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The Predictors and Contents of Post-Event Processing in Social Anxiety
Abstract
The present study investigated the factors that influence the likelihood that individuals engage in post-event processing
(PEP)—the act of engaging in a detailed, negative, and self-focused review following social situations. This study also examined
the cognitive contents of PEP in a nonclinical sample (N=40). Participants undertook both a 5-min speech and conversation and then completed measures assessing cognitions, behaviours,
and physiological processes that occurred during each task. Twenty-four hours later, PEP was measured in relation to both
tasks. Results showed firstly that PEP was greater following the speech than the conversation. Secondly, negative assumptions
were found to be a unique predictor of PEP over and above depression, trait anxiety, and other cognitive-behavioural variables.
Finally, higher levels of social anxiety were associated with experiencing more negative self-perceptions and regret-based
cognitions during PEP. Current findings underscore the importance of targeting negative assumptions, self-related cognitions,
and regret-based thoughts in therapy.
KeywordsSocial phobia–Social anxiety–Post-event processing
... In contrast to the previous studies, other studies have highlighted the importance of other predictors. Makkar and Grisham (2011) showed with an unselected sample of participants that in general a speech task led to more post-event processing compared to a conversation task. In terms of specific predictors, Makkar and Grisham (2011) demonstrated that for the speech task, depression levels, trait social anxiety, and state negative social-evaluative beliefs positively predicted level of post-event processing in the subsequent 24 hr. ...
... Makkar and Grisham (2011) showed with an unselected sample of participants that in general a speech task led to more post-event processing compared to a conversation task. In terms of specific predictors, Makkar and Grisham (2011) demonstrated that for the speech task, depression levels, trait social anxiety, and state negative social-evaluative beliefs positively predicted level of post-event processing in the subsequent 24 hr. For the conversation task, Makkar and Grisham (2011) only found depression levels as the only positive predictor of post-event processing in the subsequent 24 hr. ...
... In terms of specific predictors, Makkar and Grisham (2011) demonstrated that for the speech task, depression levels, trait social anxiety, and state negative social-evaluative beliefs positively predicted level of post-event processing in the subsequent 24 hr. For the conversation task, Makkar and Grisham (2011) only found depression levels as the only positive predictor of post-event processing in the subsequent 24 hr. Kiko et al. (2012) also demonstrated in their study with a sample of participants with SAD that in general a speech task led to more post-event processing compared to a conversation task. ...
Two repetitive thinking processes that have been proposed in prominent maintenance models of social anxiety disorder (SAD) are anticipatory processing and post-event processing. Research into these two processes has steadily increased over the last 20 years. This review highlights the main lines of existing research on anticipatory processing and post-event processing, including studies on the nature of these processes, their association with social anxiety, the predictors, and consequences of these processes, as well as how these processes respond to treatments for SAD. The review also highlights some of the conceptual and methodological issues that have prevented the literature on anticipatory processing and post-event processing from being more integrated and focused. Finally, the review draws together some new directions in terms of theory and research to further advance the field.
... To date, various studies have investigated predictors of PEP. While some authors suggest that PEP might be a specific expression of a more general rumination disposition (Brozovich & Heimberg, 2011; Makkar & Grisham, 2011), there is mounting evidence that PEP results from internal processes during the preceding social situation. Situational determinants investigated so far included state anxiety (Dannahy & Stopa, 2007; Laposa & Rector, 2011; Makkar & Grisham, 2011 ), self-focused attention (Gaydukevych & Kocovski, 2012; Makkar & Grisham, 2011; Rapee & Abbott, 2007 ) as well as perceptions of one's performance (Abbott & Rapee, 2004), and the perceived threat of negative evaluation (Rapee & Abbott, 2007). ...
... While some authors suggest that PEP might be a specific expression of a more general rumination disposition (Brozovich & Heimberg, 2011; Makkar & Grisham, 2011), there is mounting evidence that PEP results from internal processes during the preceding social situation. Situational determinants investigated so far included state anxiety (Dannahy & Stopa, 2007; Laposa & Rector, 2011; Makkar & Grisham, 2011 ), self-focused attention (Gaydukevych & Kocovski, 2012; Makkar & Grisham, 2011; Rapee & Abbott, 2007 ) as well as perceptions of one's performance (Abbott & Rapee, 2004), and the perceived threat of negative evaluation (Rapee & Abbott, 2007). Further evidence for the relevance of situational factors stems from findings that the relationship between trait social anxiety and PEP is mediated by state anxiety, attentional focus, and negative cognitions about oneself or one's performance (Chen, Rapee, & Abbott, 2013; Kiko et al., 2012; Perini et al., 2006). ...
... While some authors suggest that PEP might be a specific expression of a more general rumination disposition (Brozovich & Heimberg, 2011; Makkar & Grisham, 2011), there is mounting evidence that PEP results from internal processes during the preceding social situation. Situational determinants investigated so far included state anxiety (Dannahy & Stopa, 2007; Laposa & Rector, 2011; Makkar & Grisham, 2011 ), self-focused attention (Gaydukevych & Kocovski, 2012; Makkar & Grisham, 2011; Rapee & Abbott, 2007 ) as well as perceptions of one's performance (Abbott & Rapee, 2004), and the perceived threat of negative evaluation (Rapee & Abbott, 2007). Further evidence for the relevance of situational factors stems from findings that the relationship between trait social anxiety and PEP is mediated by state anxiety, attentional focus, and negative cognitions about oneself or one's performance (Chen, Rapee, & Abbott, 2013; Kiko et al., 2012; Perini et al., 2006). ...
Background and objectives:
Cognitive approaches to social anxiety suggest that an excessive brooding about one's performance in a social situation (post-event processing; PEP) is involved in the maintenance of anxiety. To date, most studies investigating PEP were conducted in laboratory settings. The present study sought to replicate previous findings on predictors of PEP after a naturalistic social performance situation.
Methods:
Sixty-five students, who had to give an evaluated presentation for credits, completed measures of trait social anxiety. Immediately after their presentation, participants rated state anxiety and attentional focus during the presentation, and provided an overall evaluation of their performance. One week after the presentation, they rated PEP during the preceding week, and reappraised their performance.
Results:
Regression analyses demonstrated that the performance ratings after and self-focused attention during the presentation were unique predictors of PEP over and above the effects of trait and state anxiety. There was no evidence that PEP was associated with a biased recall of individual performance evaluations.
