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Adamis AM, Walske S, Olatunji BO. Attention mechanisms of social anxiety in daily life: Unique effects of negative self-focused attention on post-event processing. Behav Res Ther 2025; 191:104759. [PMID: 40318602 DOI: 10.1016/j.brat.2025.104759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2025] [Revised: 03/07/2025] [Accepted: 04/28/2025] [Indexed: 05/07/2025]
Abstract
Social anxiety disorder (SAD) is characterized by biased patterns of attention that are theorized to play a key role in maintaining symptoms. SAD has been linked to externally oriented attentional biases (i.e., towards social-evaluative threats) and internally oriented attentional biases (i.e., towards anxiety-laden thoughts and sensations), both of which might increase proneness for post-event processing (PEP), a form of rumination about the negative aspects of past social events. However, prior research examining attentional biases in SAD has primarily been conducted in laboratory settings, leaving unanswered questions about the naturalistic patterns of attention and cognition that most strongly characterize and maintain social anxiety. The present study applied ecological momentary assessment (EMA) to examine attentional biases during real-world social interactions and their effects on subsequent PEP in a sample of adults with high (n = 108) and low (n = 94) levels of social anxiety. Three times per day for one week, participants reported their attention orientation (i.e., internal versus external), the valence of their attentional foci (i.e., negative versus positive), and their degree of PEP following salient social events. Results revealed that high (vs. low) levels of social anxiety were associated with relatively more internally oriented and negatively valenced attention during social interactions, which in turn predicted increases in subsequent PEP. Findings highlight the salience of negative self-focused attention and ruminative thinking as maintenance factors in social anxiety, and suggest that interventions targeting these mechanisms could show promise in future research.
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Affiliation(s)
- Alexandra M Adamis
- Vanderbilt University, 111 21st Avenue South, Nashville, TN, 37203, USA.
| | - Savannah Walske
- Vanderbilt University, 111 21st Avenue South, Nashville, TN, 37203, USA
| | - Bunmi O Olatunji
- Vanderbilt University, 111 21st Avenue South, Nashville, TN, 37203, USA
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2
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Flynn AJ, Yoon KL. Post-event processing in social anxiety: A scoping review. J Anxiety Disord 2025; 109:102947. [PMID: 39622110 DOI: 10.1016/j.janxdis.2024.102947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Revised: 10/17/2024] [Accepted: 11/21/2024] [Indexed: 01/13/2025]
Abstract
Graded exposure successfully reduces fear in specific phobias and anxiety disorders, yet social exposure in daily life often fails to mitigate social anxiety. Post-event processing, perseverative, negative, self-referential thinking that occurs following a social-evaluative event, may partly explain inhibited desensitization to social fears. Post-event processing has been studied extensively since its first description by Clark and Wells (1995) and previously reviewed (e.g., Brozovich & Heimberg, 2008; Wong, 2016). However, these reviews are now dated or limited in scope. In the present scoping review, we pay particular attention to contemporary research that addresses unanswered questions raised in past reviews (e.g., Brozovich & Heimberg, 2008), synthesizing existing knowledge. Specifically, we discuss post-event processing's evolving role in cognitive models of social anxiety disorder, its core features, its eliciting situations (e.g., performance vs. social interactions), its relation to other cognitive and affective constructs (e.g., memory, performance appraisal, self-focused attention), and its assessment. Our findings indicate that post-event processing is more frequent after performance situations than social interactions, is related to negative memory biases, is bi-directionally related to worsening performance appraisals, and may be precipitated by self-focused attention. Future research directions include elucidating post-event processing's course, clarifying post-event processing's potential causal role in the development of social anxiety disorder, and identifying factors that underlie post-event processing's deleterious nature.
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Affiliation(s)
- Aidan J Flynn
- University of Maryland, Baltimore County, Baltimore, USA.
| | - K Lira Yoon
- University of Maryland, Baltimore County, Baltimore, USA
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3
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Basanovic J, Kowal L, Millward S, MacLeod C. The legacy of social anxiety-linked negative expectancy: A pathway from pre-event negative expectancies to post-event negative thinking. J Behav Ther Exp Psychiatry 2024; 83:101937. [PMID: 38134620 DOI: 10.1016/j.jbtep.2023.101937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 07/12/2023] [Accepted: 12/09/2023] [Indexed: 12/24/2023]
Abstract
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.
