Post-event processing in social anxiety

Can an intervention designed to reduce repetitive negative thinking alter the response to a psychosocial stressor? A randomized controlled study

Prior research suggests that repetitive negative thinking (RNT) negatively impacts mental health by intensifying and prolonging emotional reactivity to stress. This study investigated whether an intervention designed to reduce RNT alters emotional reactivity. Young adults with high trait RNT (N = 79) were randomly allocated to an RNT-focused intervention (smartphone app-based, 10 days) or a waiting list before exposure to a standardized stressor. The pre-registered analysis did not reveal a significant condition * time interaction for negative affect. However, exploratory analyses showed that whilst initial increases in negative affect in response to the stressor did not differ between conditions, participants in the intervention condition reported less negative affect throughout the following recovery phase. Additionally, participants in the intervention condition appraised their ability to cope with the stressor as higher and reported less RNT in the recovery phase. In contrast, the intervention did not affect biological stress responses. The findings indicate that RNT-focused interventions might have positive effects on mental health by breaking the self-reinforcing cycle of RNT, negative affect and maladaptive appraisals in response to stress. However, as findings are partly based on exploratory analyses, further research is needed to confirm whether reduced subjective stress reactivity mediates the effects of RNT-focused interventions on psychopathological symptoms.

Acute psychosocial stress modulates neural and behavioral substrates of cognitive control

Acute psychosocial stress affects learning, memory, and attention, but the evidence for the influence of stress on the neural processes supporting cognitive control remains mixed. We investigated how acute psychosocial stress influences performance and neural processing during the Go/NoGo task-an established cognitive control task. The experimental group underwent the Trier Social Stress Test (TSST) acute stress induction, whereas the control group completed personality questionnaires. Then, participants completed a functional magnetic resonance imaging (fMRI) Go/NoGo task, with self-report, blood pressure and salivary cortisol measurements of induced stress taken intermittently throughout the experimental session. The TSST was successful in eliciting a stress response, as indicated by significant Stress > Control between-group differences in subjective stress ratings and systolic blood pressure. We did not identify significant differences in cortisol levels, however. The stress induction also impacted subsequent Go/NoGo task performance, with participants who underwent the TSST making fewer commission errors on trials requiring the most inhibitory control (NoGo Green) relative to the control group, suggesting increased vigilance. Univariate analysis of fMRI task-evoked brain activity revealed no differences between stress and control groups for any region. However, using multivariate pattern analysis, stress and control groups were reliably differentiated by activation patterns contrasting the most demanding NoGo trials (i.e., NoGo Green trials) versus baseline in the medial intraparietal area (mIPA, affiliated with the dorsal attention network) and subregions of the cerebellum (affiliated with the default mode network). These results align with prior reports linking the mIPA and the cerebellum to visuomotor coordination, a function central to cognitive control processes underlying goal-directed behavior. This suggests that stressor-induced hypervigilance may produce a facilitative effect on response inhibition which is represented neurally by the activation patterns of cognitive control regions.

Women's Safety Behaviors before and during Sexual Activity: Psychometric Properties of Its Self-Report Questionnaire in German Women

Sexual safety behaviors (SSB) may constitute a relevant factor for the development and maintenance of sexual dysfunctions. The present study aims to improve the understanding of SSB in women. A total of N = 923 women completed an online survey consisting of the Questionnaire on Behaviors Before and During Sexual Activities, a measure of SSB, and a set of other questionnaires that assessed sexual dysfunctions, anxiety, depression, and other clinically relevant variables. Exploratory and confirmatory factor analyses of the QBSA revealed a robust three-factor solution with 1) cognitive and behavioral avoidance, 2) use of lubricants, and 3) thought and body control. While some SSB were generally common in women, others discriminated well between women with sexual dysfunctions, women with sexual problems, and women without impairment. SSB was significantly negatively associated with women's level of sexual functioning and positively with repetitive and negative thought processes, depression, and anxiety. Overall, the concept of SSB can be reliably measured and SSBs correlate meaningfully with variables measuring women's mental health. We argue that the concept of SSB should be further developed as it can enrich present sexual therapeutic treatment approaches, especially in the context of cognitive-behavioral therapy.

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.

