Predictors of Post‐Event Rumination Related to Social Anxiety

Specificity of cost and probability biases in social anxiety: Comparing status and belongingness threats

BACKGROUND

Social anxiety (SA) is characterized by concerns about the expected occurrence (probability) and anticipated distress (cost) of social threats. Unclear is whether SA correlates specifically with biased expectations of belongingness or status threats.

AIMS

We aimed to discern if SA is uniquely tied to biased expectancies of either belongingness or status threats.

MATERIALS AND METHODS

We assessed 757 participants' perceptions of exclusion and put-down scenarios, analysing associations between SA and threat perceptions.

DISCUSSION

Our findings support the status-sensitivity hypothesis, suggesting individuals with high SA are particularly attuned to the perceived cost of status threats, potentially informing treatment approaches.

CONCLUSION

Understanding SA's link to status concerns enhances therapeutic strategies, emphasizing the need to address status-related situations, cognitions, and emotions in interventions.

The legacy of social anxiety-linked negative expectancy: A pathway from pre-event negative expectancies to post-event negative thinking

BACKGROUND AND OBJECTIVES

Following engagement in a social event people with heightened vulnerability to social anxiety report elevated levels of negative thinking about the event, and this post-event negative thinking is implicated in the maintenance of social anxiety vulnerability. It has also been established that heightened social anxiety vulnerability is associated with disproportionately negative expectations of upcoming social events. However, contribution of social anxiety-linked pre-event negative expectancy to post-event negative thinking has not been directly investigated. The objective of the present study was to test the hypothesis that the relationship between social anxiety vulnerability and post-event negative thinking is mediated by pre-event negative expectancies that drive increased state anxiety at the time of encountering the event.

METHODS

One-hundred and ten participants who varied in social anxiety vulnerability completed a simulated job interview. Participants reported negativity of expectancies before the event, state anxiety experienced at the time of encountering the event, and post-event negative thinking across the seven days following the event.

RESULTS

Analyses revealed elevated social anxiety predicted increased negative post-event thinking. The association between social anxiety and post-event negative thinking was fully mediated by a mediation pathway involving pre-event negative expectancies and state anxiety at the time of encountering the interview event.

LIMITATIONS

The study used a laboratory-based social experience, and conclusions could usefully be tested in the context of natural social events.

CONCLUSIONS

The findings suggest that social anxiety-linked variation in pre-event negative expectancy may contribute to post-event negative thinking following a social event via its impact on state anxiety.

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.

Cross-lagged analysis of rumination and social anxiety among Chinese college students

BACKGROUND

Social anxiety, which is widely prevalent among Chinese college students, poses a significant barrier to their holistic psychological and physiological development. Although numerous cross-sectional studies have examined the relationship between rumination and social anxiety, there is still a gap in understanding their interplay over time. This longitudinal study aimed to explore and analyze the intricate interrelations between these two factors, with the ultimate goal of informing the development of effective mental health education interventions for university students.

METHODS

Using the Ruminative Responses Scale (RRS) and the Interaction Anxiousness Scale (IAS), a two-stage longitudinal follow-up study of 392 college students from three universities in Henan Province was conducted over a six-month period (October 2022 to March 2023) using a cross-lagged model to explore the correlation between rumination and social anxiety. The results of the correlation analysis showed that rumination was positively associated with social anxiety at both time points (r = 0.18,0.12, p < 0.01).

RESULTS

Cross-lagged regression analyses revealed that the predictive effect of the first measure (T1) rumination on the second measure (T2) rumination was statistically significant (β = 0.32, p < 0.001). The predictive effect of T1 social anxiety on T2 social anxiety was statistically significant (β = 0.65, p < 0.001), the predictive effect of T1 rumination on T2 social anxiety was statistically significant (β = 0.33, p < 0.001), and the prediction of T1 social anxiety on T2 rumination was statistically significant (β = 0.28, p < 0.001).

CONCLUSION

College students' rumination and social anxiety are mutually predictive of each other, and interventions by educators in either of these areas have the potential to interrupt the vicious cycle between ruminant thinking and social anxiety.

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.

