to social stress.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.24223213.

A retrospective study of negative and positive post-event processing following stressful and pleasant social interactions

BACKGROUND AND OBJECTIVES

Negative post-event processing (PEP) is a key maintenance factor of social anxiety, but little is known about the role positive PEP, particularly in relation to situations that are not perceived as stressful. The objective was to examine negative and positive PEP following stressful and pleasant social interactions. We were also interested in how participants remembered and described the interactions.

METHODS

Young adults (n = 411) recalled a recent pleasant or stressful social interaction and indicated how much negative and positive PEP they engaged in since the interaction. They also completed questionnaires measuring social anxiety and the memory's phenomenological qualities and wrote a description of the interaction.

RESULTS

Higher social anxiety was linked with more negative and less positive PEP, regardless of whether the interaction was perceived as stressful or pleasant. Participants reporting more negative PEP used more negative words in describing the interaction and their memory was more negative and emotionally intense. Those reporting more positive PEP used more positive and less negative words in their descriptions. For stressful interactions, positive PEP was related to a more positive memory; for pleasant ones, it was related to increased emotional intensity.

LIMITATIONS

Limitations included the sample type (restricted age range, non-clinical) and the retrospective, cross-sectional nature of the study.

CONCLUSIONS

Results provide insight into PEP following stressful and pleasant social interactions. We also found preliminary evidence that positive PEP may be helpful and protective. Future studies may benefit from longitudinal and mixed methods designs.

Understanding the Dimensions of Post-Event Processing: Applying a Bifactor Modeling Approach to the EPEPQ-15

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.

Ecological momentary assessment of post-event processing in between two speech tasks: Relationships with cognitive and affective factors involved in the maintenance of social anxiety

Socially anxious individuals tend to review past distressing social situations, a process called post-event processing. The goal of this 4-day study was to investigate how PEP evolved over time in between two speech tasks in a sample of 101 students using ecological momentary assessment (EMA). In addition, we examined the relationships between post-event processing and other cognitive and affective processes involved in social anxiety, including anticipatory processing, anxiety, performance appraisals, and memory. Results from EMA showed that post-event and anticipatory processing decreased over time. Higher anxiety during the speech and poorer performance appraisals predicted more post-event processing, though post-event processing was unrelated to changes in performance appraisals over time. Post-event processing the day following the first speech was positively associated with anticipatory processing the day before the second speech. Participants who engaged in more post-event processing also remembered the first speech differently (e.g., more negative and emotionally intense). Implications for the cognitive-behavioural treatment of social anxiety are discussed.

The relationship between three subtypes of safety behaviors and social anxiety: Serial mediating effects of state and trait post-event processing

The cognitive model for social anxiety disorder (SAD) highlights the role of safety behaviors and post-event processing (PEP). We identify the serial mediating effect of state and trait PEP between three types of safety behaviors (impression management, avoidance behavior, and anxiety-symptom control) and social anxiety. Given that the associations between the three subtypes of safety behaviors and two perspectives of PEP have not yet been examined, we aimed to investigate these relationships according to the level of social anxiety. A total of 487 participants participated in an online survey. Participants were classified into two groups, high and low, based on their social anxiety scores. We used Social Behavior Questionnaire to distinguish three types of safety behaviors and the State and Trait versions of the Post-Event Processing Inventory to identify two perspectives of PEP. We used descriptive statistics and an independent t-test to compare the high and low social anxiety groups. Mediation effects were examined using mediation analysis and bootstrapping with 5,000 replications. The results showed that the three safety behaviors had different effects on social anxiety via PEP. In the high social anxiety group, avoidance behavior and anxiety-symptom control predicted social anxiety positively, whereas impression management did not. However, with state PEP and trait PEP as mediators, impression management and avoidance behavior positively predicted social anxiety but not anxiety-symptom control. In the low social anxiety group, only avoidance behavior was significantly related to social anxiety, but when the state and trait PEP were mediated, the effect disappeared. These results indicated that impression management could affect social anxiety only when mediated by PEP in people with high social anxiety. A better understanding of the content and processes underpinning safety behavior and PEPs might have important implications for the prevention and treatment of social anxiety disorder.

Measuring state pre-event and post-event rumination in Social Anxiety Disorder: Psychometric properties of the Socially Anxious Rumination Questionnaire (SARQ)

Cognitive models have consistently recognised pre-event and post-event rumination as maintaining factors in Social Anxiety Disorder (SAD). This study aimed to investigate the psychometric properties of a state-based measure of pre-event and post-event rumination in SAD: The Socially Anxious Rumination Questionnaire (SARQ), which was formerly known as the Thoughts Questionnaire. In particular, we examined the factor structure, internal consistency, test-retest reliability, construct validity, sensitivity to treatment response, clinical cut-off scores (relative to non-clinical participants), and associated test performance indicators of the SARQ. The sample comprised 505 adults with a principal diagnosis of SAD and 130 non-clinical controls. Pre-event and post-event rumination were assessed in relation to a three-minute impromptu speech. Results indicated single factors for the SARQ: Pre-event and SARQ: Post-event scales, along with excellent internal consistency, good test-retest reliability, sound sensitivity to cognitive-behavioural treatment response, and a clear ability to discriminate between individuals with a principal diagnosis of SAD and non-clinical controls. The findings justify the SARQ's use as a robust and reliable measure of state rumination for individuals with SAD that can be used both before and after encountering a social threat.

The Impact of Brief Mindfulness Training on Postevent Processing Among Individuals With Clinically Elevated Social Anxiety

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.