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Affiliation(s)
- Julian Basanovic
- Psychology, University of Exeter, United Kingdom; Centre for the Advancement of Research on Emotion, School of Psychological Science, The University of Western Australia, Australia.
| | - Lily Kowal
- Centre for the Advancement of Research on Emotion, School of Psychological Science, The University of Western Australia, Australia
| | | | - Colin MacLeod
- Centre for the Advancement of Research on Emotion, School of Psychological Science, The University of Western Australia, Australia
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4
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Edgar EV, Richards A, Castagna PJ, Bloch MH, Crowley MJ. Post-event rumination and social anxiety: a systematic review and meta-analysis. J Psychiatr Res 2024; 173:87-97. [PMID: 38518572 PMCID: PMC11018455 DOI: 10.1016/j.jpsychires.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 02/03/2024] [Accepted: 03/12/2024] [Indexed: 03/24/2024]
Abstract
Post-event rumination, the extent to which one engages in persistent, detailed, and negative thinking following social situations, serves as a risk process in the pathophysiology of social anxiety. Although a substantial body of research has assessed post-event rumination and social anxiety, this literature has produced inconsistent results. We conducted a systematic review and meta-analysis to examine whether the magnitude of the association between post-event rumination and social anxiety varied as a function of questionnaire and/or task utilized. We included all studies reporting a correlation between post-event rumination and social anxiety symptomatology. Fisher's z correlation coefficients were calculated through random-effect meta-analyses. Results indicated a moderate association between post-event rumination and social anxiety symptomatology (r = 0.45, p < 0.001, 95%CI [0.40-0.50]). Subgroup meta-analyses indicated that the type of questionnaire used to assess post-event rumination (Q = 44.36, df = 3, p < 0.001) and social anxiety (Q = 26.44, df = 8, p < 0.001), as well as the task conducted prior to assessing post-event rumination (Q = 14.31, df = 2, p < 0.001), influenced the effect size. This study demonstrates a moderate relation between post-event rumination and social anxiety across the anxiety spectrum, illustrating the importance of treatments specifically targeting post-event rumination. Moreover, we highlight the importance of taking care when designing studies to explore relations between post-event rumination and social anxiety.
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Affiliation(s)
- Elizabeth V Edgar
- Yale Child Study Center, Yale School of Medicine, New Haven, CT, USA.
| | - Ashlyn Richards
- Department of Psychology, Sewanee the University of the South, Sewanee, TN, USA
| | - Peter J Castagna
- Department of Psychology, The University of Alabama, Tuscaloosa, AL, USA
| | - Michael H Bloch
- Yale Child Study Center, Yale School of Medicine, New Haven, CT, USA
| | - Michael J Crowley
- Yale Child Study Center, Yale School of Medicine, New Haven, CT, USA
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Wanza C, Rief W, Doering BK. The Inventory of Social Expectations in Bereavement: Development and psychometric validation of a new instrument. DEATH STUDIES 2024; 49:238-248. [PMID: 38424671 DOI: 10.1080/07481187.2024.2318592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Negative expectations concerning social interactions contribute to feelings of loneliness. Since loneliness is one of the most pronounced challenges for bereaved individuals, we investigated grief-specific social expectations and its association with loneliness and grief severity. Initially, we developed an Inventory of Social Expectations in Bereavement (ISEB). Its factorial and psychometric validity was then tested in a bereaved sample (N = 344; 28.3 ± 11.1 years; 74.4% female). A two-factor solution for the scale fit the data best (factor 1: "relationship to others," factor 2: "relationship to the deceased") and demonstrated good psychometric validity. Higher ISEB-levels were associated with higher levels in grief severity and loneliness. The results suggest that individual social expectations affect the experience of loneliness after the loss of a significant other. The ISEB assesses these expectations time-efficiently and provides a basis for therapeutic interventions. Expressing expectations as probabilistic beliefs about the future renders them amenable for corrective experiences in clinical practice.
