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

Short-term prospective and reciprocal relations between social anxiety symptoms and sleep quality among community-recruited adolescents

OBJECTIVE

Research conducted with socially anxious youth suggests that there is an increased risk for poor sleep quality; however, this link is not consistent across the few studies and there is evidence to suggest that poor sleep quality may increase the risk for elevated social anxiety symptoms. The present study investigates both prospective and reciprocal associations between levels of self-reported social anxiety and global sleep quality while also distinguishing between within-person and between-person variations in these associations.

METHOD AND MEASURES

Community-recruited adolescents from the United States (N = 71; Mage=16.04, SD = 1.08; 64.8% girls; 80.3% White) completed a battery of questionnaires across three time-points within a six-month period; each wave occurred three months apart. A random-intercepts cross-lagged panel model was used for the analysis.

RESULTS

Findings indicated a positive relation between social anxiety and poor sleep quality at both within- and between-person levels. Higher levels of social anxiety were associated with poorer sleep quality three months later, but the reverse relation was not observed.

CONCLUSIONS

These findings provide evidence supporting the link between elevated social anxiety symptoms and future sleep problems among adolescents and lay groundwork for investigation of mechanisms driving this link. Findings suggests a need to screen for and treat sleep problems in socially anxious youth.

Increased default mode network activation in depression and social anxiety during upward social comparison

Social comparisons are a core feature of human life. Theories posit that social comparisons play a critical role in depression and social anxiety triggering negative evaluations about the self, as well as negative emotions. We investigated the neural basis of social comparisons in participants with major depression and/or social anxiety (MD-SA, n = 56) and healthy controls (n = 47) using functional magnetic resonance imaging. While being scanned participants performed a social comparison task, during which they received feedback about their performance and the performance of a coplayer. Upward social comparisons (being worse than the coplayer) elicited high levels of negative emotions (shame, guilt, and nervousness) across participants, with this effect being enhanced in the MD-SA group. Notably, during upward comparison the MD-SA group showed greater activation than the control group in regions of the default mode network (DMN). Specifically, for upward comparison MD-SA participants demonstrated increased activation in the dorsomedial prefrontal cortex and reduced deactivation in the posteromedial cortex, regions linked to self-referential processing, inferences about other people's thoughts, and rumination. Findings suggest that people with depression and social anxiety react to upward comparisons with a more negative emotional response, which may be linked to introspective processes related to the DMN.

Post-event processing in social anxiety: A scoping review

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.

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

BACKGROUND AND OBJECTIVES

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

METHODS

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

RESULTS

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

LIMITATIONS

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

CONCLUSIONS

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

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.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

A positive side effect of wearing face coverings for socially anxious females: Findings from a speech task

Background

Wearing face masks has become more common due to the COVID-19 pandemic. Until now, it has not been investigated whether socially anxious individuals can reduce their acute anxiety symptoms by wearing face masks during a speech task.

Method

Fifty-nine socially anxious females were asked to prepare and give an oral presentation. Participants were randomly allocated either to a group that was asked to wear a face mask during the task, or to a group that was not asked to wear a face mask during the task. Dependent variables included physiological parameters (systolic/diastolic blood pressure, heart rate) and self-reports (valence and arousal at baseline, as well as directly before and after the presentation).

Results

The analyses showed that the group without face masks had a higher systolic blood pressure than the group with face masks, directly before as well as after the presentation. The two groups did not differ in the other measures.

Conclusion

Wearing face masks has a small stress-reducing effect on socially anxious females.

Repetitive Thoughts and Behaviors in Autism Spectrum Disorder: A Symptom-Based Framework for Novel Therapeutics

While the core symptoms of autism spectrum disorder include repetitive thoughts and repetitive behaviors, repetitive phenomena also occur in many other psychiatric disorders. Types of repetitive thoughts include preoccupations, ruminations, obsessions, overvalued ideas, and delusions. Types of repetitive behaviors include tics, stereotypies, compulsions, extrapyramidal symptoms, and automatisms. We provide a description of how to recognize and classify different types of repetitive thoughts and behaviors in autism spectrum disorder, providing clarity on which phenomena should be considered a core feature of autism spectrum disorder and which phenomena are indicative of a comorbid psychiatric disorder. Clinical features that can be used to differentiate types of repetitive thoughts include whether they are distressing and the degree of insight the individual has, while repetitive behaviors can be classified based on whether they are voluntary, goal-directed/purposeful, and rhythmic. We present the psychiatric differential diagnosis of repetitive phenomena within the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) framework. Careful clinical consideration of these transdiagnostic features of repetitive thoughts and behaviors can improve diagnostic accuracy and treatment outcomes, and influence future research.