The role of fear of negative evaluation on the effects of self-control on affective states and life satisfaction: a moderated mediation analysis

Previous studies have found a robust positive relationship between trait self-control and life satisfaction mediated by both positive and negative affect, but the simultaneous inclusion of the effect of apprehension of being evaluated by others is less commonly investigated. The present study aimed to examine (1) whether the relationship between self-control and life satisfaction was mediated by positive affect and negative affect in parallel, and (2) whether fear of negative evaluation would moderate the strengths of the mediational pathways. With a sample of two hundred fifty university students in Hong Kong, mediational analysis (ME) revealed that both positive affect and negative affect were the mediators between self-control and life satisfaction. Subsequent moderated mediation analysis (moME) supported the moderating role of fear of negative evaluation on the mediational pathway through positive affect, but not on the pathway through negative affect. In particular, higher scores on fear of negative evaluation would attenuate the strength of association between self-control and positive affect. Therefore, to optimize university students' well-being and mental health functioning, treatment modalities should target both behavioral (i.e., self-control) and socio-emotional (i.e., apprehension of being evaluated critically from others) aspects.

Trait rumination and social anxiety separately influence stress-induced rumination and hemodynamic responses

We aimed to investigate stress-reactive rumination in response to social stress and its association with social anxiety and trait rumination. From previous investigations we know that people with a certain vulnerability to rumination show increased stress-reactive rumination. However, up to date the possible influence of social anxiety on this relationship is still unclear. Therefore, we reanalyzed the data of two of our previous studies assessing healthy low and high trait ruminators and depressed patients performing the Trier Social Stress Test (TSST). We measured cortical oxygenation using functional Near-Infrared Spectroscopy (fNIRS) as well as different behavioral outcome measures (subjective stress levels, negative affect, state rumination). On a behavioral level, we found an influence of both, social anxiety and trait rumination, on state rumination, even when correcting for the other factor, respectively, implying two potentially independent factors of influence. On a neural level, we observed reduced activation in brain regions of the cognitive control network (CCN) for higher social anxiety and trait rumination, which might be a result of reduced cognitive and attentional control. Results indicate a specific role of social anxiety, at least on a behavioral level, and therefore implicate a crucial factor to be considered in the treatment of depression.

Positive Beliefs about Post-Event Processing in Social Anxiety Disorder

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.

Perfectionism, Self-Esteem, and the Will to Win Among Adolescent Athletes: The Effects of the Level of Achievements and Gender

This study examined the relationships between perfectionism, self-esteem, and the will to win and the effects of gender and the level of achievement on these variables. A total of 318 adolescents in the age group of 12–19 years (M = 16.10 ± 1.01) completed the self-esteem questionnaire, the will-to-win questionnaire, and the perfectionism inventory. Interstate level (ISL) athletes obtained higher scores than interdistrict level (IDL) athletes on the following variables: self-esteem, the will to win, and four of the eight dimensions of perfectionism (i.e., concern over mistakes, the need for approval, organization, and planfulness). Further, male athletes obtained higher self-esteem and perfectionism (i.e., the need for approval and rumination) scores than female athletes. Self-esteem, the will to win, and the dimensions of perfectionism were positively and significantly interrelated. However, one dimension, namely, perceived parental pressure, was unrelated to any factor except striving for excellence. Further, the will to win, concern over mistakes, high standard for others, and planfulness were unrelated to striving for excellence. The results of the discriminant analysis revealed that there was no significant difference between ISL and IDL athletes (variance explained = 9.480%). Finally, using path analysis showed that Model 3 (perfectionism self-esteem will-to-win) has provided good model fit such as Bentler's comparative fit index (CFI) (0.987), Tucker-Lewis index (TLI) (0.876), normed fit index (NFI) (0.973), and the root mean square error of approximation (RMSEA) (0.097).

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.

Post-event processing after embarrassing situations: Comparing experience sampling data of depressed and socially anxious individuals

Background

Post-event processing (PEP) after social interactions (SIs) contributes to the persistence of social phobia (SP). This study investigated whether PEP as a transdiagnostic process also occurs in major depressive disorder (MDD) and controls. We also tested to what extent PEP was explained by trait levels of social anxiety (SA) or depression.