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Affiliation(s)
- Caroline Wanza
- Clinical Psychology and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Winfried Rief
- Clinical Psychology and Psychotherapy, Philipps-University Marburg, Marburg, Germany
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Sujamani M, Kanth B. Self-compassion, Positive and Negative Affect and Social Avoidance among Adolescence: Mediating Role of Mindfulness. Clin Pract Epidemiol Ment Health 2023; 19:e17450179268979. [PMID: 38660066 PMCID: PMC11041389 DOI: 10.2174/0117450179268979231114045116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/02/2023] [Accepted: 10/10/2023] [Indexed: 04/26/2024]
Abstract
Objective Mindfulness is an attribute of consciousness to manage social fear avoidance and promote well-being. Social anxiety is a common psychological experience noted among the general population. Social anxiety develops during adolescence and is prevalent among college students. This study investigates the factors contributing to social anxiety - fear and avoidance of social situations of female first-year undergraduates. Methods The study used a survey research design. A sample of 821 first-year female undergraduate students aged between 17 and 19. Data were collected using the Liebowitz Social anxiety scale, the Five-Facet mindfulness questionnaire, A short form of the Self-compassion scale, and the Positive and Negative affect scale. Results Mindfulness weakens social fear and reduces the tendency to avoid social situations. Mindfulness effectively mediates the impact of self-compassion's positive affect and negative effects on social fear. Mindfulness and social fear jointly mediate the impact of self-compassion, positive affect, and negative affect on social avoidance. Conclusion Mindfulness is the awareness and acceptance of the feelings, thoughts and sensations attached to self and its possible reciprocity with social surroundings to mitigate fear-self-compassion and positive emotional affect augment, and negative emotional affect attenuate mindfulness. Results analysis highlights the mediation of mindfulness on social anxiety, self-compassion, positive affect, and negative affect.
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Affiliation(s)
- M.S. Sujamani
- Department of Psychology, Presidency College, Chennai, India
| | - Barani Kanth
- Department of Applied Psychology, Pondicherry University, Pondicherry-605014, India
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Gavric D, Cameron D, Waechter S, Moscovitch DA, McCabe RE, Rowa K. Just do something: An experimental investigation of brief interventions for reducing the negative impact of post-event processing in social anxiety disorder. J Anxiety Disord 2023; 98:102744. [PMID: 37478698 DOI: 10.1016/j.janxdis.2023.102744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 06/02/2023] [Accepted: 07/12/2023] [Indexed: 07/23/2023]
Abstract
Post-Event Processing (PEP) is prevalent and problematic in Social Anxiety Disorder (SAD) but is typically not a direct target in evidence-based treatments such as cognitive behavioural therapy (CBT) for SAD. The primary aim of the current study was to examine the impact of several theoretically and empirically derived interventions for PEP in SAD, including concrete thinking, abstract thinking, and distraction in comparison to a control (i.e., do nothing) condition. Based on prior research, we hypothesized that the concrete and distract conditions would be associated with positive benefits, including reductions in PEP and improvements in self-perception, whereas the abstract and control conditions would not. The second aim of the study was to identify baseline variables that predict the trajectory of change in PEP over time. Participants (N=92) with a principal diagnosis of SAD completed a social stress task and were randomly assigned to one of four conditions. Participants completed measures at baseline, post-intervention/control, and at 1-week, and 1-month follow-up. Contrary to hypotheses, all three active conditions were similarly effective at reducing PEP and improving self-perceptions relative to the control condition. In the absence of an intervention, engagement in PEP remained high up to a month following the social stress task. Higher levels of baseline state anxiety, intolerance of uncertainty, and use of safety behaviours predicted greater PEP, even in the presence of an intervention. These results highlight the benefits of relatively brief interventions that disrupt the course of PEP for people with SAD. Such interventions can be easily incorporated into CBT protocols for SAD to enhance their effects.