Psychological interventions for pre-event and post-event rumination in social anxiety: A systematic review and meta-analysis

Pre-event and post-event rumination have been consistently identified by cognitive models as important maintaining factors in Social Anxiety Disorder (SAD). This systematic review and meta-analysis aimed to investigate the effectiveness of psychological treatment in reducing pre-event and post-event rumination in adults with social anxiety. A comprehensive literature search identified 26 eligible studies, with 1524 total participants. Psychological treatments demonstrated large significant within-group effect sizes (from pre- to post-treatment) in reducing pre-event rumination (g = 0.86) and post-event rumination (g = 0.83). Subgroups analysed showed CBT to have large significant effect sizes in reducing pre-event rumination (g = 0.97) and post-event rumination (g = 0.85). Interventions that specifically addressed rumination were found to be significantly more effective in reducing pre-event rumination than those that did not (p = .006). Both individual and group treatment formats were equally effective in reducing pre-event rumination and post-event rumination. Meta-regressions revealed that pre-event rumination treatment effects were significantly larger in individuals with higher baseline social anxiety, meanwhile post-event rumination treatment effects were larger for those with higher baseline depression. Overall findings show that pre-event and post-event rumination are effectively reduced through psychological treatment, and clinical implications for the enhancement of evidence-based treatment protocols are discussed.

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

Social anxiety disorder is maintained in part by rumination about past social experiences, known as post-event processing. The Extended Post-Event Processing Questionnaire (EPEPQ-15) assesses post-event processing as three correlated factors. Competing against this structure is a bifactor model that has not yet been evaluated for the EPEPQ-15. These models were tested for the conventional state version of the EPEPQ-15 and a new trait version in two separate samples (Ns = 327 and 351). In both samples, the fit of the bifactor model was better than that of correlated factor models. Moreover, the results did not support the group factors, indicating that a unidimensional interpretation of the EPEPQ-15 is most appropriate. The general dimension of the EPEPQ-15 was highly correlated with social interaction anxiety, beliefs related to social anxiety, anticipatory processing, and safety behaviors. These results overall suggest post-event processing is best conceptualized as a unitary construct.

Rumination as a Transdiagnostic Phenomenon in the 21st Century: The Flow Model of Rumination

Rumination and its related mental phenomena share associated impairments in cognition, such as executive functions and attentional processes across different clinical conditions (e.g., in psychotic disorders). In recent decades, however, the notion of rumination has been increasingly narrowed to the "self-focused" type in depressive disorders. A closer review of the literature shows that rumination may be construed as a broader process characterized by repetitive thoughts about certain mental contents that interfere with one's daily activities, not only limited to those related to "self". A further examination of the construct of rumination beyond the narrowly focused depressive rumination would help expand intervention opportunities for mental disorders in today's context. We first review the development of the clinical construct of rumination with regard to its historical roots and its roles in psychopathology. This builds the foundation for the introduction of the "Flow Model of Rumination (FMR)", which conceptualizes rumination as a disruption of a smooth flow of mental contents in conscious experience that depends on the coordinated interactions between intention, memory, affect, and external events. The conceptual review concludes with a discussion of the impact of rapid technological advances (such as smartphones) on rumination. Particularly in contemporary societies today, a broader consideration of rumination not only from a cognition viewpoint, but also incorporating a human-device interaction perspective, is necessitated. The implications of the FMR in contemporary mental health practice are discussed.

The relationship between salivary Fibroblast Growth Factor-2 and cortisol reactivity and psychological outcomes prior to and during the COVID-19 pandemic

Background

Fibroblast growth factor-2 (FGF2) is a biomarker that is associated with depression, anxiety and stress in rodents. In humans, we have previously demonstrated that salivary FGF2 increased following stress in a similar pattern to cortisol, and FGF2 (but not cortisol) reactivity predicted repetitive negative thinking, a transdiagnostic risk factor for mental illness. The current study assessed the relationship between FGF2, cortisol, and mental health before and during the COVID-19 pandemic.

Methods

We employed a longitudinal correlational design using a convenience sample. We assessed whether FGF2 and cortisol reactivity following the Trier Social Stress Task (TSST) were associated with DASS-21 depression, anxiety and stress, measured at the time of the TSST in 2019-20 (n = 87; time 1), and then again in May 2020 during the first wave of COVID-19 in Sydney (n = 34 of the original sample; time 2).

Results

FGF2 reactivity (but not absolute FGF2 levels) at time 1 predicted depression, anxiety, and stress across timepoints. Cortisol reactivity at time 1 was associated with stress over timepoints, and absolute cortisol levels were associated with depression across timepoints.

Limitations

The sample was comprised of mostly healthy participants from a student population, and there was high attrition between timepoints. The outcomes need to be replicated in larger, more diverse, samples.

Conclusions

FGF2 and cortisol may be uniquely predictive of mental health outcomes in healthy samples, potentially allowing for early identification of at-risk individuals.