Conclusions:
The results support cognitive theories that emphasize the importance of negative self-perceptions in the development of social anxiety and related processes, and underline self-focused attention and self-evaluative processes as important targets during treatment.
... Ultimately, PEP serves to intensify negative self-perceptions and increase future avoidance of similar social situations for individuals with social anxiety (Rachman, Grüter-Andrew, & Shafran, 2000). Engaging in PEP is related to greater social anxiety in both nonclinical and clinical samples (e.g., Laposa & Rector, 2011;Makkar & Grisham, 2011), and like safety behaviors, PEP has been identified as a central mechanism maintaining social anxiety over time Heimberg et al., 2014;Hofmann, 2007). Given that safety behaviors have been directly linked with negative perceived performance following a social situation, researchers have hypothesized that the use of safety behaviors may influence the amount of PEP engagement by socially anxious individuals following a social situation, and that in turn, PEP may serve as a catalyst for engaging in future safety behaviors. ...
... Safety behavior use has demonstrated a strong positive relationship with PEP, such that socially anxious individuals who report using safety behaviors frequently during social situations also endorse greater levels of PEP up to 24 hours following the event (Kiko et al., 2012;Makkar & Grisham, 2011;Mitchell & Schmidt, 2014). Safety behaviors of the avoidance and impression management subtypes positively predicted PEP, whereas safety behaviors intended to manage physiological symptoms of anxiety did not (Mitchell & Schmidt, 2014). ...
... Safety behaviors of the avoidance and impression management subtypes positively predicted PEP, whereas safety behaviors intended to manage physiological symptoms of anxiety did not (Mitchell & Schmidt, 2014). However, safety behaviors did not uniquely predict PEP when examined in conjunction with other predictors, such as negative assumptions and dysfunctional cognitions (Kiko et al., 2012;Makkar & Grisham, 2011). Taken together, safety behaviors demonstrate a clear and positive relationship to PEP but may be best conceptualized as a contributing factor to dysfunctional thoughts and negative assumptions, which subsequently contribute to higher levels of PEP (Kiko et al., 2012). ...
Safety behaviors are considered an important factor in the maintenance of social anxiety disorder (SAD). Safety behaviors are typically employed by socially anxious individuals to reduce anxiety in feared social situations. However, by preventing individuals with social anxiety from gathering evidence that would disconfirm their maladaptive beliefs about social situations, the use of safety behaviors ultimately maintains social anxiety over time. Twenty years ago, Wells and colleagues (1995) demonstrated that use of safety behaviors diminishes the efficacy of exposure treatment for SAD, suggesting that reduction in the use of safety behaviors during exposure can enhance treatment response. Research on safety behaviors has expanded considerably since Wells et al.’s seminal publication, and our understanding of the role safety behaviors may play in the maintenance of social anxiety has grown in breadth and depth. In this paper, we present a detailed review of the published research on safety behaviors relevant to social anxiety and social anxiety-related processes. Finally, we evaluate the impact of safety behaviors on the outcome of treatment for SAD, and we look to the literature on safety behaviors in other anxiety disorders to inform our understanding of use of safety behaviors during exposure and to facilitate future research in SAD.
Keywords:
Social anxiety disorder; anxiety disorders; social anxiety; safety behaviors; avoidance
... Scholars investigating social anxiety generally distinguish between social interaction and performance type situations (e.g., Beazley, Glass, Chambless, & Arnkoff, 2001;Makkar & Grisham, 2011). It has been found that individuals (non-anxious college students) report engaging in greater negative thinking following performance situations (e.g., a presentation; Kocovski & Rector, 2007;Makkar & Grisham, 2011) than interpersonal situations (e.g., a party), although Fehm, Schneider, and Hoyer (2007) observed the opposite pattern of results. ...
... Scholars investigating social anxiety generally distinguish between social interaction and performance type situations (e.g., Beazley, Glass, Chambless, & Arnkoff, 2001;Makkar & Grisham, 2011). It has been found that individuals (non-anxious college students) report engaging in greater negative thinking following performance situations (e.g., a presentation; Kocovski & Rector, 2007;Makkar & Grisham, 2011) than interpersonal situations (e.g., a party), although Fehm, Schneider, and Hoyer (2007) observed the opposite pattern of results. In addition, Kocovski and Rector (2007) demonstrated that factors predicting levels of post-event processing following an anxiety-provoking social event tend to differ according to the type of situation. ...
... Further advancing the current literature, the present study began to investigate possible differences in AP related to the type of social situation. Past research has found differences in cognitions based on the type of social situation assessed (Beazley et al., 2001;Kocovski & Rector, 2007;Makkar & Grisham, 2011). In line with the results reported by Kocovski and Rector (2007), performance situations appear to evoke a greater degree of anticipatory processing compared with social interaction situations. ...
Anticipatory processing is a repetitive thinking process that precedes social-evaluative events. The aim of this study was to examine factors that may predict the extent to which individuals engage in anticipatory processing. Perfectionistic beliefs, social interaction anxiety, anxiety sensitivity, anticipatory processing prior to a past social/performance situation, and positive beliefs about anticipatory processing were assessed in a large college student sample (N = 225). Anticipatory processing was greater prior to performance situations relative to social interaction situations. In addition, social interaction anxiety and anxiety sensitivity, but not perfectionistic beliefs or positive beliefs about anticipatory processing, significantly predicted the extent to which the participants engaged in anticipatory processing related to an anxiety-provoking event. Finally, there was preliminary evidence that factors impacting on the anticipatory processing may vary according to the nature of social situation.
... In addition, studies have begun to investigate the specific sorts of cognitions and emotions that characterise PEP. Makkar and Grisham (2011b) found that higher levels of social anxiety (controlling for depression) were associated with more frequent negative self-perceptions, thoughts about the past and regret during PEP. Indeed, previous studies also found that PEP is characterised by a sense of regret and a desire to change aspects of the prior social event (Kocovski, Endler, Rector, & Flett, 2005;Rachman et al., 2000). ...
... Indeed, previous studies also found that PEP is characterised by a sense of regret and a desire to change aspects of the prior social event (Kocovski, Endler, Rector, & Flett, 2005;Rachman et al., 2000). Using a semistructured interview, Makkar and Grisham (2011b) found that PEP consisted of negative self-focused thoughts and beliefs, catastrophic and regretful cognitions, negative performance appraisals, high standards, and distorted images of the self. Collectively, these findings suggest that deliberately engaging in PEP may lead to a number of unhelpful cognitive, behavioural, and emotional consequences that maintain social anxiety. ...