Metacognitions about suicidal thoughts

BACKGROUND

Rumination about suicide has recently been identified as a risk factor for suicidal behavior. According to the metacognitive model of emotional disorders, the activation and maintenance of rumination is dependent on specific metacognitive beliefs. On this background, the current study is concerned with the development of a questionnaire to assess suicide-specific positive and negative metacognitive beliefs.

METHODS

Factor structure, reliability and validity of the Scales for Suicide-related Metacognitions (SSM) were investigated in two samples comprised of participants suffering from lifetime suicide ideation. Participants of sample 1 (N = 214; 81.8% female; M_age = 24.9, SD_age = 4.0) took part in a single assessment using an online survey. Participants of sample 2 (N = 56; 71.4% female; M_age = 33.2, SD_age = 12.2) took part in two online assessments within a two week time-period. To establish convergent validity questionnaire-based assessments of suicidal ideation, general and suicide specific rumination and depression were used. Furthermore, it was analyzed whether suicide-related metacognitions predict suicide-specific rumination cross-sectionally and prospectively.

RESULTS

Factor analyses revealed a two-factor structure of the SSM. Results indicated good psychometric properties, and provided evidence for construct validity and stability of the subscales. Positive metacognitions predicted concurrent and prospective suicide-specific rumination beyond the effect of suicide ideation and depression and rumination predicted concurrent and prospective negative metacognitions.

CONCLUSION

Taken together the results provide initial evidence that the SSM is a valid and reliable measure of suicide-related metacognitions. Furthermore, findings are in line with a metacognitive conceptualization of suicidal crises and provide first indications of factors that might be relevant for the activation and maintenance of suicide-specific rumination.

Please Don’t Compliment Me! Fear of Positive Evaluation and Emotion Regulation—Implications for Adolescents’ Social Anxiety

In recent years, fear of positive evaluation has emerged as one of the key aspects of social anxiety, alongside fear of negative evaluation. Fears of evaluation intensify during adolescence, a time when individuals are expected to navigate new, emotionally challenging situations. The purpose of this study was to examine the associations between social anxiety, fear of positive and negative evaluation, and three emotion regulation strategies relevant to social anxiety, i.e., suppression, acceptance, and rumination. To this end, data were collected from 647 adolescents via an online survey and analyzed using structural equation modeling. We found that fear of negative evaluation was significantly related to rumination, whereas fear of positive evaluation was significantly and negatively related to acceptance. We further found an indirect effect of social anxiety on suppression via fear of positive evaluation and acceptance in a serial mediation and an indirect effect of social anxiety on rumination via fear of negative evaluation. Not only do fears of positive and negative evaluation appear to be distinct constructs, but they are also differentially associated with three emotion regulation strategies pertinent to social anxiety. Fear of evaluation and its associations with emotion regulation deficits might hinder the therapeutic process by acting as a deterrent to positive reinforcement or potentially impeding the development of a successful therapeutic alliance.

Classical Music Students’ Pre-performance Anxiety, Catastrophizing, and Bodily Complaints Vary by Age, Gender, and Instrument and Predict Self-Rated Performance Quality