Enhanced recognition of disgusted expressions occurs in spite of attentional avoidance at encoding

Introduction

Negative emotional content is prioritized in memory. Prioritized attention to negative stimuli has been suggested to mediate this valence-memory association. However, research suggests only a limited role for attention in this observed memory advantage. We tested the role of attention in memory for disgusted facial expressions, a powerful social-emotional stimulus.

Methods

We measured attention using an incidental, free-viewing encoding task and memory using a surprise memory test for the viewed expressions.

Results and Discussion

Replicating prior studies, we found increased attentional dwell-time for neutral over disgusted expressions at encoding. However, contrary to the attention-memory link hypothesis, disgusted faces were better remembered than neutral faces. Although dwell-time was found to partially mediate the association between valence and memory, this effect was much weaker than the opposite direct effect. These findings point to independence of memory for disgusted faces from attention during encoding.

Dimensions of inattention: Cognitive, behavioral, and affective consequences

Inattention to one's on-going task leads to well-documented cognitive, behavioral, and physiological consequences. At the same time, the reliable association between mind-wandering and negative mood has suggested that there are affective consequences to task inattention as well. We examined this potential relationship between inattention and mood in the following study. Six hundred and fifty-five participants completed self-report questionnaires related to inattentive thinking (i.e., attentional lapses, daydreaming, mindfulness, rumination, reflection, worry, postevent processing, inattentiveness, and counterfactual thinking), a questionnaire about depressive symptoms, and a questionnaire about anxiety symptoms. First, an exploratory factor analysis was conducted to identify potential underlying constructs of types of inattentive thinking. Using ordinary least squares extraction and Oblimin rotation, a three-factor model demonstrated suitable fit, broadly representing mind-wandering/inattentive consequences, repetitive negative thinking, and reflective/introspective thinking. Second, after eliminating measures that did not strongly load on any factor, structural equation modeling was conducted and found that the relationship between mind-wandering and depression was partially explained by repetitive negative thinking, whereas the relationship between mind-wandering and anxiety was fully explained by repetitive negative thinking. The present findings suggest that understanding how inattentive thoughts are interrelated not only influences mood and affect but also reveals important considerations of intentionality, executive functioning, and qualitative styles of these thoughts.

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.

Cognitive-affective reactions to a non-judgmental and judgmental mirror gazing task in individuals with body dysmorphic concerns

BACKGROUND AND OBJECTIVES

The look into the mirror represents a typical trigger situation for people with body dysmorphic concerns. Mirror exposure on the other hand is commonly used in the treatment of Body Dysmorphic Disorder even though little is known about its precise effects. This study aimed to investigate cognitive-affective processes related to mirror gazing.

METHODS

A total of 125 individuals (screening for body dysmorphic concerns: N_BDD+ = 56, negative N_BDD- = 69) participated in a laboratory study using a guided 10-min mirror gazing task. Participants were randomized to one of two experimental conditions, a non-judgmental and judgmental description of the own body during mirror gazing. Distress, self-hostile cognitions and post-event processing were assessed after the task and at follow-up.

RESULTS

Participants with body dysmorphic concerns showed higher values regarding subjective appearance distortion, stress induced by the exposure, distress, self-hostile cognitions and post-event processing compared to the symptom negative group. The two conditions did not yield differential effects.

LIMITATIONS

The short duration of the mirror gazing and the only internal description of the body may have contributed to a missing effect for the approach.

CONCLUSIONS

The results indicate the importance of cognitive and affective processes in reaction to mirror exposure. They support the cognitive model of BDD and suggest post-event processing as a relevant factor requiring further investigation in future research.

Systematic literature review of human studies assessing the efficacy of cannabidiol for social anxiety

The current review evaluates the potential of cannabidiol (CBD) as a promising pharmacotherapy for social anxiety disorder (SAD). Although a number of evidence-based treatments for SAD are available, less than a third of affected individuals experience symptom remission after one year of treatment. Therefore, improved treatment options are urgently needed, and CBD is one candidate medication that may have certain benefits over current pharmacotherapies, including the absence of sedating side effects, reduced abuse liability, and rapid course of action. The current review provides a brief overview of CBD's mechanisms of action, neuroimaging in SAD, and evidence for CBD's effects on the neural substrates of SAD, as well as systematically reviewing literature directly examining the efficacy of CBD for improving social anxiety among healthy volunteers and individuals with SAD. In both populations, acute CBD administration significantly decreased anxiety without co-occurring sedation. A single study has also shown chronic administration to decrease social anxiety symptoms in individuals with SAD. Collectively, the current literature suggests CBD may be a promising treatment for SAD. However, further research is needed to establish optimal dosing, assess the timecourse of CBD's anxiolytic effects, evaluate long-term CBD administration, and explore sex differences in CBD for social anxiety.