... Specifically, our main aim was to determine whether deliberate engagement in PEP after an anxiety-provoking social situation leads to increases in avoidance, anxiety, negative performance appraisals, negative thoughts about the self, and decrements in actual social performance. The PEP manipulation used in the present study was primarily derived from two sources: (1) a pilot interview study by Makkar and Grisham (2011b), which investigated the naturalistic contents of PEP in high and low socially anxious individuals; and (2) important features of PEP based on Clark and Wells' (1995) model of social phobia. In addition, given that social phobia patients regularly experience negative self-images during social situations (e.g., Hackmann, Surawy, & Clark, 1998) we presumed that such negative self-representations also formed a major component of PEP. ...
Post event processing (PEP), the act of engaging in a detailed, self-focused, and negative analysis of a prior social situation, has been hypothesised to contribute to the maintenance of social phobia (Clark & Wells, 1995). In light of this proposal, the present study investigated whether deliberate engagement in PEP as opposed to distraction following a speech task elicits unhelpful effects on emotion, cognition, and behaviour in a subsequent speech task in high and low socially anxious participants. The PEP manipulation instructed participants to focus on the anxious thoughts, images, feelings, and somatic sensations relating to the first speech. Contrary to hypotheses, results demonstrated that engaging in PEP as opposed to distraction led to a number of constructive outcomes such as: increased willingness among low socially anxious participants to give the second speech; a reduction in negative performance appraisals and underestimation of performance among high socially anxious participants; and better self-perceived speech quality irrespective of social anxiety level. However, there were no effects of response condition on anxiety, performance appraisals, observable behaviour, and negative cognitions. The findings underscore the need for additional research identifying the precise contents, construals, and processing modes that distinguish between adaptive and maladaptive forms of PEP.
... In studies employing analogue samples, it has been found that in response to a speech task high socially anxious individuals engage in greater and more negative levels of post-event processing (Edwards, Rapee, & Franklin, 2003); are more likely to use ruminative coping strategies than distraction strategies (Kocovski, Endler, Rector, & Flett, 2005); and show greater memory biases for negative feedback regarding speech performance (Cody & Teachman, 2010). Furthermore, for speech tasks, consistently the results reveal that social anxiety is a unique predictor of post-event processing over and above that of depression and trait anxiety (Abbott & Rapee, 2004;Edwards et al., 2003;Makkar & Grisham, 2011a). ...
... Dannahy and Stopa (2007) SAD engaged in more negative rumination, experienced these thoughts as more distressing, perceived they had less control over these thoughts, and perceived their performance as worse than NC. Makkar and Grisham (2011a) 40 undergraduates All anxiety disorders showed heightened and equivalent post-event processing ratings and that peak state anxiety during the first CBGT session predicted subsequent level of post-event processing, regardless of anxiety group. PEP improved significantly following both CBGT and ATT. ...
Cognitive models of social anxiety disorder (SAD) emphasize post-event processing as a prominent maintaining factor that occurs after social-evaluative events. Post-event processing involves repetitive negative thinking revolved around perceived social failure. The present review concentrates on the relevant and available empirical literature on post-event processing in social anxiety which centres on Clarke and Wells (1995) theoretical framework. Correlational and experimental studies have investigated the relationship between post-event processing and the behavioural, physiological, cognitive and affective outcomes for socially anxious individuals. The majority of study designs include those investigating post-event processing in response to social-evaluative threat, and in response to treatment. Limitations of the existing literature are discussed and suggestions for future research examining the underlying cognitive functions of post-event processing are proposed.
... Of the 10 metacognitive belief studies, four were conducted in the United Kingdom (Dannahy & Stopa, 2007;Field & Cartwright-Hatton, 2008;Gkika & Wells, 2016;Wells & Carter, 2001), two in the United States (Fergus, Valentiner, McGrath, Gier-Lonsway, & Jencius, 2013;Fisak & Hammond, 2013), two in Australia Wong & Moulds, 2010), one in Norway (Nordahl, Nordahl, & Wells, 2016), and one in Greece (Vassilopoulos et al., 2015). Of the 13 social belief studies, 11 were conducted in Australia (Makkar & Grisham, 2011Wong, McEvoy, & Rapee, 2016;Wong & Moulds, 2009, 2011a, 2011b, 2011c, 2012a, 2012bWong et al., 2014Wong et al., , 2017, one in Belgium and Switzerland (Heeren et al., 2014), and one in the United States (Holzman et al., 2014). Four studies on metacognitive beliefs (Fergus et al., 2013;Nordahl et al., 2016;Wells & Carter, 2001) and two on social beliefs (Wong et al., , 2017 used clinical samples. ...
... partial η 2 = .12. Finally, Makkar and Grisham (2011) found the total SBSA scale was a unique predictor of the post-mortem following a speech task, β = .46, t(26) = 2.08, p < .05, ...
Cognitive–behavioural and metacognitive approaches to emotional disorder implicate beliefs in social anxiety, but the types of beliefs differ across these perspectives. Cognitive models suggest that social beliefs about the self (i.e., high standards and conditional and unconditional beliefs) are central. In contrast, the metacognitive model gives centre stage to metacognitive beliefs (i.e., positive and negative beliefs about thinking) as main contributors to the maintenance of the disorder. Despite an expanding research interest in this area, the evidence for such contributions has not yet been reviewed. This study set out to systematically review relevant cross-sectional, longitudinal, and experimental investigations of the direct and indirect (through cognitive processes, such as anticipatory processing, self-focused attention, the post-mortem, and avoidance) relationships of social and metacognitive beliefs with social anxiety. Clinical and nonclinical samples were included, and correlation and regression coefficients as well as results from group comparisons (e.g., t tests and analyses of variance) were extracted. Overall, 23 papers were located, through PsycINFO, PubMed, and Web of Science, and reviewed using narrative synthesis. The results showed a robust positive relationship between social beliefs and social anxiety that appeared to be mediated by cognitive processes. Specific metacognitive beliefs were found to positively contribute to social anxiety both directly and indirectly, through cognitive processes. The study's findings are limited to 2 models of social anxiety and other minor limitations (e.g., grey literature was excluded). With these accounted for, the results are discussed in terms of the conceptualization and treatment of social anxiety and suggestions for future research are made.