Music performance anxiety (MPA) is a multifaceted phenomenon occurring on a continuum of severity. In this survey study, we investigated to what extent the affective (anxiety), cognitive (catastrophizing), and somatic (bodily complaints) components of MPA prior to solo performances vary as a function of age, gender, instrument group, musical experience, and practice as well as how these MPA components relate to self-rated change in performance quality from practice to public performance. The sample comprised 75 male and 111 female classical music university students, aged 15–45 years. Age was positively associated with anxious feelings and bodily complaints. Compared to male students, female students reported significantly more anxious feelings and catastrophizing. Singers reported less anxious feelings and catastrophizing than instrumentalists. Breathing-, mouth- and throat-related complaints were highest among singers and wind players; hand- and arm-related complaints were highest among string players and pianists. The indices of musical experience and practice had marginal effects. An average of four bodily complaints bothered the participants strongly to very strongly. Worsening in performance quality from practice to public performance was reported by almost half of the participants and was best predicted by anxious feelings and breathing-related complaints. We conclude that age, gender and instrument play a significant role in understanding the phenomenology of MPA. Musicians should be examined according to these characteristics rather than as one homogenous population. In particular, it might be valuable to develop assessment tools for MPA that incorporate items related to the bodily complaints that are most relevant to the different instrument groups. Breathing-related complaints could add an important dimension to the investigation of MPA and music performance. Finally, the high percentage of students reporting worsening of their performance quality from practice to public performance highlights the need of professional support to help music students be able to perform at their best and thrive as artists.

A Two-Person Neuroscience Approach for Social Anxiety: A Paradigm With Interbrain Synchrony and Neurofeedback

Social anxiety disorder has been widely recognised as one of the most commonly diagnosed mental disorders. Individuals with social anxiety disorder experience difficulties during social interactions that are essential in the regular functioning of daily routines; perpetually motivating research into the aetiology, maintenance and treatment methods. Traditionally, social and clinical neuroscience studies incorporated protocols testing one participant at a time. However, it has been recently suggested that such protocols are unable to directly assess social interaction performance, which can be revealed by testing multiple individuals simultaneously. The principle of two-person neuroscience highlights the interpersonal aspect of social interactions that observes behaviour and brain activity from both (or all) constituents of the interaction, rather than analysing on an individual level or an individual observation of a social situation. Therefore, two-person neuroscience could be a promising direction for assessment and intervention of the social anxiety disorder. In this paper, we propose a novel paradigm which integrates two-person neuroscience in a neurofeedback protocol. Neurofeedback and interbrain synchrony, a branch of two-person neuroscience, are discussed in their own capacities for their relationship with social anxiety disorder and relevance to the paradigm. The newly proposed paradigm sets out to assess the social interaction performance using interbrain synchrony between interacting individuals, and to employ a multi-user neurofeedback protocol for intervention of the social anxiety.

Perseverative Thinking about Suicide Questionnaire (PTSQ): Validation of a new measure to assess suicide-specific rumination

BACKGROUND

Suicide-specific rumination has been shown to be associated with lifetime suicide attempts as well as suicide intent and might be an important risk factor for the transition from suicidal ideation to suicidal behavior. Based on this background, the wording of the items of an often-used self-report measure assessing core characteristics of rumination was adapted to assess specifically suicide-specific rumination.

METHODS

The entire study sample comprised N = 1689 participants from the German healthcare sector. A total of 721 participants with a history of suicidal ideation (68% female; M_age = 30.63, SD_age = 8.41, range: 18-81 years) who had completed five measures assessing suicide-specific rumination, suicidal ideation, depression, hopelessness, and resilience were included for the present examination. Factorial validity (Exploratory [EFA] to determine the appropriate number of factors and confirmatory factor analyses [CFA] after randomly splitting of the sample to validate the EFA solution), construct validity, and reliability were evaluated.

RESULTS

The EFA revealed a one-factor solution consisting of four items, which could be confirmed within a CFA (RMSR = 0.006; RMSEA = 0.039; CFI = 0.999; TLI = 0.998). Internal consistency was excellent with Cronbachs α = 0.93. Construct validity was given with moderate to high positive correlations with suicidal ideation (0.76), depression (0.55), and hopelessness (0.38) and negative correlation with resilience (-0.31). Participants with recent suicidal ideation and/or lifetime suicide attempt reported significantly more suicide-specific rumination than those with only lifetime suicidal ideation.

CONCLUSION

A new 4-item measure for suicide-specific rumination was developed and could be shown to be a reliable and valid instrument in a large German sample. Results emphasize the potential importance of suicide-specific rumination for the understanding of trajectories of suicidal ideation and suicide risk assessments.