Method

For seven days, a total of n = 165 patients (n = 47 SP, n = 118 MDD) and n = 119 controls completed five surveys per day on their smartphones. Event-based experience sampling was used. PEP was assessed following subjective embarrassment in SIs with two reliable items from the Post-Event Processing Questionnaire. Data were analysed via multilevel regression analyses.

Results

Individuals with SP or MDD experienced more embarrassing SIs than controls and, accordingly, more PEP. The relative frequency of PEP after embarrassing SIs was equally high in all groups (86-96%). The groups did not differ regarding the amount of time PEP was experienced. After controlling trait depression, embarrassment occurred more frequently only in SP compared to controls. When controlling trait SA, between-group differences in indications of embarrassment, and consequently in PEP, dissipated.

Conclusions

PEP could be interpreted as a common coping strategy among all individuals, while more frequent embarrassment might be specific for clinical groups. Embarrassment was primarily driven by SA. The alleviation of SA could lead to the reduction of embarrassment and, further, of PEP. On this basis, a model describing PEP in MDD is proposed, while current models of PEP in SP are complemented.

Individuals with social phobia or major depression experienced more embarrassing social interactions than healthy controls and, accordingly, more post-event processing.

The frequency of post-event rumination within embarrassing interactions was high in all groups (86-96%).

After controlling trait levels of social anxiety, between-group differences in the number of embarrassing situations, and consequently in post-event processing, dissipated.

When controlling trait levels of depression, post-event rumination was higher in social phobia compared to healthy controls and major depression.

Effects of Group-Based CBT on Post-Event Processing in Children with Social Anxiety Disorder Following an Experimental Social Stressor

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.

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.

Context-specific drinking and social anxiety: The roles of anticipatory anxiety and post-event processing

Individuals with clinically elevated social anxiety are especially vulnerable to alcohol-related problems, despite not drinking more than those with less anxiety. It is therefore important to identify contexts in which socially anxious persons drink more to inform intervention efforts. This study tested whether social anxiety was related to greater drinking before, during, or after a social event and whether such drinking was related to the psychosocial factors anticipatory anxiety or post-event processing (PEP; review of the social event). Among past-month drinkers, those with clinically elevated or higher social anxiety (HSA; n = 212) reported more anticipatory anxiety, more pre-event drinking to manage anxiety, and PEP than those with normative or lower social anxiety (LSA; n = 365). There was a significant indirect effect of social anxiety on pre-drinking via anticipatory anxiety. Social anxiety was related to more drinking during the event indirectly via the serial effects of anticipatory anxiety and pre-drinking. Unexpectedly, PEP did not mediate or moderate the relation between social anxiety and post-event drinking. In sum, anticipatory anxiety was related to more drinking before, during, and after a social event and HSA drinkers were especially vulnerable to drinking more to manage this anxiety, which increased drinking before and during the event. This effect was specific to anticipatory anxiety and not evident for another social anxiety-specific risk factor, PEP. Thus, anticipatory anxiety may be an important therapeutic target for drinkers generally and may be especially important among HSA drinkers.

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

PURPOSE

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

METHOD

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

RESULTS

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

CONCLUSION

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

Cannabis-Related Problems and Social Anxiety: The Mediational Role of Post-Event Processing

BACKGROUND

Cannabis is the most commonly used illicit drug in the US, and is associated with a range of psychological, social, and physical health-related problems. Individuals who endorse elevated levels of social anxiety are especially at risk for experiencing cannabis-related problems, including cannabis use disorder, despite not using cannabis more often than those with more normative social anxiety. Identification of mechanisms that underlie the relationship between social anxiety and cannabis-related problems may inform treatment and prevention efforts. Post-event processing (PEP, i.e., cognitively reviewing past social interactions/performances) is a social anxiety-related phenomenon that may be one such mechanism.

OBJECTIVES

The current study sought to test PEP as a mediator of the relationship between social anxiety and cannabis-related problems, adjusting for cannabis use frequency.