... However, an increase in SFA is not always associated with reduced external attention (i.e., avoidance). Some studies have shown nonsignificant, and sometimes positive, associations between self-reported SFA and external attention, which attests to the independence of these constructs (e.g., Makkar & Grisham, 2011). In addition, although heightened social threat may suggest an increase in arousal, Mansell et al. (2003) did not directly assess physiological arousal. ...
... Therefore, in contrast to the Clark and Wells' (1995) model, SFA did not underlie avoidance in the present study. Indeed, previous studies have shown that SFA and external attention are either uncorrelated (e.g., Woody, 1996) or positively associated (Makkar & Grisham, 2011). Alternative cognitive models propose that social anxiety patients simultaneously engage in monitoring of external cues signaling negative evaluation as well as an internal representation of how the self appears to others (Rapee & Heimberg, 1997), which suggests that avoidance might not be mediated by SFA. ...
Background:
Socially anxious individuals are theorized to avoid social cues and engage in safety behaviors to prevent negative evaluation, which prevents disconfirmation of social fears. Cognitive models propose that this avoidance is driven by (1) self-focused attention (SFA) and (2) physiological arousal.
Design:
To examine these proposed mechanisms, we compared high socially anxious (HSA; n=29) and low socially anxious (LSA; n=28) participants on a view-time task involving faces.
Method:
Participants engaged in a task in which they viewed socially threatening (i.e., disgust, anger) and nonthreatening (i.e., happy, neutral) faces.
Results:
Results revealed that HSA participants endorsed greater SFA during the view-time task and spent less time viewing angry, disgusted, and neutral facial expressions relative to LSA participants. Regression analyses revealed that arousal, as indexed by salivary α-amylase, was a unique predictor of increased face-viewing time among HSA participants. In contrast, arousal predicted decreased face-viewing time among LSA participants.
Conclusions:
Findings underscore the need for further investigation of avoidance mechanisms in social anxiety.
... This process is problematic because the individual is prone to recalling the event as being more negative than it objectively was. Empirical studies have demonstrated that socially anxious individuals are more likely to engage in PEP than anxious controls following a therapy session (Perera, Rowa, and McCabe, 2016) and non-anxious controls following a social encounter (see Brozovich & Heimberg, 2008 for review) and that PEP is associated with a number of negative emotional and cognitive consequences (Kocovski, Endler, Rector, & Flett, 2005;Makkar & Grisham, 2011;Rachman, Grüter-Andrew, & Shafran, 2000;Rowa, Antony, Swinson, & McCabe, 2014;Rowa, Gavric, Stead, LeMoult, & McCabe, 2016). ...
... Sample items include "did you find it difficult to forget about the event" and "did you ever wonder about whether you could have avoided or prevented your behaviour/feelings during the event"? The scale has been widely used and has demonstrated good internal consistency and construct validity (Makkar & Grisham, 2011;McEvoy & Kingsep, 2006). Participants completed the PEPQ-R at the 1, 4 and 7 day follow-ups and the measure showed excellent internal consistency across all time points (a ranging from 0.89 to 0.90). ...
Background:
Post-event processing (PEP) is defined as repetitive negative thinking following anxiety provoking social events. PEP is thought to maintain anxiety symptoms in Social Anxiety Disorder (SAD) but little is known about the specific factors that contribute to the maintenance of PEP.
Aims:
The current study investigated how perceptions of performance and positive metacognitive beliefs might contribute to the persistence of PEP.
Method:
Participants with SAD (n = 24) as well as anxious (n = 24) and healthy (n = 25) control participants completed a standardized social performance task in the lab. Their engagement in PEP and perceptions of performance were assessed in the week that followed.
Results:
Immediately following the social task, individuals with SAD rated their performance more negatively and endorsed a greater number of positive metacognitive beliefs about PEP than did participants in both control groups. Importantly, both metacognitive beliefs and initial negative self-ratings of performance mediated the relationship between group status and PEP in the days following the event.
Conclusions:
These results are consistent with cognitive and metacognitive models of SAD and enhance our understanding of the cognitive processes which may function to initiate and maintain negative thinking patterns in SAD.
... In studies employing analogue samples, it has been found that in response to a speech task high socially anxious individuals engage in greater and more negative levels of post-event processing (Edwards, Rapee, & Franklin, 2003); are more likely to use ruminative coping strategies than distraction strategies (Kocovski, Endler, Rector, & Flett, 2005); and show greater memory biases for negative feedback regarding speech performance (Cody & Teachman, 2010). Furthermore, for speech tasks, consistently the results reveal that social anxiety is a unique predictor of post-event processing over and above that of depression and trait anxiety (Abbott & Rapee, 2004;Edwards et al., 2003;Makkar & Grisham, 2011a). ...
... Dannahy and Stopa (2007) SAD engaged in more negative rumination, experienced these thoughts as more distressing, perceived they had less control over these thoughts, and perceived their performance as worse than NC. Makkar and Grisham (2011a) 40 undergraduates All anxiety disorders showed heightened and equivalent post-event processing ratings and that peak state anxiety during the first CBGT session predicted subsequent level of post-event processing, regardless of anxiety group. PEP improved significantly following both CBGT and ATT. ...
... While some studies have demonstrated that individuals with high social anxiety levels (both analogue samples and clinical samples with SAD) engage in more PEP and endorse stronger maladaptive socialevaluative beliefs compared to individuals with low social anxiety levels (Abbott and Rapee 2004;Rachman et al. 2000;Wong and Moulds 2011;Wong et al. 2014), only two studies have examined the specific relationship between PEP and maladaptive social-evaluative beliefs. In a correlational study, Makkar and Grisham (2011) showed that after a speech task, post-task maladaptive social-evaluative beliefs were positively associated with PEP levels twenty-four hours later (over and above social anxiety, depression, trait anxiety and task-related variables). In an experimental study, Wong and Moulds (2009) designed and utilised a PEP manipulation and demonstrated that after a speech task, high socially anxious individuals who engaged in PEP endorsed higher levels of unconditional beliefs (but not high standard or conditional beliefs) than those who distracted. ...
... Clark and Wells 1995;Nolen-Hoeksema and Watkins 2011). This study thus extends previous research that has examined RNT and PEP in relation to maladaptive social-evaluative beliefs (e.g., Makkar and Grisham 2011;Wong and Moulds 2012a). ...