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Affiliation(s)
- Dubravka Gavric
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 3K7, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L8S 4L8, Canada.
| | - Duncan Cameron
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 3K7, Canada
| | - Stephanie Waechter
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 3K7, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - David A Moscovitch
- Department of Psychology and Centre for Mental Health Research and Treatment, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Randi E McCabe
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 3K7, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Karen Rowa
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 3K7, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L8S 4L8, Canada
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Falon SL, Kangas M, Crane MF. The coping insights involved in strengthening resilience: The Self-Reflection and Coping Insight Framework. ANXIETY STRESS AND COPING 2021; 34:734-750. [PMID: 33834896 DOI: 10.1080/10615806.2021.1910676] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Recent theoretical work suggests that self-reflection on daily stressors and the efficacy of coping strategies and resources is beneficial for the enhancement of resilient capacities. However, coping insights emerging from self-reflection, and their relationship to resilient capacities, is an existing gap in our understanding. OBJECTIVES Given that insights come in many forms, the objective of this paper is to delineate exemplar coping insights that strengthen the capacity for resilience. METHODS After providing an overview of self-reflection and insight, we extend the Systematic Self-Reflection model of resilience strengthening by introducing the Self-Reflection and Coping Insight Framework to articulate how the emergence of coping insights may mediate the relationship between five self-reflective practices and the enhancement of resilient capacities. RESULTS We explore the potential for coping insights to convey complex ideas about the self in the context of stressor exposure, an awareness of response patterns to stressors, and principles about the nature of stress and coping across time and contexts. CONCLUSIONS This framework adds to existing scholarship by providing a characterization of how coping insight may strengthen resilient capacities, allowing for a guided exploration of coping insight during future research.
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Affiliation(s)
- Samantha L Falon
- Department of Psychology, Macquarie University, North Ryde, NSW, Australia
| | - Maria Kangas
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
| | - Monique F Crane
- Department of Psychology, Macquarie University, North Ryde, NSW, Australia
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Chiu K, Clark DM, Leigh E. Cognitive predictors of adolescent social anxiety. Behav Res Ther 2021; 137:103801. [PMID: 33421893 PMCID: PMC7846721 DOI: 10.1016/j.brat.2020.103801] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 12/10/2020] [Accepted: 12/28/2020] [Indexed: 11/25/2022]
Abstract
Background Identifying psychological processes that maintain social anxiety holds promise for improving treatment outcomes for young people. Experimental and prospective studies in adults suggest negative social cognitions, safety behaviours, self-focused attention, and pre- and post-event processing are all implicated in the maintenance of social anxiety. Despite social anxiety typically starting in adolescence, prospective studies examining these cognitive processes in youth are lacking. The current study examined prospective associations between these five cognitive processes and social anxiety in a sample of 614 participants (53% girls; aged 11–14 years). Methods Psychological processes, social anxiety symptoms, and depressive symptoms were assessed using self-report questionnaires at two time points. Results Negative social cognitions, safety behaviours, self-focused attention, and post-event processing predicted prospective levels of social anxiety over and above the effect of baseline levels of social anxiety. When these process variables were entered together in a regression model, three of them were independently associated with prospective social anxiety. Neither pre- nor post-event processing independently predicted later social anxiety over and above the effects of other psychological process variables. Conclusions The findings indicate that these psychological processes are promising targets for treatment in adolescent social anxiety. The applicability of the cognitive model of Clark & Wells was tested in a sample of 614 adolescents. Negative social cognitions independently predicted increases in social anxiety. Safety behaviours independently predicted increases in social anxiety. Self-focused attention independently predicted increases in social anxiety. Unexpectedly, neither pre- or post-event processing was an independent predictor of social anxiety.
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Affiliation(s)
- Kenny Chiu
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King'sCollege London, London, UK
| | - David M Clark
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Eleanor Leigh
- Department of Experimental Psychology, University of Oxford, Oxford, UK.