METHOD

Cannabis-using (past 3-month) undergraduate students recruited in 2015 (N = 244; 76.2% female; 74.2% Non-Hispanic Caucasian) completed an online survey of cannabis use, cannabis-related problems, social anxiety, and PEP.

RESULTS

Bootstrap estimate of the indirect effect of social anxiety through PEP was significant, suggesting PEP is a mediator of the social anxiety-cannabis-related problems relationship. Conclusions/Importance: Treatment and prevention efforts may benefit from targeting PEP among individuals with elevated social anxiety and cannabis-related problems.

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.

A Comprehensive Review of the Cognitive Determinants of Anxiety and Rumination in Social Anxiety Disorder

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.

Shame as a predictor of post-event rumination in social anxiety

Evidence shows that people with high social anxiety levels ruminate about distressing social events, which contributes to the maintenance of social anxiety symptoms. The present study aimed to explore the role of shame in maintaining post-event rumination (PER) following a negative social event (an impromptu speech with negative feedback) in a student sample (N = 104). Participants reported negative rumination related to the event one day and one week after the speech. PER measured one day after the speech was not associated with social anxiety symptoms and state anxiety. One week later, participants with clinically relevant social anxiety symptoms experienced greater PER. State shame was the only significant predictor of PER in a regression equation that also included social anxiety symptoms, state anxiety and self-evaluation of performance. Possible explanations and implications are discussed in light of cognitive models of social anxiety.

Social anxiety and post-event processing among African-American individuals

BACKGROUND

Social anxiety is among the most prevalent psychiatric conditions, yet little attention has been paid to whether putative cognitive vulnerability factors related to social anxiety in predominantly White samples are related to social anxiety among historically underrepresented groups.

DESIGN

We tested whether one such vulnerability factor, post-event processing (PEP; detailed review of social event that can increase state social anxiety) was related to social anxiety among African-American (AA; n = 127) persons, who comprise one of the largest underrepresented racial groups in the U.S. Secondarily, we tested whether AA participants differed from non-Hispanic White participants (n = 127) on PEP and social anxiety and whether race moderated the relation between PEP and social anxiety.

METHOD

Data were collected online among undergraduates.

RESULTS

PEP was positively correlated with social anxiety among AA participants, even after controlling for depression and income, pr = .30, p = .001. AA and White participants did not differ on social anxiety or PEP, β = -1.57, 95% CI: -5.11, 1.96. The relation of PEP to social anxiety did not vary as a function of race, β = 0.00, 95% CI: -0.02, 0.02.

CONCLUSIONS

PEP may be an important cognitive vulnerability factor related to social anxiety among AA persons suffering from social anxiety.

Post-event processing in social anxiety disorder after real-life social situations - An ambulatory assessment study

Excessive post-mortem processing after social situations, a core symptom of social anxiety disorder (SAD), is thought to contribute to the perpetuation of social anxiety by consolidating negative self-schemata. Empirical findings on actual mechanisms underlying this so-called Post-Event Processing (PEP) are still scarce. The present study sought to identify variables associated with the experience of PEP after real-life social situations in a sample of 49 individuals diagnosed with SAD. Using an ambulatory assessment approach, individuals were asked to report on each distressing social event experienced during one week. A total of 192 events were captured. Hierarchical linear modeling indicated that next to trait social anxiety, the type of social situation (performance vs. interaction situations), self-focused attention, safety behavior use, and negative affect predicted levels of PEP after social situations. These findings add to the growing literature that emphasizes the importance of situational factors for the experience of PEP, and highlight potential venues to prevent it.

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.

Post-Event Processing across Multiple Anxiety Presentations: Is it Specific to Social Anxiety Disorder?

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.

Phenomenological aspects of the cognitive rumination construct

OBJECTIVE

To evaluate the importance of phenomenological aspects of the cognitive rumination (CR) construct in current empirical psychiatric research.

METHOD

We searched SciELO, Scopus, ScienceDirect, MEDLINE, OneFile (GALE), SpringerLink, Cambridge Journals and Web of Science between February and March of 2014 for studies whose title and topic included the following keywords: cognitive rumination; rumination response scale; and self-reflection. The inclusion criteria were: empirical clinical study; CR as the main object of investigation; and study that included a conceptual definition of CR. The studies selected were published in English in biomedical journals in the last 10 years. Our phenomenological analysis was based on Karl Jaspers' General Psychopathology.