Theoretical models propose that transdiagnostic and disorder-specific repetitive thinking processes each interact with individual environmental conditions to predict symptoms. The current study aimed to test this hypothesis in the context of social anxiety. Specifically, we aimed to predict future maladaptive social-evaluative beliefs (high standard, conditional, and unconditional beliefs) from: (a) the transdiagnostic tendency to engage in repetitive negative thinking (RNT), (b) the social anxiety-specific tendency to engage in post-event processing (PEP), and (c) the interaction of these repetitive thinking tendencies with the frequency of recent negative social events and social anxiety levels. An initial undergraduate sample (N = 331) was recruited and 215 participants completed measures of the constructs of interest at two time points within an acceptable timeframe (average 8.44 days apart). Using hierarchical linear modelling, significant interactions were only obtained for conditional and unconditional beliefs with a specific component of PEP that focuses on thinking about the past involved in prediction. Follow-up simple slopes analyses indicated mainly no change in these beliefs or decreasing trajectories over time for different combinations of levels on the predictor variables. However, for participants with high social anxiety levels who experienced a high number of recent negative social events, those who reported low levels of thinking about the past exhibited a pattern of increasing trajectories for conditional and unconditional beliefs. These findings indicate that RNT and PEP differ in their ability to predict social-evaluative beliefs, and highlight the importance of research comparing different types of repetitive thinking to better understand these processes.
... Recently, several studies have found evidence to support this prediction. Makkar and Grisham (2011a) found a significant, moderate relation between SFA and PEP across social performance events and social interaction events. In addition, Chen, Rapee, and Abbott (2013) observed a marginally significant indirect link between inappropriate attentional focus (e.g., attention toward physical symptoms) and PEP through immediate performance appraisals. ...
... In addition, the use of a standardized social performance event limits the extent to which findings might generalize to social interaction events. Although there is evidence that SFA is related to social performance anxiety even after accounting for social interaction anxiety (Holzman, Valentiner, & McCraw, 2014) and social performance events produce more negative PEP than social interaction events (Makkar & Grisham, 2011a), less research has examined how the type of situation affects SFA and related outcomes. Future research could examine the effects of SFA, PEP, and performance appraisals following social interaction events. ...
Background and objectives:
Cognitive-behavioral models highlight the conjoint roles of self-focused attention (SFA), post-event processing (PEP), and performance appraisals in the maintenance of social anxiety. SFA, PEP, and biased performance appraisals are related to social anxiety; however, limited research has examined how SFA affects information-processing following social events. The current study examined whether SFA affects the relationships between performance appraisals and PEP following a social event..
Methods:
137 participants with high (n = 72) or low (n = 65) social anxiety were randomly assigned to conditions of high SFA or low SFA while engaging in a standardized social performance. Subsequent performance appraisals and PEP were measured.
Results:
Immediate performance appraisals were not affected by SFA. High levels of SFA led to a stronger, inverse relationship between immediate positive performance appraisals and subsequent negative PEP. High levels of SFA also led to a stronger, inverse relationship between negative PEP and changes in positive performance appraisals..
Limitations:
Future research should examine whether the current findings, which involved a standardized social performance event, extend to interaction events as well as in a clinical sample.
Conclusions:
These findings suggest that SFA affects the processing of positive information following a social performance event. SFA is particularly important for understanding how negative PEP undermines positive performance appraisals..
... The present study extends the growing literature on cognitive-behavioral features of anticipatory and post-event processing in SA (e.g., Edwards, Rapee, & Franklin, 2003; Gaydukevych & Kocovski, 2012; Kashdan & Roberts, 2007; Makkar & Grisham, 2011; Mellings & Alden, 2000; Morgan & Banerjee, 2008; Van Boven & Ashworth, 2007; Vassilopoulos, 2005) by directly comparing the nature and impact of anticipatory images and memories with those generated during post-event processing of an anxiety-provoking social event. While previous studies have investigated retrospectively-or typically-occurring mental images in social situations (e.g., Hackmann et al., 2000;), the current study examined these phenomena in the context of an in vivo anxiety-provoking social task, thereby helping to mitigate the potential threat of reporting biases. ...
The features of negative mental images and associated autobiographical memo-ries were compared in high (n = 39) versus low (n = 46) socially anxious (HSA and LSA) participants using a modied version of the Waterloo Images and Memories Interview (WIMI; Moscovitch, Gavric, Bielak, Merrield, & Moscovitch, 2011) either in anticipation of a videotaped speech or during post-event processing. Results indicated that negative images and memories were endorsed more fre-quently by HSA (vs. LSA) participants, and by those in the Anticipation (vs. Post-Event Processing) condition. Moreover, HSA relative to LSA participants reported more negative emotional consequences associated with bringing their images and memories to mind. Finally, post-event relative to anticipatory images and memories were associated with greater reported negative impact on participants' perceptions of self and others. Results and their potential theoretical and clini-cal implications are discussed in relation to contemporary cognitive-behavioral models of social anxiety. Empirical interest in the phenomenon of mental imagery in social anxiety (SA) has grown significantly in recent years (see Mosco-vitch, Gavric, Merrifield, Bielak, & Moscovitch, 2011; Stopa & Jen-kins, 2007; Wild, Hackmann, & Clark, 2007). Studies have found
... Investigators have turned their attention to studying what characteristics of a social situation predict later PEP. Makkar & Grisham (2011a) explored the predictors of PEP following a speech task. SA predicted PEP over and above depression and trait anxiety, consistent with previous studies. ...
Research on social anxiety and social anxiety disorder has proliferated over the years since the explication of the disorder through cognitive-behavioral models. This review highlights a recently updated model from our group and details recent research stemming from the (a) information processing perspective, including attention bias, interpretation bias, implicit associations, imagery and visual memories, and (b) emotion regulation perspective, including positive emotionality and anger. In addition, we review recent studies exploring the roles of self-focused attention, safety behaviors, and post-event processing in the maintenance of social anxiety. Within each area, we detail the ways in which these topics have implications for the treatment of social anxiety and for future research. Finally, we conclude with a discussion of how several of the areas reviewed contribute to our model of social anxiety disorder.
... The ideas were based on the cognitive components of PEP (e.g. Clark & McManus, 2002;Kashdan & Roberts, 2007;Wells, 1997), cognitive biases that are present among social phobia patients, as well as the findings from an interview study conducted in our laboratory that investigated the contents of PEP (Makkar & Grisham, 2012b). In addition, we wanted to ensure our AE-PEP manipulation encouraged abstract-evaluative processing of negative self-related information. ...