The heterogeneity of social anxiety symptoms among Chinese adolescents: Results of latent profile analysis

BACKGROUND

The main objective of the current study was to investigate the symptoms of social anxiety in Chinese adolescents by conducting latent profile analysis (LPA), a person-centered statistical approach, with items from the Social Anxiety Scale for Adolescents (SAS-A).

METHOD

In total, a sample of 2,755 adolescents aged 11‒19 years were recruited from six urban public schools in the Beijing District and Sichuan Province, China. Latent profile analysis, regression mixture modelling, and multinomial logistical regression were adopted to investigate the latent profiles and profiles validity.

RESULTS

A four-profile model was suggested as the optimum: low group with diffuse social anxiety, moderate group with difficulties in new situations, moderate group with cognitive disturbance, and high group with diffuse social anxiety. With regression mixture modelling, results showed a greater possibility for older adolescents and girls fall into the high group with diffuse social anxiety. Finally, to examine the validity and interpretability of the social anxiety profiles, two cognitive factors-post-event rumination and self-focused attention-were adopted for their potential to significantly predict the moderate and high group social anxiety profiles.

CONCLUSIONS

The current study, which was the first effort to investigate the features of social anxiety among Chinese adolescents with LPA, supports an innovative model of social anxiety symptoms in a large, non-Western sample. Limitations and clinical implications are included.

Self-Help for Social Anxiety: Randomized Controlled Trial Comparing a Mindfulness and Acceptance-Based Approach With a Control Group

There are many barriers to the delivery of evidence-based treatment, including geographical location, cost, and stigma. Self-help may address some of these factors but there is a paucity of research on the efficacy of self-help for many problems, including social anxiety. The present research evaluated the efficacy of a mindfulness and acceptance-based self-help approach for the treatment of social anxiety. Individuals seeking help for social anxiety or shyness were recruited from the community. Participants (N = 117) were randomly assigned to a book (n = 58) or wait-list control condition (n = 59) on a 1:1 ratio. Hierarchical linear modelling results supported the efficacy of the self-help condition with between-group effect sizes on social anxiety outcomes ranging from .74 to .79. Significant change was also observed on self-compassion, mindfulness, acceptance, and depression. Some variables, including social anxiety and acceptance, were assessed weekly for those in the book condition. Additional participants (n = 35) were recruited for the book condition increasing the sample size to 93 for the latent change score modelling analyses. A unidirectional model was supported: increases in acceptance were associated with subsequent decreases in social anxiety. Overall these results support the use of a mindfulness and acceptance-based self-help approach for social anxiety.

Repetitive Thinking in Social Anxiety Disorder: Are Anticipatory Processing and Post-Event Processing Facets of an Underlying Unidimensional Construct?

Existing literature suggests that anticipatory processing and post-event processing-two repetitive thinking processes linked to social anxiety disorder (SAD)-might be better conceptualized as facets of an underlying unidimensional repetitive thinking construct. The current study tested this by examining potential factor structures underlying anticipatory processing and post-event processing. Baseline data from two randomized controlled trials, consisting of 306 participants with SAD who completed anticipatory processing and post-event processing measures in relation to a speech task, were subjected to confirmatory factor analysis. A bifactor model with a General Repetitive Thinking factor and two group factors corresponding to anticipatory processing and post-event processing best fit with the data. Further analyses indicated an optimal model would include only the General Repetitive Thinking factor (reflecting anticipatory processing and a specific aspect of post-event processing) and Post-event Processing group factor (reflecting another specific aspect of post-event processing that is separable), providing evidence against a unidimensional account of repetitive thinking in SAD. Analyses also indicated that the General Repetitive Thinking factor had moderately large associations with social anxiety and life interference (rs = .43 to .47), suggesting its maladaptive nature. The separable Post-event Processing group factor only had small associations with social anxiety (rs = .16 to .27) and was not related to life interference (r = .11), suggesting it may not, in itself, be a maladaptive process. Future research that further characterises the bifactor model components and tests their utility has the potential to improve the conceptualisation and assessment of repetitive thinking in SAD.

Examining the Relationships Among Self-Compassion, Social Anxiety, and Post-Event Processing

Post-event processing refers to negative and repetitive thinking following anxiety provoking social situations. Those who engage in post-event processing may lack self-compassion in relation to social situations. As such, the primary aim of this research was to evaluate whether those high in self-compassion are less likely to engage in post-event processing and the specific self-compassion domains that may be most protective. In study 1 ( N = 156 undergraduate students) and study 2 ( N = 150 individuals seeking help for social anxiety and shyness), participants completed a battery of questionnaires, recalled a social situation, and then rated state post-event processing. Self-compassion negatively correlated with post-event processing, with some differences depending on situation type. Even after controlling for self-esteem, self-compassion remained significantly correlated with state post-event processing. Given these findings, self-compassion may serve as a buffer against post-event processing. Future studies should experimentally examine whether increasing self-compassion leads to reduced post-event processing.

Repetitive negative thinking and suicide: a burgeoning literature with need for further exploration

Extant research has found a significant overlap between various repetitive negative thinking (RNT) patterns, such as rumination and worry, across different affective disorders implicating that the process of repetitive negative thinking is likely trans-diagnostic. Furthermore, RNT patterns at the core of psychiatric disorders associated with suicide (e.g., rumination and worry) have been found to be associated with suicide even after accounting for the disorder. A synthesis of existing literature on repetitive negative thoughts suggest that following negative emotional experiences, RNTs may lead to a sense of entrapment and hopelessness that may contribute to the onset of suicidal ideation and then facilitate the transition from thinking about suicide to making a suicide attempt by increasing an individual's capability for suicide through repetitive exposure to violent thoughts and imagery associated with suicide.