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

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

The fear of losing control

Although a great deal of research has focused on various aspects of control and their relations to psychopathology, new insights and therapeutic potential could be revealed through an examination and perhaps emphasis on fears of losing control. Although elements of control-related beliefs and phenomena have been highlighted in association with obsessive-compulsive disorder and social anxiety disorder, this paper will give a fresh perspective on fears and beliefs about losing control, with implications for understanding and perhaps treating a broad range of psychological problems including panic disorder, posttraumatic stress disorder (PTSD), and others. New research questions and hypotheses are proposed, along with potential implications for expanded research into this domain and for clinical applications within a cognitive-behavioural approach.

The Bi-factor model of repetitive negative thinking: Common vs. unique factors as predictors of depression and anxiety

BACKGROUND AND OBJECTIVES

Different forms of repetitive negative thinking (RNT) have traditionally been conceptualized as being distinctly linked to specific disorders. However, emerging evidence suggests that a common process lies at the core of different RNT manifestations. This common process might also largely explain the link between RNT and psychopathology. To examine the latent factor structure of RNT, we compared three structural-equation models, assuming (a) a common factor across different RNT measures (single-factor model); (b) scale-specific factors for each RNT measures (separate-factor model); and (c) both a common and scale-specific factors (bi-factor model). We additionally tested whether these latent factors predicted depression and anxiety at a follow-up time-point.

METHODS

A community sample (N = 523) completed an online assessment comprising measures of rumination, worry and content-independent RNT as well as depressive and anxiety symptoms at baseline (t1) and three months later (t2).

RESULTS

The bi-factor model showed the best fit to the data among the three models. Moreover, the common factor of the bi-factor model significantly predicted depression and anxiety three months later. Next to the common factor, some but not all scale-specific factors additionally predicted symptoms.

LIMITATIONS

The study was conducted in a non-clinical sample and the assessment of psychopathology was restricted to depressive and anxiety symptoms.

CONCLUSIONS

The findings support transdiagnostic conceptualizations of RNT, which highlight common aspects of different forms of RNT as well as the relevance of RNT across different diagnostic categories.

Clinical, demographic and theory-derived maintaining factors as moderators of treatment outcome in internet-delivered cognitive behavioural therapy for children and adolescents with social anxiety disorder

Internet-delivered cognitive behavioural therapy (ICBT) is an efficacious treatment for social anxiety disorder (SAD) in youth. However, we have limited knowledge about patient characteristics that may be associated with better (or worse) treatment outcome. Particularly concerning factors suggested to be involved in the maintenance of SAD (e.g., anticipatory anxiety and post-event processing). The aim of the current study was to evaluate possible predictors and moderators of the effect of ICBT in a randomised controlled trial where children and adolescents (N = 103; 10-17 years) with SAD received either ICBT or internet-delivered supportive therapy, ISUPPORT. Examined variables were pre-treatment levels of social anxiety, depression symptoms, putative maintaining factors as well as demographic variables like age and gender. Latent growth curve models were used to examine predictors and moderators of changes in youth and clinician rated social anxiety symptoms, from pre-treatment to 3-month follow-up. Baseline depression symptoms moderated the outcome, with higher depression scores being associated with greater reduction of SAD symptoms in ICBT compared to ISUPPORT. More difficulties at baseline with anticipatory anxiety, post-event processing, focus of attention and safety behaviours predicted greater reduction of SAD symptoms, regardless of treatment condition. No other clinical or demographic variable predicted or moderated the outcome. In summary, baseline depression severity may be an important moderator of ICBT, but the preliminary finding needs replication in sufficiently powered trials.

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

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

Always Saying the Wrong Thing: Negative Beliefs About Losing Control Cause Symptoms of Social Anxiety

Background

Individuals with social anxiety disorder (SAD) often report a fear that they will lose control of their emotions or report intense, unpleasant thoughts or images of uncontrollably humiliating themselves in social situations. These fears and associated beliefs that one is likely to lose control may underlie the anxiety and/or cognitive biases (e.g., self-focused attention and negative post-event processing) experienced during and following social situations. The present experiment examined whether manipulating beliefs about losing control would cause changes in symptoms of SAD.

Methods

One hundred and twenty-six undergraduate psychology students were given false feedback that they were either at high or low risk of losing control, and then completed a social interaction task with an actor. Participants rated their anxiety before and during the interaction and completed a post-event processing questionnaire 24-hours later.

Results

Participants in the high beliefs about losing control (HLC) condition reported significantly greater subjective anxiety than those in the low beliefs about losing control (LLC) condition leading up to the social interaction task, and significantly more negative post-event processing.