... The present study extends the growing literature on cognitive-behavioral features of anticipatory and post-event processing in SA (e.g., Edwards, Rapee, & Franklin, 2003; Gaydukevych & Kocovski, 2012; Kashdan & Roberts, 2007; Makkar & Grisham, 2011; Mellings & Alden, 2000; Morgan & Banerjee, 2008; Van Boven & Ashworth, 2007; Vassilopoulos, 2005) by directly comparing the nature and impact of anticipatory images and memories with those generated during post-event processing of an anxiety-provoking social event. While previous studies have investigated retrospectively-or typically-occurring mental images in social situations (e.g., Hackmann et al., 2000;), the current study examined these phenomena in the context of an in vivo anxiety-provoking social task, thereby helping to mitigate the potential threat of reporting biases. ...
The features of negative mental images and associated autobiographical memories
were compared in high (n = 39) versus low (n = 46) socially anxious (HSA and
LSA) participants using a modi!ed version of the Waterloo Images and Memories
Interview (WIMI; Moscovitch, Gavric, Bielak, Merri!eld, & Moscovitch, 2011)
either in anticipation of a videotaped speech or during post-event processing.
Results indicated that negative images and memories were endorsed more frequently
by HSA (vs. LSA) participants, and by those in the Anticipation (vs. Post-
Event Processing) condition. Moreover, HSA relative to LSA participants reported
more negative emotional consequences associated with bringing their images
and memories to mind. Finally, post-event relative to anticipatory images and
memories were associated with greater reported negative impact on participants’
perceptions of self and others. Results and their potential theoretical and clinical
implications are discussed in relation to contemporary cognitive-behavioral
models of social anxiety.
... This study adds to the growing body of evidence that post-event processing is related to social anxiety (Edwards, Rapee, & Franklin, 2003;Mellings & Alden, 2000;Rachman et al., 2000), especially in the context of performance events (Makkar & Grisham, 2011). In addition, Clark and Wells' (1995) model implies an interaction between post-event processing and self-focused attention in explaining social anxiety persistence. ...
This study examined the roles of self-focused attention and post-event processing in social performance anxiety and social interaction anxiety. College students (N = 101) completed measures of social performance anxiety, social interaction anxiety, self-focused attention, post-event
processing, and beliefs related to social anxiety. Interoceptive self-focused attention and post-event processing predicted social performance anxiety after controlling for social interaction anxiety. The associations with social interaction anxiety were not significant after controlling for
social performance anxiety. Associations of behavioral self-focused attention with social performance anxiety and social interaction anxiety were not significant after controlling for interoceptive self-focused attention. No evidence of an interaction between self-focused attention and post-event
processing in the prediction of social anxiety was found. This study found no evidence that the associations of interoceptive self-focused attention and post-event processing with social performance anxiety were statistically mediated by high standards, conditional beliefs about self, and
unconditional beliefs about self. These results and their theoretical implications are discussed.
... A number of hypotheses were tested. First, because negative self-evaluation has been found to predict negative PEP in previous research (e.g., Dannahy & Stopa, 2007; Makkar & Grisham, 2011a, 2011b Perini et al., 2006; Rapee & Abbott, 2007), it may be expected that the more negatively the participants evaluate their own speech performance the more negative their PEP should be. Second, drawing on the ICS account (Teasdale et al., 1995) and from the findings of previous research (Watkins & Teasdale, 2001), we expected that the experiential and analytical modes of self-focus would have different effects on the activated rumination processes (i.e. the PEP of the delivered speech), the former by disrupting these processes and the latter by strengthening them. ...
According to cognitive models, negative post-event processing rumination is a key maintaining factor in social anxiety disorder (SAD). Analogue research has supported the differentiation of self-focus into different modes of self-focused attention with distinct effects on rumination in depression and social anxiety. The purpose of this study was to replicate these effects with a sample of clients with SAD (N = 12) using (a) an experimental, cross-over design and (b) an evaluation situation (impromptu speech) prior to manipulation. Processing an identical list of symptoms, half of a sample was asked to successively adopt an analytic (abstract, evaluative) and an experiential (concrete, process-focused) self-focus; the other half employed the modes in the reversed order. Effects were assessed with a thought-listing (TL) procedure. As predicted, the two modes of self-focused attention affected cognitions differently; participants in the experiential condition showed a tendency for a decreased proportion of negative thoughts, whereas those in the analytical condition reported a decreased proportion of neutral thoughts. No difference was shown on positive cognitions. Furthermore, the participants' self-evaluation following the speech predicted their degree of subsequent negative thinking. After self-focus inductions, however, this effect was only seen in those participants who started by receiving the analytical self-focus induction. The results support previous findings that the analytical and the experiential self-focus modes affect cognitions differently, and that experiential processing may have beneficial effects on rumination in SAD. However, results need to be replicated in a larger sample.
... Other aspects of cognitive models of PER are also supported by the literature, with studies suggesting that PER is predicted by, and maintains, negative self-perceptions. Dysfunctional cognitions, biased threat appraisals, and negative self-evaluations have been demonstrated to be key determinants of PER (Gramer, Schild, & Lurz, 2012;Kiko et al., 2012;Makkar & Grisham, 2011a;Penney & Abbott, 2015;Perini et al., 2006;Zou & Abbott, 2012). Moreover, socially anxious individuals report more frequent, intense, and longer PER following negative-evaluative social events compared to guilt-or anger-inducing events (Lundh & Sperling, 2002), as well as situations involving social compared to non-social threat (Fehm et al., 2007). ...
Social anxiety disorder (SAD) is characterised by a marked and persistent fear of social or performance situations. Cognitive models suggest that self-focused cognitive processes play a crucial role in generating and maintaining social anxiety, and that self-focused cognition occurs prior to, during, and following social situations (Clark & Wells, 1995; Rapee & Heimberg, 1997). There is a substantial body of empirical evidence demonstrating that socially anxious individuals engage in self-focused cognition during and following a social or performance situation. A smaller but growing body literature suggests that a similar process occurs prior to such situations, and that these three processes are interdependent. Furthermore, the vast majority of research to date indicates that self-focused cognitive processes are detrimental, and that they generate and maintain social anxiety in a variety of ways. However, there remains considerable scope for research to further explicate the role of these processes in the maintenance of SAD, and to enhance interventions designed to ameliorate their negative effects.
... Despite experiencing a decrease in negative expectations from pre-to-post speech, participants may have selectively attended to aspects of their performance they interpreted as most negative and ruminated about their speech between completing their speech and the follow-up questionnaire. Post-event processing is higher after speeches compared to other social situations (e.g., conversations; Makkar & Grisham, 2011), likely due to the fact that speeches are ambiguous (i.e., no direct feedback is given), and thus, negative self-perceptions increase over time. This has important clinical implications for exposure therapy and its high attrition rates. ...