RESULTS

Most current empirical studies adopt phenomenological cognitive elements in conceptual definitions. However, these elements do not seem to be carefully examined and are indistinctly understood as objective empirical factors that may be measured, which may contribute to misunderstandings about CR, erroneous interpretations of results and problematic theoretical models.

CONCLUSION

Empirical studies fail when evaluating phenomenological aspects of the cognitive elements of the CR construct. Psychopathology and phenomenology may help define the characteristics of CR elements and may contribute to their understanding and hierarchical organization as a construct. A review of the psychopathology principles established by Jasper may clarify some of these issues.

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.

Perfectionism, emotion regulation and their relationship to negative affect in patients with social phobia

CONTEXT

Research on the perfectionism and emotion regulation strategies in anxiety disorders has gained increased attention. These have an important implication for formulation of therapies.

AIMS

We examined perfectionism, emotion regulation were examined in 30 patients with social phobia (SP) and 30 community participants.

SETTINGS AND DESIGN

A cross-sectional design using a clinical and a community control sample was adopted in this exploratory study.

MATERIALS AND METHODS

Participants were assessed on The Mini-International Neuropsychiatric Interview, Frost's-Multidimensional Perfectionism Scale, Ruminative Response Scale of the response style questionnaire, cognitive emotion regulation questionnaire, Social Interaction Anxiety Scale and the Beck's Depression Inventory.

STATISTICAL ANALYSIS

Data was analyzed using independents samples t-test and Pearson's Product moment correlations and step-wise linear regression.

RESULTS

Individuals with SP had higher perfectionism (mean = 100.30, SD = ±17.73, t = 7.29, P < 0.001), rumination (mean = 61.47, SD = ±11.96, t = 6.71, P < 0.001) and lower levels of positive reappraisal (mean = 11.53, SD = ±3.85, t = 4.90, P < 0.001). Perfectionism was correlated with social anxiety (r = 0.44, P < 0.05) and rumination (r = 0.43, P < 0.05), but not with depression. Rumination was positively correlated with both social anxiety (r = 0.513, P < 0.01) and depression (r = 0.485, P < 0.01). Positive reappraisal was negatively correlated with depression (r = -0.396, P < 0.05) and anxiety (r = -0.335, P < 0.05). Acceptance was found to be significantly correlated only to the reflective pondering subscale of rumination. Parental criticism was a significant predictor of social anxiety (F = 11.11, P < 0.01) and brooding predicted depression (F = 10.49, P < 0.01).

CONCLUSIONS

This study highlights the role of perfectionism as a maintaining factor in SP and the importance of adaptive forms of emotion regulation that need to be addressed in psychological interventions.

The expanding cognitive-behavioural therapy treatment umbrella for the anxiety disorders: disorder-specific and transdiagnostic approaches

Cognitive-behavioural therapy (CBT) is an empirically supported treatment for anxiety disorders. CBT treatments are based on disorder-specific protocols that have been developed to target individual anxiety disorders, despite that anxiety disorders frequently co-occur and are comorbid with depression. Given the high rates of diagnostic comorbidity, substantial overlap in dimensional symptom ratings, and extensive evidence that the mood and anxiety disorders share a common set of psychological and biological vulnerabilities, transdiagnostic CBT protocols have recently been developed to treat the commonalities among the mood and anxiety disorders. We conducted a selective review of empirical developments in the transdiagnostic CBT treatment of anxiety and depression (2008-2013). Preliminary evidence suggests that theoretically based transdiagnostic CBT approaches lead to large treatment effects on the primary anxiety disorder, considerable reduction of diagnostic comorbidity, and some preliminary effects regarding the impact on the putative, shared psychological mechanisms. However, the empirical literature remains tentative owing to relatively small samples, limited direct comparisons with disorder-specific CBT protocols, and the relative absence of the study of disorder-specific compared with shared mechanisms of action in treatment. We conclude with a treatment conceptualization of the new transdiagnostic interventions as complementary, rather than contradictory, to disorder-specific CBT.