Conclusion

Results suggest beliefs about losing control may play a causal role in the development and maintenance of SAD. These beliefs may represent a novel domain to be targeted in CBT.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10608-022-10325-w.

A five-factor model of perseverative thought

Like diagnostic status, clinically relevant thought remains overwhelmingly conceptualized in terms of discrete categories (e.g., worry, rumination, obsessions). However, definitions can vary widely. The area of perseverative thought (or clinically relevant thought more broadly) would benefit substantially from a consensus-based, empirically grounded taxonomy similar to the Hierarchical Taxonomy of Psychopathology (Kotov et al., 2017) or the Big Five for personality. This article addresses three major barriers to establishing such a taxonomy: (a) a lack of research explicitly comparing categorical (subtype) versus dimensional models, (b) primary reliance on between-person measures rather than modeling at the level of the thought (within person), and (c) insufficient emphasis on replication and refinement. Participants included an unselected crowdsourced sample (790 observations from 286 participants) and an independent anxious-depressed replication sample (808 observations from 277 participants). Participants made dimensional ratings for three idiographic clinically relevant thoughts on a range of features. Multilevel latent class analysis and multilevel exploratory factor analysis were applied to identify and extract natural patterns of covariation among features at the level of the thought, controlling for person-level tendencies. A consistent five-dimension solution emerged across both samples and reliably outperformed the best-fitting categorical solution in terms of fit, replicability, and explanatory power. Identified dimensions were dyscontrol, self-focus, valence, interpersonal, and uncertainty. Findings support a five-factor latent structure of perseverative thought. Theoretical, empirical, and clinical implications and future directions are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

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.

Social phobic beliefs mediate the relationship between post-event processing regarding the worst socially aversive experience and fear of negative evaluation

The experience of socially aversive events is proposed to be a critical etiological factor in the development of social anxiety symptoms even though the experience itself is also common among healthy individuals. Rather than the event itself, accompanying factors such as maladaptive processing might be associated with higher levels of social anxiety symptoms. One-hundred-seventy-four individuals participated in this online-survey comprising questionnaires regarding social anxiety symptoms and retrospective reports concerning maladaptive processing of the worst socially aversive event. Structural equation modelling was used to analyze the hypothesized mediation of maladaptive processing and fear of negative evaluation by intrusive re-experiencing and social phobic beliefs. The positive association between retrospectively evaluated maladaptive processing after the worst socially aversive event and fear of negative evaluation was mediated by social phobic beliefs but not by intrusive re-experiencing. These results point towards the relevance of further investigating processing strategies after socially aversive events as a potential influencing factor for SAD development. Trial registration. The trial was registered at the German Clinical Trial Register (DRKS00021502) on June 3rd, 2020.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s12144-022-02805-9.

Am I really seeing what's around me? An ERP study on social anxiety under speech induction, uncertainty and social feedback

Cognitive models of social anxiety propose that socially anxious individuals engage in excessive self-focusing attention when entering a social situation. In the present study, speech anxiety was induced to socially anxious and control participants. Event-related potentials were recorded while participants performed a perceptual judgment task using distinct or ambiguous stimuli, before and after social feedback. Disputed feedback led to more revisions and decreased levels of confidence, especially among socially anxious individuals. Prior feedback, greater occipital P1 amplitudes in both groups for ambiguous probes indicated heightened sensory facilitation to ambiguous information, and greater anterior N1 amplitudes for ambiguous stimuli in highly anxious participants suggested anticipation of negative feedback in this group. Post-feedback, P1, N1 and LPP amplitudes were reduced overall among socially anxious individuals indicating a reduction in sensory facilitation of visual information. These results suggest excessive self-focusing among socially anxious individuals, possibly linked to anticipation of an anxiety-provoking social situation.

The Efficacy of Downward Counterfactual Thinking for Regulating Emotional Memories in Anxious Individuals

Aversive autobiographical memories sometimes prompt maladaptive emotional responses and contribute to affective dysfunction in anxiety and depression. One way to regulate the impact of such memories is to create a downward counterfactual thought-a mental simulation of how the event could have been worse-to put what occurred in a more positive light. Despite its intuitive appeal, counterfactual thinking has not been systematically studied for its regulatory efficacy. In the current study, we compared the regulatory impact of downward counterfactual thinking, temporal distancing, and memory rehearsal in 54 adult participants representing a spectrum of trait anxiety. Participants recalled regretful experiences and rated them on valence, arousal, regret, and episodic detail. Two to six days later, they created a downward counterfactual of the remembered event, thought of how they might feel about it 10 years from now, or simply rehearsed it. A day later, participants re-rated the phenomenological characteristics of the events. Across all participants, downward counterfactual thinking, temporal distancing, and memory rehearsal were equally effective at reducing negative affect associated with a memory. However, in individuals with higher trait anxiety, downward counterfactual thinking was more effective than rehearsal for reducing regret, and it was as effective as distancing in reducing arousal. We discuss these results in light of the functional theory of counterfactual thinking and suggest that they motivate further investigation into downward counterfactual thinking as a means to intentionally regulate emotional memories in affective disorders.