Beliefs and expectations about treatment have been shown to significantly impact treatment outcomes in medical settings. However, researchers have seldom examined the role of beliefs within the context of cognitive behavioral therapy. Beliefs may be particularly salient for safety behavior (SB) use in exposure therapy, as clinicians often hold opinions about whether judicious SB use facilitates or inhibits treatment. These beliefs may consequently be relayed during psychoeducation, influencing client expectations of SB helpfulness and exposure efficacy. We investigated experimentally the influence of SB beliefs on working memory, speech predictions, speech duration, anxiety, performance, and speech acceptability. Speech anxious undergraduate participants (N ¼ 144) received psychoeducation on exposure and were told (using random assignment) either that SBs: increase anxiety (unhelpful), decrease anxiety (helpful), or were provided with no information on SBs (control). People in the helpful condition only believed the exposure would be more successful. Crucially, exposure expectancy mediated the relationship between the helpful (but not unhelpful) condition and willingness to engage in future exposures. There were no effects of condition on most cognitive, emotional, or behavioral outcomes, suggesting that SBs (and SB beliefs) may have less impact on exposure outcomes than is currently believed.
... Indeed, some forms of self-reflection (e.g., brooding) may actually be harmful for overall human functioning (Takano & Tanno, 2009;Trapnell & Campbell, 1999;Treynor et al., 2003), particularly in cases when a person's self-reflection is characterized by repetitive and uncontrollable thoughts about the causes, negative consequences and symptoms of current negative affect (Nolen-Hoeksema, 1991) or a preoccupation with perceived threats, losses, shortcomings or injustices to the self (Takano & Tanno, 2009). Evidence points to the maladaptive role of post-event processing in the maintenance of social anxiety disorder (Clark & Wells, 1995), negative selfperceptions (Makkar & Grisham, 2011), and negative affect (Kashdan & Roberts, 2007). ...
Background
Recent theoretical work suggests that self-reflection on daily stressors and the efficacy of coping strategies and resources is beneficial for the enhancement of resilient capacities. However, coping insights emerging from self-reflection, and their relationship to resilient capacities, is an existing gap in our understanding.
Objectives
Given that insights come in many forms, the objective of this paper is to delineate exemplar coping insights that strengthen the capacity for resilience.
Methods
After providing an overview of self-reflection and insight, we extend the Systematic Self-Reflection model of resilience strengthening by introducing the Self-Reflection and Coping Insight Framework to articulate how the emergence of coping insights may mediate the relationship between five self-reflective practices and the enhancement of resilient capacities.
Results
We explore the potential for coping insights to convey complex ideas about the self in the context of stressor exposure, an awareness of response patterns to stressors, and principles about the nature of stress and coping across time and contexts.
Conclusions
This framework adds to existing scholarship by providing a characterization of how coping insight may strengthen resilient capacities, allowing for a guided exploration of coping insight during future research.
... Studies using a speech task have found that high socially anxious individuals engage in greater and more negative levels of post-event processing (Edwards, Rapee, & Franklin, 2003), are more likely to use ruminative coping strategies than distraction strategies (Kocovski, Endler, Rector, & Flett, 2005); and show greater memory biases for negative feedback regarding speech performance (Cody & Teachman, 2010). Furthermore, in terms of a speech task, social anxiety has consistently been found to be a unique predictor of post-event processing over and above that of depression and trait anxiety (Abbott & Rapee, 2004;Edwards et al., 2003;Makkar & Grisham, 2011). ...
Post-event processing has been identified as a maladaptive maintaining feature of social anxiety occurring after a social-evaluative event; however, the cognitive mechanisms thought to underlie post-event processing are still unclear. Poor attentional control may serve to maintain this thought process in social anxiety disorder. A total of 92 undergraduates were pre-screened and categorised into either high or low social anxiety groups and then randomly assigned to either a post-event processing (following a speech task) or a control condition (four groups in total). Participants completed a series of self-report questionnaires and then performed the mixed emotional saccade task whereby participants completed pro-saccades and antisaccades in response to facial expressions in either single-task or mixed-task blocks. The results showed that high socially anxious participants in the post-event processing condition did not display attentional control impairments compared to high socially anxious participants in the control condition or low socially anxious participants in either condition. Conversely, low socially anxious participants in the post-event processing condition showed improved attentional control abilities compared to low socially anxious participants in the control condition. These findings suggest that post-event processing may facilitate attentional control abilities for low socially anxious individuals.
... A 5 day follow-up period was chosen to allow enough time for PEP but to make sure the time period was not so long as to lose the impact of the experimental task. Previous studies of PEP tend to use a follow-up time period between 24 hours (e.g., Makkar & Grisham, 2011) and one week (e.g., Laposa & Rector, 2011) ...
Aims
Post-event processing (PEP) in social anxiety disorder (SAD) involves ruminating about social encounters after the fact. There is a clear relationship between PEP and SAD, but less is known about the negative effects of PEP. The goal of the current study was to investigate these negative effects in a sample of people with SAD. We hypothesized that PEP would contribute to decreased willingness to try a similar task again and to increased anxiety about engaging in a similar task. We also hypothesized that the degree of PEP would mediate the relationship between initial self-evaluation of performance and follow-up self-evaluation.
Methods
Forty-one individuals with a principal diagnosis of SAD completed the study. Participants completed baseline measures of symptom severity and state affect and then completed an impromptu speech task. After completing the speech, they completed a self-evaluation of their performance. Five days later, they rated the degree to which they engaged in PEP about their speech performance, indicated their willingness and anxiety about completing a similar speech task in the future, and completed a second self-evaluation of their performance.
Results
PEP contributed unique and significant variance to willingness (R ² change = .12, p < .05) but not to anxiety ratings (R ² change = .027, p = .13) once symptom severity, depressive symptoms, and state anxiety were controlled for. Using bias-corrected bootstrapping, PEP mediated the relationship between initial and follow-up performance ratings.
Conclusions
The more people engage in PEP, the less willing they appear to be to re-enter difficult social situations, likely perpetuating a cycle of avoidance. PEP also appears to be one factor that keeps negative self-perceptions “alive” after a challenging social situation. The current study provides unique evidence of the negative consequences of PEP for individuals with SAD.