Rumination in Children with Social Anxiety Disorder: Effects of Cognitive Distraction and Relation to Social Stress Processing

According to cognitive models of social anxiety disorder (SAD), both anticipatory processing and post-event processing are core mechanisms in disorder maintenance leading to dysfunctional coping with social situations through negative self-evaluation and increased anxiety. To date, little is known about these processes during late childhood, a critical period for disorder development. Further, it remains unclear if dysfunctional rumination in children can be altered through psychotherapeutic interventions such as cognitive distraction. In the current study, children aged 9 to 13 years with SAD and age- and gender-matched healthy controls (HCs, each: n = 30) participated in an experimental laboratory social stress task while anticipatory processing, post-event processing, subjective anxiety, self-evaluations, and autonomic arousal (skin conductance level) were assessed. Further, the impact of a brief cognitive distraction intervention on post-event processing was assessed. Children with SAD reported more negative anticipatory and post-event processing compared to HC children. Further, negative anticipatory processing was associated with higher subjective anxiety and reduced subjective performance ratings during the social stress task. In the aftermath of the stressor, distraction led to reduced subjective anxiety in the group with SAD and lower autonomic arousal in all children but did not alter post-event processing. The current study suggests that both anticipatory and post-event processing already play a key role in the maintenance of SAD in childhood. While distraction may be beneficial in reducing prolonged subjective anxiety and autonomic arousal after social situations, more research on interventions targeting ruminative processes is needed.

Repetitive Negative Thinking About Suicide: Associations With Lifetime Suicide Attempts

Background

Repetitive negative thinking has been identified as an important predictor of suicide ideation and suicidal behavior. Yet, only few studies have investigated the effect of suicide-specific rumination, i.e., repetitive thinking about death and/or suicide on suicide attempt history. On this background, the present study investigated, whether suicide-specific rumination differentiates between suicide attempters and suicide ideators, is predictive of suicide attempt history and mediates the association between suicide ideation and suicide attempts.

Method

A total of 257 participants with a history of suicide ideation (55.6% female; Age M = 30.56, Age SD = 11.23, range: 18-73 years) completed online measures on suicidality, general and suicide-specific rumination.

Results

Suicide-specific rumination differentiated suicide attempters from suicide ideators, predicted suicide attempt status (above age, gender, suicide ideation, general rumination) and fully mediated the association between suicide ideation and lifetime suicide attempts.

Conclusion

Overall, though limited by the use of a non-clinical sample and a cross-sectional study design, the present results suggest that suicide-specific rumination might be a factor of central relevance in understanding transitions to suicidal behavior.

Examining the Interrelation Among Change Processes: Decentering and Anticipatory Processing Across Cognitive Behavioral Therapy for Social Anxiety Disorder

As evidence grows supporting certain mechanisms of change in psychological treatments and we improve statistical approaches to measuring them, it is important that we also explore how mechanisms and processes are related to each other, and how they together affect treatment outcomes. To answer these questions about interrelating processes and mechanisms, we need to take advantage of frequent assessment and modeling techniques that allow for an examination of the influence of one mechanism on another over time. Within cognitive behavioral therapy, studies have shown support for both decentering, the ability to observe thoughts and feelings as objective events in the mind, and anticipatory processing, the repetitive thinking about upcoming social situations, as potentially related mechanisms of change. Therefore, the current study examined weekly ratings of decentering and a single-item anticipatory processing question to examine the interrelation among these change mechanisms in 59 individuals who received a 12-weeks of Cognitive Behavioral Group Therapy for social anxiety disorder. Overall, these results found that both anticipatory processing and decentering changed over the course therapy for clients. Change in both anticipatory processing and decentering was related to outcome. The bivariate latent difference score analysis showed that anticipatory processing was a leading indicator of change in decentering, but not the reverse, indicating that change in anticipatory processing is leading to change in decentering. It may be that with the focus on cognitive reappraisal in this treatment, that reducing anticipatory processing is freeing up the cognitive resources for decentering to occur.