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Asbrand J, Schmitz J, Krämer M, Nitschke K, Heinrichs N, Tuschen-Caffier B. Effects of Group-Based CBT on Post-Event Processing in Children with Social Anxiety Disorder Following an Experimental Social Stressor. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 47:1945-1956. [PMID: 31073879 DOI: 10.1007/s10802-019-00558-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Theoretical models and previous research suggest that post-event processing (PEP) after social situations maintains social anxiety disorder (SAD). To date, little is known about PEP in childhood, a critical period for disorder development, or about possible positive effects of cognitive behavioral therapy (CBT) on PEP in children. Children with SAD (n = 71; aged 9-13 years) and healthy controls (n = 55) participated in a social stress task (Trier Social Stress Test for Children, TSST-C), which was repeated in children with SAD after either 12 sessions of CBT or a waiting period. PEP was assessed daily with regard to both valence and frequency, as well as in more detail regarding specific negative and positive ruminative thoughts 1 week after each TSST-C. Daily PEP after the TSST-C was more frequent and more negative in children with SAD compared to healthy controls, in particular during the first 2 days after the TSST-C. After CBT treatment, children with SAD reported more positive PEP but not less negative PEP compared to children in the waitlist control group. The current study suggests that negative PEP in children with SAD is most pronounced in the first days following social stress. Group-based CBT seems to be effective in building up positive cognitions after social stress in children, but developing specific interventions targeting negative PEP immediately after a social stressor may be necessary to further increase treatment efficacy.
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Affiliation(s)
- Julia Asbrand
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg im Breisgau, Germany.
| | - Julian Schmitz
- Department for Clinical Child and Adolescent Psychology, Leipzig University, Leipzig, Germany.,Leipzig Research Center for Early Child Development, Leipzig University, Leipzig, Germany
| | - Martina Krämer
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg im Breisgau, Germany
| | - Kai Nitschke
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg im Breisgau, Germany
| | - Nina Heinrichs
- Institute of Psychology, University of Braunschweig, Braunschweig, Germany
| | - Brunna Tuschen-Caffier
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg im Breisgau, Germany
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Self-Focused Attention as a Predictor of Post-event and Anticipatory Processing: Examination of a Moderation Model. Int J Cogn Ther 2020. [DOI: 10.1007/s41811-020-00072-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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12
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Buckner JD, Lewis EM, Terlecki MA, Albery IP, Moss AC. Context-specific drinking and social anxiety: The roles of anticipatory anxiety and post-event processing. Addict Behav 2020; 102:106184. [PMID: 31770693 DOI: 10.1016/j.addbeh.2019.106184] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 10/11/2019] [Accepted: 10/14/2019] [Indexed: 10/25/2022]
Abstract
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.
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Blackie RA, Kocovski NL. Examining the Relationships Among Self-Compassion, Social Anxiety, and Post-Event Processing. Psychol Rep 2017; 121:669-689. [DOI: 10.1177/0033294117740138] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
| | - Nancy L. Kocovski
- Department of Psychology, Wilfrid Laurier University, Waterloo, Canada
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14
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Wong QJJ, Gregory B, McLellan LF, Kangas M, Abbott MJ, Carpenter L, McEvoy PM, Peters L, Rapee RM. Anticipatory Processing, Maladaptive Attentional Focus, and Postevent Processing for Interactional and Performance Situations: Treatment Response and Relationships With Symptom Change for Individuals With Social Anxiety Disorder. Behav Ther 2017; 48:651-663. [PMID: 28711115 DOI: 10.1016/j.beth.2017.03.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 03/29/2017] [Accepted: 03/29/2017] [Indexed: 10/19/2022]
Abstract
Anticipatory processing, maladaptive attentional focus, and postevent processing are key cognitive constructs implicated in the maintenance of social anxiety disorder (SAD). The current study examined how treatment for SAD concurrently affects these three cognitive maintaining processes and how these processes are associated with each other as well as with symptom change from pre- to posttreatment. The sample consisted of 116 participants with SAD receiving group cognitive behavioral therapy. All three cognitive maintaining processes were measured relative to a speech task and again relative to a conversation task. Across both tasks, the three cognitive process variables demonstrated decreases from pre- to posttreatment. Within the same task, a slower rate of decrease in a specific cognitive process variable from pre- to posttreatment was predicted from higher pretreatment levels of either one or both of the other cognitive process variables. Additionally, higher levels of pretreatment conversation-related anticipatory processing and maladaptive attentional focus predicted a slower rate of decrease in social anxiety symptoms from pre- to posttreatment. Results are consistent with cognitive models of SAD and have important implications for enhancing existing treatments.