The Association Between Salivary FGF2 and Physiological and Psychological Components of the Human Stress Response

Background

Fibroblast Growth Factor 2 (FGF2) is a neurotrophic protein that has been implicated as a biomarker for anxiety and depressive disorders, which comprise a significant component of the global burden of disease. Research using rodents has indicated that FGF2 is part of the stress response, but whether this translates to humans has yet to be investigated. In this study, we aimed to explore the potential role of FGF2 in the human stress response by examining its association with physiological and psychological processes during and following the Trier Social Stress Test (TSST).

Methods

Participants in the active stress experiment (N  =  87) underwent the TSST, provided saliva samples to obtain levels of cortisol and FGF2, and reported on post-event rumination related to the TSST task over the following week. Participants in the no-stress experiment (N  =  25) provided saliva samples for measurement of FGF2 and cortisol across a corresponding time period.

Results

Salivary FGF2 levels changed after the TSST and were associated with the pattern of change in salivary cortisol. Cortisol responses in the active stress condition were blunted in females (relative to males), however, sex did not interact with any other effect. FGF2 reactivity (ie, the magnitude of change over time) was not correlated with cortisol reactivity. Lower FGF2 reactivity following the TSST, but not overall FGF2 levels, or cortisol, was associated with higher fear of negative evaluation, repetitive negative thinking and post-event processing, as well as repetitive negative thinking in the week following the TSST. Participants in the no-stress experiment showed a decrease in cortisol, yet no change in their FGF2 levels.

Conclusion

These findings suggest that FGF2 is involved in the human stress response and higher levels of FGF2 reactivity may be associated with protective cognitive processes following stress exposure.

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.

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.

Perceived stress in the time of COVID-19: the association with brooding and COVID-related rumination in adults with and without migraine

Background

The main goal of this research was to explore whether migraineurs had a higher level of perceived stress than healthy controls during the times of the coronavirus and related restrictive measures, and to examine the relationship between different subtypes of rumination and perceived stress in these groups. We measured two facets of depressive rumination, brooding and reflection, along with rumination about the current COVID-19 situation to see whether these different subtypes of rumination explained perceived stress among migraineurs and healthy controls.

Methods

Healthy adults (n = 64) and migraine patients (n = 73) filled out self-report questionnaires online. A multiple linear regression model was used to test whether depressive rumination (i.e. brooding and reflection) and COVID-related rumination explained perceived stress among adults with and without migraine during the times of COVID-19, after controlling for gender, age, migraine/control group status and migraine disability.

Results

Although we did not find any difference in the level of perceived stress among migraineurs and the control group, perceived stress was more strongly associated with brooding as well as COVID-related rumination among migraineurs than healthy controls. COVID-related rumination and brooding (but not reflection) explained the level of perceived stress after controlling for gender, age, migraine/control group status and migraine disability.

Conclusions

The similar degree of perceived stress among migraineurs and the control group may imply that there is great variation in the personal experience of people regarding the pandemic, that may be determined by numerous other factors. Our results demonstrate that ruminating about the pandemic and related difficulties, as well as brooding (but not reflection) appear to be associated with higher level of perceived stress during the times of the coronavirus. This association was slightly stronger among migraineurs, hinting at the increased vulnerability of this patient group in stressful situations like the COVID-19 pandemic. Our results also suggest that ruminating about the pandemic and its consequences is weakly associated with trait-level depressive rumination, thus may be more contingent on specific factors.

Biopsychosocial Model Social Anxiety and Substance Use Revised

PURPOSE OF REVIEW

To review data published in the past 5 years to evaluate the utility of our biopsychosocial model of social anxiety's relation to substance misuse to evaluate the model's utility and update it.

RECENT FINDINGS

Data support the utility of our revised model-e.g., socially anxious persons report using substances to manage subjective anxiety, despite evidence that some substances may not have a direct effect on physiological responding. Other factors with promise include social influence, cognitive processes (e.g., post-event processing), and avoidance. Data highlight the importance of context as socially anxious persons use some substances more in some high-risk situations, despite lack of relation between social anxiety and use generally. Sociocultural factors remain understudied. This updated model is a theory- and data-driven model of the relations between social anxiety and substance misuse that can inform future work to improve substance-related outcomes among this especially vulnerable group.