Personality Trait Interactions in Risk for and Protection against Social Anxiety Symptoms

Previous attempts to identify personality traits that enhance inclination to social anxiety (SA) have been limited by a tendency to focus on selected traits in isolation, rather than examining their interactions. Additional research is needed to better understand whether and how these dimensions are linked to SA. In a prospective study, it was examined how interactions between the Big Five personality factors predict SA symptoms. A total of 135 individuals, aged 18-50 years, were recruited. Personality traits were measured at baseline, and SA symptoms were assessed one month later. Results showed that low emotional stability was an independent predictor of higher levels of SA. Additionally, two significant interactions emerged: the interactions between extraversion and openness, and between openness and agreeableness predicted SA symptoms. At high openness, higher extraversion was associated with significantly lower levels of SA, suggesting that the interaction provides incrementally greater protection against SA. Thus, extraverts are likely to be protected against social anxiety symptoms, but more so the more open they are. Moreover, at high levels of agreeableness, low openness has been shown to be uniquely predictive for higher levels of SA symptoms, indicating that the combined effect of openness with agreeableness may be more important to SA than either trait in isolation. These findings highlight the importance of testing interaction effects of personality traits on psychopathology.

Comparing cognitive styles in social anxiety and major depressive disorders: An examination of rumination, worry, and reappraisal

OBJECTIVE

Social anxiety disorder (SAD) and major depressive disorder (MDD) are commonly occurring and frequently comorbid disorders. Though individuals with SAD and MDD are more likely to engage in rumination and worry, relatively few studies have compared individuals with SAD, MDD, or both disorders on their use of these cognitive styles. Similarly, the extent to which the disorders differ in their use of reappraisal remains unclear. Thus, the current study sought to systematically examine rumination, worry, and reappraisal in individuals with and without SAD, MDD, or both disorders.

METHODS

The study comprised 330 participants recruited from the community (n = 54 with SAD, n = 61 with MDD, n = 69 with comorbid SAD/MDD, and n = 146 healthy controls). Following confirmation of diagnostic status via clinical interview, participants completed measures of rumination, worry, and reappraisal.

RESULTS

Healthy controls reported less use of rumination (i.e., brooding and reflection) and worry than individuals with a psychiatric diagnosis. Individuals with SAD or MDD did not differ from each other, but participants in both groups reported less rumination, particularly brooding, than individuals with comorbid SAD/MDD. Diagnostic group differences in reappraisal only emerged when reappraisal was considered alongside other cognitive styles. Further, moderation analyses indicated that reappraisal was only associated with SAD or MDD when participants also reported high levels of rumination and worry.

CONCLUSIONS

Results support transdiagnostic conceptualizations of rumination and worry. They also suggest that reappraisal is only useful when it is used by people who experience frequent and habitual negative cognitions.

PRACTITIONER POINTS

Individuals with SAD or MDD report more rumination and worry than healthy controls, but do not differ from each other in their reliance on these cognitive styles. Individuals with comorbid SAD/MDD endorse more rumination than individuals with SAD or MDD alone, even after adjusting for differences in symptom severity. Reappraisal may only predict diagnostic group status when considered alongside other cognitive styles. In particular, high reappraisal may be associated with reduced risk of psychiatric disorder, but only when rumination and worry are also high.

LIMITATIONS

The study was limited by its cross-sectional design and reliance on self-report measures. Participants were diagnosed using DSM-IV-TR criteria for SAD and MDD.

Social anxiety questionnaire (SAQ): Development and preliminary validation

BACKGROUND

The Social Anxiety Questionnaire (SAQ) was designed to assess five dimensions of social anxiety as posited by the Clark and Wells' (1995; Clark, 2001) cognitive model.

METHODS

The development of the SAQ involved generation of an item pool, followed by a verification of content validity and the theorized factor structure (Study 1). The final version of the SAQ was then assessed for reliability, temporal stability (test re-test reliability), and construct, criterion-related, and contrasted-group validity (Study 2, 3, and 4).

RESULTS

Following a systematic process, the results provide support for the SAQ as reliable, and both theoretically and empirically valid measure. A five-factor structure of the SAQ verified and replicated through confirmatory factor analyses reflect five dimensions of social anxiety: negative self-processing; self-focused attention and self-monitoring; safety behaviours; somatic and cognitive symptoms; and anticipatory and post-event rumination.

LIMITATIONS

Results suggest that the SAQ possesses good psychometric properties, while recognizing that additional validation is a required future research direction. It is important to replicate these findings in diverse populations, including a large clinical sample.