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Gkika S, Wittkowski A, Wells A. Social cognition and metacognition in social anxiety: A systematic review. Clin Psychol Psychother 2017; 25:10-30. [PMID: 28836318 DOI: 10.1002/cpp.2127] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 07/17/2017] [Accepted: 07/19/2017] [Indexed: 01/12/2023]
Abstract
Cognitive-behavioural and metacognitive approaches to emotional disorder implicate beliefs in social anxiety, but the types of beliefs differ across these perspectives. Cognitive models suggest that social beliefs about the self (i.e., high standards and conditional and unconditional beliefs) are central. In contrast, the metacognitive model gives centre stage to metacognitive beliefs (i.e., positive and negative beliefs about thinking) as main contributors to the maintenance of the disorder. Despite an expanding research interest in this area, the evidence for such contributions has not yet been reviewed. This study set out to systematically review relevant cross-sectional, longitudinal, and experimental investigations of the direct and indirect (through cognitive processes, such as anticipatory processing, self-focused attention, the post-mortem, and avoidance) relationships of social and metacognitive beliefs with social anxiety. Clinical and nonclinical samples were included, and correlation and regression coefficients as well as results from group comparisons (e.g., t tests and analyses of variance) were extracted. Overall, 23 papers were located, through PsycINFO, PubMed, and Web of Science, and reviewed using narrative synthesis. The results showed a robust positive relationship between social beliefs and social anxiety that appeared to be mediated by cognitive processes. Specific metacognitive beliefs were found to positively contribute to social anxiety both directly and indirectly, through cognitive processes. The study's findings are limited to 2 models of social anxiety and other minor limitations (e.g., grey literature was excluded). With these accounted for, the results are discussed in terms of the conceptualization and treatment of social anxiety and suggestions for future research are made.
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Affiliation(s)
- Styliani Gkika
- The University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Anja Wittkowski
- The University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Adrian Wells
- The University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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Gavric D, Moscovitch DA, Rowa K, McCabe RE. Post-event processing in social anxiety disorder: Examining the mediating roles of positive metacognitive beliefs and perceptions of performance. Behav Res Ther 2017; 91:1-12. [DOI: 10.1016/j.brat.2017.01.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 12/22/2016] [Accepted: 01/03/2017] [Indexed: 11/17/2022]
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Wong QJJ, Rapee RM. The aetiology and maintenance of social anxiety disorder: A synthesis of complimentary theoretical models and formulation of a new integrated model. J Affect Disord 2016; 203:84-100. [PMID: 27280967 DOI: 10.1016/j.jad.2016.05.069] [Citation(s) in RCA: 173] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 04/24/2016] [Accepted: 05/28/2016] [Indexed: 01/21/2023]
Abstract
BACKGROUND Within maintenance models of social anxiety disorder (SAD), a number of cognitive and behavioural factors that drive the persistence of SAD have been proposed. However, these maintenance models do not address how SAD develops, or the origins of the proposed maintaining factors. There are also models of the development of SAD that have been proposed independently from maintenance models. These models highlight multiple factors that contribute risk to the onset of SAD, but do not address how these aetiological factors may lead to the development of the maintaining factors associated with SAD. METHODS A systematic review of the literature was conducted to identify aetiological and maintenance models of SAD. We then united key factors identified in these models and formulated an integrated aetiological and maintenance (IAM) model of SAD. A systematic review of the literature was then conducted on the components of the IAM model. RESULTS A number of aetiological and maintaining factors were identified in models of SAD. These factors could be drawn together into the IAM model. On balance, there is empirical evidence for the association of each of the factors in the IAM model with social anxiety or SAD, providing preliminary support for the model. LIMITATIONS There are relationships between components of the IAM model that require empirical attention. Future research will need to continue to test the IAM model. CONCLUSIONS The IAM model provides a framework for future investigations into the development and persistence of SAD.