Anticipatory and Post-Event Rumination in Social Anxiety Disorder: A Review of the Theoretical and Empirical Literature

Social anxiety disorder (SAD) is a psychological disorder characterised by an excessive and persistent fear of social or performance situations, which interferes with daily functioning. Cognitive models of SAD (Clark & Wells, 1995; Hofmann, 2007; Rapee & Heimberg, 1997) emphasise the importance of negative pre- and post-event rumination as a maintaining factor in the cycle of SAD. While the link between negative rumination and SAD is well supported by empirical research, little is understood about this cognitively important process; thus, research investigating the predictors of negative rumination in SAD is important to consider. Within the current literature, performance appraisal appears to be the most likely unique cognitive predictor of post-event rumination. There is limited research into cognitive predictors of pre-event rumination. Treatments targeting this maintaining factor are important to consider. Suggestions for future research examining the cognitive models of SAD by experimentally manipulating perceived social standards in order to examine the impact of high and low perceived social standard on appraisal processes (i.e., threat appraisal and performance appraisal), state social anxiety, and negative pre-event and post-event rumination, are proposed. Implications for theoretical models and efficacious treatments for SAD are discussed.

Validation of the Dutch Version of the Perseverative Thinking Questionnaire (PTQ-NL)

Repetitive negative thinking (RNT) has been shown to be involved in the maintenance of a variety of emotional problems. In addition, earlier research found that different forms of RNT such as worry and rumination show very similar characteristics. It was therefore suggested that RNT is best conceptualized as a transdiagnostic process. The Perseverative Thinking Questionnaire (PTQ) was developed as a content-independent measure of RNT to allow research into this process from a transdiagnostic perspective. In a recent study, good psychometric properties were established for the original German and English versions of the measure. The current study describes the crossvalidation of the PTQ in two Dutch-speaking samples, one from the Netherlands and one from Belgium (total N = 1,845). The factor structure of the original PTQ with one higher-order factor and three lower-order factors was replicated for the Dutch-language version of the measure (PTQ-NL) using confirmatory factor analyses. In addition, the PTQ-NL showed good internal consistency and satisfactory stability. The validity of the measure was supported by substantial correlations with existing measures of RNT as well as with symptom levels of depression and anxiety.

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.

Does social anxiety predict rumination and co-rumination among adolescents?

Social anxiety in adolescence is manifested by anxiety about and avoidance of social interactions. The present study examined whether social anxiety predicts higher levels of both rumination and co-rumination over time. Rumination and co-rumination were studied as possible outcomes because the cognitive content of these processes often involves interpersonal concerns. A three-wave longitudinal study of 575 adolescents (aged 13-16 years old) was conducted over 6 months. Adolescent girls reported higher levels of social anxiety, rumination, and co-rumination than boys. Structural equation modelling analysis showed that social anxiety directly predicted higher levels of rumination and indirectly predicted higher levels of co-rumination over time. A gender difference was noted in that these relationships were more robust for girls than for boys.

Mindfulness and the attenuation of post-event processing in social phobia: an experimental investigation

The present experimental study examined the ability of metacognitive strategies to reduce the distress associated with post-event processing (PEP). Individuals with DSM-IV generalized social phobia (N = 57) were randomly allocated to receive brief training in mindfulness, distraction, or no training (control group). Next, they underwent an experimental PEP induction. Following the induction, they were instructed to apply the metacognitive strategy (mindfulness or distraction) they were taught or to continue thinking about the social event the way they typically would following such an event (control). Participants rated their distress on a visual analogue scale prior to the PEP induction, and then every minute for 5 min while applying the metacognitive strategy. They also rated their affect immediately after applying the metacognitive strategy. Results suggest that mindfulness reduces distress significantly over the post-event period and results in significantly more positive affect than when receiving no training. In contrast, distraction does not reduce distress over the post-event period performs comparable to receiving no training. The results of this experimental investigation suggest that mindfulness has the potential to reduce distress associated with PEP and provide further support for the clinical utility of mindfulness in the treatment of generalized social phobia.