CONCLUSIONS

The SAQ is a promising measure that supports social anxiety as a multidimensional construct, and the foundational role of self-focused cognitive processes in generation and maintenance of social anxiety symptoms. The findings make a significant contribution to the literature, moreover, the SAQ is a first instrument that offers to assess all, proposed by the Clark-Wells model, specific cognitive-affective, physiological, attitudinal, and attention processes related to social anxiety.

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

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.

The Development and Evaluation of the Psychometric Properties of the Negative Beliefs about Post-Event Processing Scale

BACKGROUND

Although negative beliefs have been found to be associated with worry symptoms and depressive rumination, negative beliefs have yet to be examined in relation to post-event processing and social anxiety symptoms.

AIMS

The purpose of the current study was to examine the psychometric properties of the Negative Beliefs about Post-Event Processing Questionnaire (NB-PEPQ).

METHOD

A large, non-referred undergraduate sample completed the NB-PEPQ along with validation measures, including a measure of post-event processing and social anxiety symptoms.

RESULTS

Based on factor analysis, a single-factor model was obtained, and the NB-PEPQ was found to exhibit good validity, including positive associations with measures of post-event processing and social anxiety symptoms.

CONCLUSIONS

These findings add to the literature on the metacognitive variables that may lead to the development and maintenance of post-event processing and social anxiety symptoms, and have relevant clinical applications.

Is positive thinking in anticipation of a performance situation better than distraction? An experimental study in preadolescents

The current study compares the effects of experimentally induced positive anticipatory thinking and distraction in preadolescents aged 12-13. Eighty-seven participants were instructed to either engage in positive anticipatory thoughts or perform a distraction task while preparing to perform a sporting activity in front of their peers. Results revealed that trait social anxiety was associated with more negative estimates of sport performance and catastrophic thoughts relating to the impending sport activity. Additionally, compared to children who distracted, children in the positive anticipation condition showed significantly increased anxiety levels, more catastrophic thoughts and more negative predictions of sport performance and appearance, although these effects did not appear to interact with trait social anxiety. Finally, no significant manipulation effect on participants' observable behavior was found. The findings further highlight the utility of distracting from an impending, anxiety-provoking situation to keep anxious feelings to a low level.

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

Social anxiety disorder (SAD) is characterised by an intense fear of social situations in which the individual believes they may be negatively evaluated (American Psychiatric Association, 2013). A number of cognitive models (Clark & Wells, 1995; Hofmann, 2007; Rapee & Heimberg, 1997) have been proposed that provide frameworks for understanding the key cognitive processes involved in SAD. Negative rumination, which can be divided into pre- and post-event rumination, appears to be a key maintaining factor in the cycle of social anxiety. However, there are mixed findings regarding the cognitive predictors of post-event rumination and a lack of research regarding the consequences and predictors of pre-event rumination. Furthermore, there has been little empirical research investigating the effects of targeting negative rumination and state anxiety in social anxiety treatment. If the cognitive predictors of negative rumination can be determined then they can be targeted when designing interventions that aim to break the vicious cycle of social anxiety. The state of research investigating the cognitive determinants of state anxiety and negative rumination is reviewed and suggestions are made for continuing research.

The aetiology and maintenance of social anxiety disorder: A synthesis of complimentary theoretical models and formulation of a new integrated model

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.

Examination of the Contribution of Ruminative Thinking and Maladaptive Self-Beliefs to Social Anxiety

The purpose of this study was to examine the relative contribution of 3 components of the Clark and Wells (1995) model to social anxiety symptoms. In particular, based on theory and previous research, it was hypothesized that the association between post-event processing and social anxiety and between anticipatory anxiety and social anxiety would be mediated by maladaptive self-beliefs. To test this hypothesis, a large, nonclinical sample of young adults completed a measure of anticipatory processing, post-event processing, maladaptive self-beliefs, and social anxiety. Based on a structural equation modeling approach, full mediation was found between post-event processing and social anxiety, and partial mediation was found between anticipatory processing and social anxiety. Overall, the results contribute to the literature by elucidating cognitive processes that may lead to the development and maintenance of social anxiety symptoms.