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.

COVID-19: Risk Factors and Protective Role of Resilience and Coping Strategies for Emergency Stress and Secondary Trauma in Medical Staff and Emergency Workers—An Online-Based Inquiry

The COVID-19 crisis has placed a heavy burden on medical staff and emergency workers, who may be at risk of developing psychological distress and secondary trauma. Coping and resilience to stress during a pandemic are protective factors that can mitigate the potential adverse psychological effects. Here, we investigated the direct and mediated effects of coping strategies and hardiness on secondary trauma among Italian medical staff (physicians and nurses, n = 140) and emergency workers (firefighters, civil protection, and ambulance personnel, n = 100) involved in the first phase of the pandemic. For this purpose, we collected data from participants through online questionnaires to measure emergency stress, coping strategies, hardiness, and secondary trauma. Other variables analyzed were age, sex, direct contact with COVID-19 patients, and use of personal protective equipment (PPE). We performed a correlational analysis, regressions, and a mediation analysis. The results show that nurses and physicians experienced higher levels of emergency stress than emergency workers. Direct contact with COVID-19 patients, female sex, unexpected events, and lack of PPE were risk factors for emergency stress, while resilience and coping strategies played a protective role. Mediation analysis shows that coping strategies and hardiness are protective factors and reduce the effect of stress on secondary trauma.

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.

Recurrent involuntary autobiographical memories: characteristics and links to mental health status

Memories of events from one's personal past that come to mind unintentionally and effortlessly are termed involuntary autobiographical memories (IAMs). Recurrent IAMs are known as relevant to many disorders within clinical literature. However, less is known about their links with mental health status in the general population. In the current study, 2184 undergraduate students completed surveys assessing occurrence of any recurrent IAMs. Participants also wrote a description of their most frequently recurring IAM and rated it on phenomenological characteristics, such as frequency, valence, vividness, and centrality. Results showed that the majority of our sample experienced recurrent IAMs, replicating previous findings, but most of these memories were emotionally negative, unlike past work. Importantly, negative recurrent IAMs were associated with significantly more mental health concerns, including symptoms of depression, anxiety, and posttraumatic stress. We also found that frequency of IAM recurrence was predicted by the memory's age, level of completeness/detail, emotional intensity, and centrality to one's life story. Further, descriptions of positive recurrent IAMs contained significantly more episodic detail compared to negative or neutral ones, suggesting that emotional regulation may play a role in how recurrent IAMs are recounted. Recurrent IAMs, and their characteristics, serve as a window into mental health status.

Review of EEG, ERP, and Brain Connectivity Estimators as Predictive Biomarkers of Social Anxiety Disorder

Social anxiety disorder (SAD) is characterized by a fear of negative evaluation, negative self-belief and extreme avoidance of social situations. These recurrent symptoms are thought to maintain the severity and substantial impairment in social and cognitive thoughts. SAD is associated with a disruption in neuronal networks implicated in emotional regulation, perceptual stimulus functions, and emotion processing, suggesting a network system to delineate the electrocortical endophenotypes of SAD. This paper seeks to provide a comprehensive review of the most frequently studied electroencephalographic (EEG) spectral coupling, event-related potential (ERP), visual-event potential (VEP), and other connectivity estimators in social anxiety during rest, anticipation, stimulus processing, and recovery states. A search on Web of Science provided 97 studies that document electrocortical biomarkers and relevant constructs pertaining to individuals with SAD. This study aims to identify SAD neuronal biomarkers and provide insight into the differences in these biomarkers based on EEG, ERPs, VEP, and brain connectivity networks in SAD patients and healthy controls (HC). Furthermore, we proposed recommendations to improve methods of delineating the electrocortical endophenotypes of SAD, e.g., a fusion of EEG with other modalities such as functional magnetic resonance imaging (fMRI) and magnetoencephalograms (MEG), to realize better effectiveness than EEG alone, in order to ultimately evolve the treatment selection process, and to review the possibility of using electrocortical measures in the early diagnosis and endophenotype examination of SAD.

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.

Perpetuating factors of social anxiety: a serial mediation model

BACKGROUND

There is evidence that individuals with high levels of social anxiety utilize more safety behaviours and experience more post-event processing than those with lower levels of social anxiety. There are also data to suggest that the relationship between safety behaviour use and social anxiety symptoms is mediated by perceived control of one's anxiety. Furthermore, it has been suggested that post-event processing influences anticipatory anxiety for a future social situation.

AIM

A direct link between the perpetuating factors of social anxiety described above has not been established in the literature. The aim of the current study was to test a model examining the relationship between these constructs.