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Affiliation(s)
- Quincy J J Wong
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia.
| | - Ronald M Rapee
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
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Blackie RA, Kocovski NL. Development and validation of the trait and state versions of the Post-Event Processing Inventory. ANXIETY STRESS AND COPING 2016; 30:202-218. [DOI: 10.1080/10615806.2016.1230668] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Piccirillo ML, Taylor Dryman M, Heimberg RG. Safety Behaviors in Adults With Social Anxiety: Review and Future Directions. Behav Ther 2016; 47:675-687. [PMID: 27816080 DOI: 10.1016/j.beth.2015.11.005] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Revised: 11/23/2015] [Accepted: 11/24/2015] [Indexed: 11/28/2022]
Abstract
Safety behaviors are considered an important factor in the maintenance of social anxiety disorder (SAD). Safety behaviors are typically employed by socially anxious individuals to reduce anxiety in feared social situations. However, by preventing individuals with social anxiety from gathering evidence that would disconfirm their maladaptive beliefs about social situations, the use of safety behaviors ultimately maintains social anxiety over time. Twenty years ago, Wells and colleagues (1995) demonstrated that use of safety behaviors diminishes the efficacy of exposure treatment for SAD, suggesting that reduction in the use of safety behaviors during exposure can enhance treatment response. Research on safety behaviors has expanded considerably since Wells et al.'s seminal publication, and our understanding of the role safety behaviors may play in the maintenance of social anxiety has grown in breadth and depth. In this paper, we present a detailed review of the published research on safety behaviors relevant to social anxiety and social-anxiety-related processes. Finally, we evaluate the impact of safety behaviors on the outcome of treatment for SAD, and we look to the literature on safety behaviors in other anxiety disorders to inform our understanding of use of safety behaviors during exposure and to facilitate future research in SAD.
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Post-event processing in social anxiety disorder after real-life social situations - An ambulatory assessment study. Behav Res Ther 2016; 84:27-34. [PMID: 27442226 DOI: 10.1016/j.brat.2016.07.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 05/30/2016] [Accepted: 07/11/2016] [Indexed: 02/05/2023]
Abstract
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.
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Holzman JB, Valentiner DP. Self-focused attention affects subsequent processing of positive (but not negative) performance appraisals. J Behav Ther Exp Psychiatry 2016; 50:295-302. [PMID: 26562327 DOI: 10.1016/j.jbtep.2015.10.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 09/16/2015] [Accepted: 10/26/2015] [Indexed: 11/15/2022]
Abstract
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..
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Self-Focused Cognition in Social Anxiety: A Review of the Theoretical and Empirical Literature. BEHAVIOUR CHANGE 2016. [DOI: 10.1017/bec.2016.2] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Social anxiety disorder (SAD) is characterised by a marked and persistent fear of social or performance situations. Cognitive models suggest that self-focused cognitive processes play a crucial role in generating and maintaining social anxiety, and that self-focused cognition occurs prior to, during, and following social situations (Clark & Wells, 1995; Rapee & Heimberg, 1997). There is a substantial body of empirical evidence demonstrating that socially anxious individuals engage in self-focused cognition during and following a social or performance situation. A smaller but growing body literature suggests that a similar process occurs prior to such situations, and that these three processes are interdependent. Furthermore, the vast majority of research to date indicates that self-focused cognitive processes are detrimental, and that they generate and maintain social anxiety in a variety of ways. However, there remains considerable scope for research to further explicate the role of these processes in the maintenance of SAD, and to enhance interventions designed to ameliorate their negative effects.