METHOD

Participants first completed a battery of questionnaires. They then participated in an impromptu, 3-minute speech and were informed they would be videotaped. Following the speech, participants completed measures of anxiety and were instructed to return the following week. During the second session, they were informed they would deliver an additional speech and provided ratings of their anxiety in anticipation of delivering the second speech.

RESULTS

The results of a serial mediation support that greater levels of social anxiety lead to less perceived control over one's anxiety, leading to increased safety behaviour use. The increase in safety behaviours led to an increase of post-event processing which resulted in greater anticipatory anxiety for a future speech task.

CONCLUSIONS

This study provides novel evidence for the importance of perceived control in the genesis of social anxiety, which has implications for treatment.

A Short-Term Longitudinal Investigation of Hookups and Holistic Outcomes Among College Students

Majority of college students hook up at least once during their time in school. The literature on casual sex encounters among college students is growing, though most studies are cross-sectional and individual studies focus on few outcomes at a time, leaving piecemeal and mixed results. The current longitudinal study clarifies prior work by analyzing how post-event process (PEP), an understudied construct within the hookup literature, and emotional (i.e., positive or negative) hookup reactions interact to predict a breadth of outcomes, representing holistic student well-being. The inclusion of PEP reframes the current literature to consider PEP as a predictor variable of hookup outcomes, as moderated by emotional hookup reactions. This is consistent with literature indicating emotional experiences affect PEP across a variety of incidents. Participants (N = 377, 87.6% female) completed self-report measures at 2-month intervals. We tested relationships between the main and interaction effects of PEP and emotional hookup reactions as a moderation regression analyses on anxiety, academic engagement, religious coping, and psychological flourishing. The main effect of PEP predicted more anxiety and less negative religious coping, negative hookup reactions predicted more anxiety, and positive hookup reactions predicted more flourishing. Regarding interaction effects, high levels of positive hookup reactions and PEP were associated with less anxiety, less academic engagement, more negative religious coping, and less psychological flourishing; high levels of negative hookup reactions and PEP were associated with less anxiety and more negative religious coping and were unrelated to academic engagement or flourishing over two months.

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.

Does Repetitive Negative Thinking Influence Alcohol Use? A Systematic Review of the Literature

Over the past 20 years, researchers have used various methodologies to assess different forms of repetitive negative thinking (RNT) and their influence on alcohol consumption. Contrasting results between clinical and general populations were observed. To summarize the current literature on RNT and alcohol use, a systematic review was conducted according to the Preferred Reporting for Systematic Review and Meta-Analysis (PRISMA) guidelines (Moher et al., 2009). Among the 27 included studies, the seven conducted among patients with alcohol use disorder (AUD) and the three focusing on other adult samples demonstrated a strong positive association between RNT and alcohol use or alcohol-related problems, regardless of the form of RNT. The results were more heterogeneous in the 17 studies conducted among adolescents and students, leading the authors to conclude that the results varied as a function of the severity of alcohol use. The results of this study suggest to focus on RNT from a transdiagnostic perspective in AUD. This processual approach may improve AUD treatment and relapse prevention. Finally, some gaps in the literature must be addressed: (1) the gender differences in the link between RNT and alcohol use and (2) the specific influence of RNT on alcohol use among young adults.

Intrusive social images in individuals with high and low social anxiety: a multi-method analysis

BACKGROUND

Models of social anxiety suggest that intrusive images/memories are common in social anxiety and contribute to the maintenance of social anxiety.

AIMS

We examined the context and phenomenological features of intrusive social images using quantitative and qualitative measures across various levels of social anxiety.

METHOD

Undergraduate students (n = 191) completed measures of social anxiety (i.e. Social Interaction Anxiety Scale and Social Phobia Scale) and wrote a description of an intrusive social image. Individuals who reported an intrusive social image (n = 77) rated the frequency, interference and phenomenological (e.g. vividness, emotional intensity) characteristics of the image. A content analysis of the intrusive image narratives was completed by independent raters.

RESULTS

High social anxiety (HSA) increased the likelihood and frequency of experiencing intrusive images, and to some extent the interference caused by these images. However, the characteristics of these images with regard to their content and quality were similar across levels of social anxiety. Among participants who provided narratives, HSA individuals (n = 34) did not differ from low socially anxious (LSA) individuals (n = 28) in themes that reflect concerns about their own thoughts, actions and behaviours. However, HSA individuals reported greater concerns about how other individuals would react, and their intrusive images were often from an observer perspective when compared with LSA individuals.

CONCLUSIONS

These results are interpreted in relation to cognitive models of emotion, memory and cognitive behavioural models of social anxiety.