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Wong QJJ, McEvoy PM., Rapee RM. A Comparison of Repetitive Negative Thinking and Post-Event Processing in the Prediction of Maladaptive Social-Evaluative Beliefs: A Short-Term Prospective Study. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2015. [DOI: 10.1007/s10862-015-9506-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Grisham JR, King BJ, Makkar SR, Felmingham KL. The contributions of arousal and self-focused attention to avoidance in social anxiety. ANXIETY STRESS AND COPING 2014; 28:303-20. [DOI: 10.1080/10615806.2014.968144] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Mitchell MA, Schmidt NB. General in-situation safety behaviors are uniquely associated with post-event processing. J Behav Ther Exp Psychiatry 2014; 45:229-33. [PMID: 24309066 DOI: 10.1016/j.jbtep.2013.11.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 08/15/2013] [Accepted: 11/04/2013] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND OBJECTIVES Research suggests that state anxiety and in-situation safety behaviors are associated with post-event processing (PEP) in social anxiety. Past research has obtained mixed results on whether one or both factors contribute to PEP. The current investigation evaluated state anxiety and in-situation safety behaviors (including subtypes of in-situation safety behaviors) simultaneously to determine their relative contributions to PEP. METHODS A prospective study assessed social anxiety, state anxiety, in-situation safety behaviors, PEP, and depression in the context of a speech stressor. RESULTS Consistent with theory, in-situation safety behaviors were uniquely associated with greater PEP. State anxiety was not uniquely associated with PEP. Furthermore, restricting and active subtypes of in-situation safety behaviors showed specificity to PEP. LIMITATIONS Limitations of the present study include the use of a nonclinical analog sample and retrospective reporting of PEP. CONCLUSIONS These findings highlight the importance of research on in-situation safety behaviors as a potential contributor to PEP.
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Affiliation(s)
- Melissa A Mitchell
- Department of Psychology, Florida State University, Tallahassee, FL 32306-4301, USA
| | - Norman B Schmidt
- Department of Psychology, Florida State University, Tallahassee, FL 32306-4301, USA.
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Anticipatory and Post-Event Rumination in Social Anxiety Disorder: A Review of the Theoretical and Empirical Literature. BEHAVIOUR CHANGE 2014. [DOI: 10.1017/bec.2014.3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
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.
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Holzman JB, Valentiner DP, McCraw KS. Self-Focused Attention and Post-Event Processing: Relevance to Social Performance Anxiety and Social Interaction Anxiety. J Cogn Psychother 2014; 28:72-82. [DOI: 10.1891/0889-8391.28.1.72] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
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.
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Perfectionism as a Predictor of Post-event Rumination in a Socially Anxious Sample. JOURNAL OF RATIONAL-EMOTIVE AND COGNITIVE-BEHAVIOR THERAPY 2013. [DOI: 10.1007/s10942-013-0175-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
Research on social anxiety and social anxiety disorder has proliferated over the years since the explication of the disorder through cognitive-behavioral models. This review highlights a recently updated model from our group and details recent research stemming from the (a) information processing perspective, including attention bias, interpretation bias, implicit associations, imagery and visual memories, and (b) emotion regulation perspective, including positive emotionality and anger. In addition, we review recent studies exploring the roles of self-focused attention, safety behaviors, and post-event processing in the maintenance of social anxiety. Within each area, we detail the ways in which these topics have implications for the treatment of social anxiety and for future research. Finally, we conclude with a discussion of how several of the areas reviewed contribute to our model of social anxiety disorder.
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Affiliation(s)
- Amanda S Morrison
- Department of Psychology, Temple University, Philadelphia, Pennsylvania 19122, USA.
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Nilsson JE, Lundh LG, Viborg G. Effects of Analytical and Experiential Self-focus on Rumination After a Stress Induction in Patients with Social Anxiety Disorder: A Pilot Study. Cogn Behav Ther 2012; 41:310-20. [DOI: 10.1080/16506073.2012.682088] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Constructive Effects of Engaging in Post-Event Processing in High and Low Socially Anxious Individuals. BEHAVIOUR CHANGE 2012. [DOI: 10.1017/bec.2012.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
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.
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Chiupka CA, Moscovitch DA, Bielak T. In Vivo Activation of Anticipatory vs. Post-Event Autobiographical Images and Memories in Social Anxiety. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2012. [DOI: 10.1521/jscp.2012.31.8.783] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Predicting post-event processing in social anxiety disorder following two prototypical social situations: State variables and dispositional determinants. Behav Res Ther 2012; 50:617-26. [DOI: 10.1016/j.brat.2012.06.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Revised: 04/03/2012] [Accepted: 06/12/2012] [Indexed: 02/05/2023]
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Gaydukevych D, Kocovski NL. Effect of self-focused attention on post-event processing in social anxiety. Behav Res Ther 2012; 50:47-55. [DOI: 10.1016/j.brat.2011.10.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 10/12/2011] [Accepted: 10/25/2011] [Indexed: 02/05/2023]
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