... A summary score was derived from the average of all items. The SBQ has shown good internal consistency in adolescents (Schreiber et al., 2012) and good discriminant validity when compared to a measure of anxious appearance in adults (Makkar & Grisham, 2011). The internal consistency of the ASBQ in this sample was α = .92 ...
Background
Identifying psychological processes that maintain social anxiety holds promise for improving treatment outcomes for young people. Experimental and prospective studies in adults suggest negative social cognitions, safety behaviours, self-focused attention, and pre- and post-event processing are all implicated in the maintenance of social anxiety. Despite social anxiety typically starting in adolescence, prospective studies examining these cognitive processes in youth are lacking. The current study examined prospective associations between these five cognitive processes and social anxiety in a sample of 614 participants (53% girls; aged 11−14 years).
Methods
Psychological processes, social anxiety symptoms, and depressive symptoms were assessed using self-report questionnaires at two time points.
Results
Negative social cognitions, safety behaviours, self-focused attention, and post-event processing predicted prospective levels of social anxiety over and above the effect of baseline levels of social anxiety. When these process variables were entered together in a regression model, three of them were independently associated with prospective social anxiety. Neither pre- nor post-event processing independently predicted later social anxiety over and above the effects of other psychological process variables.
Conclusions
The findings indicate that these psychological processes are promising targets for treatment in adolescent social anxiety.
... Finally, previous studies have typically anchored the measurement of a specific cognitive process to either social interactions or speeches/public speaking (e.g., Price & Anderson, 2011) and the majority of studies have not examined both types of social situations together (for an exception, see . The examination of both types of social situations is also important considering evidence that cognitive processes may be activated to different extents depending on the situation type (Kiko et al., 2012;Makkar & Grisham, 2011). ...
Anticipatory processing, maladaptive attentional focus, and post-event 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 post-treatment. The sample consisted of 116 participants with SAD receiving group cognitive behavioural 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 post-treatment. Within the same task, a slower rate of decrease in a specific cognitive process variable from pre- to post-treatment was predicted from higher pre-treatment levels of either one or both of the other cognitive process variables. Additionally, higher levels of pre-treatment conversation-related anticipatory processing and maladaptive attentional focus predicted a slower rate of decrease in social anxiety symptoms from pre- to post-treatment. Results are consistent with cognitive models of SAD and have important implications for enhancing existing treatments.
... Fourth, while PEP is often assessed after a social performance task (Schmitz et al. 2011), PEP after social interactions with same-aged peers might be different, as interactions are more ambiguous (Beidel 1991). In adult samples, PEP was more pronounced after a speech task in comparison to an interaction task in both nonclinical participants (Makkar and Grisham 2011) and participants with SAD (Kiko et al. 2012). Fifth, although PEP results before treatment were shown to be stable even when we controlled for depressive symptoms, we did not assess depressive symptoms after treatment, as social anxiety was our main focus. ...
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.
... These proposals are based generally on a review of the social anxiety literature on anticipatory processing and post-event processing. Cross-sectional, longitudinal, and experimental studies were found that consistently demonstrated that trait social anxiety is positively associated with both anticipatory processing (e.g., Hinrichsen & Clark, 2003;Hodson et al., 2008;Miers et al., 2014;Mills et al., 2013;Vassilopoulos, 2004) and postevent processing (e.g., Makkar & Grisham, 2011;Miers et al., 2014;Schmitz et al., 2011;Wong, 2015;see Brozovich & Heimberg, 2008;Penney & Abbott, 2014, for reviews; see also Table 4). Additionally, in support of the maintenance function of the secondary cognitive processes, the majority of experimental studies have shown that engaging in anticipatory processing (e.g., Hinrichsen & Clark, 2003;Mills, Grant, Judah, & Lechner, 2014, Mills, Grant, Judah, & White, 2014Vassilopoulos, 2005;Wong & Moulds, 2011b) and post-event processing (e.g., Brozovich & Heimberg, 2011, 2013Kocovski et al., 2011;Rowa et al., 2014;Wong & Moulds, 2009) results in higher levels of social anxiety and more negative cognitive outcomes for socially anxious individuals (see also Table 4). ...
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.
... A variety of factors may predict or exacerbate PEP. For instance, past research has shown that PEP may be influenced by baseline social anxiety (Kocovski and Rector 2007), fear of negative evaluation (Penney and Abbott 2015), negative selfimagery (Makkar and Grisham 2011), in-situation state anxiety (Kiko et al. 2012), safety behaviors (Helbig-Lang et al. 2016), self-focused attention (Helbig-Lang et al. 2016;Gaydukevych and Kocovski 2012), and negative selfperceptions of performance (Dannahy and Stopa 2007;Perini et al. 2006). ...
Post-event processing (PEP) refers to a prolonged and negative rumination following anxiety-provoking social events. Because PEP may maintain social anxiety over time, it is important to reduce this repetitive, negative thinking. Past research has shown that PEP can be reduced through self-compassion. As such, the primary purpose of the present study was to examine the circumstances under which self-compassion buffers against PEP. Given that PEP may be exacerbated by negative performance feedback, we examined whether self-compassion would buffer against PEP under these circumstances (i.e., receiving negative performance feedback). Participants (N = 66) provided an impromptu speech and were randomly assigned to receive either positive or negative speech feedback. As expected, negative performance feedback led to significantly more PEP than positive feedback. However, whereas this effect was particularly pronounced amongst those low on self-compassion, there were no significant differences between conditions on PEP amongst those high on self-compassion. The findings from the present study suggest that trait self-compassion serves to limit PEP in situations where negative performance feedback is provided. This work builds on the benefits of self-compassion in the context of social stress.
This study investigated self-reported state (anxiety, physical symptoms, cognitions, internally focused attention, safety behaviors, social performance) and trait (social anxiety, depressive symptoms, dysfunctional self-consciousness) predictors of post-event processing (PEP) subsequent to two social situations (interaction, speech) in participants with a primary diagnosis of social anxiety disorder (SAD) and healthy controls (HC). The speech triggered significantly more intense PEP, especially in SAD. Regardless of the type of social situation, PEP was best predicted by situational anxiety and dysfunctional cognitions among the state variables. If only trait variables were considered, PEP following both situations was accounted for by trait social anxiety. In addition, dysfunctional self-consciousness contributed to PEP-speech. If state and trait variables were jointly considered, for both situations, situational anxiety and dysfunctional cognitions were confirmed as the most powerful PEP predictors above and beyond trait social anxiety (interaction) and dysfunctional self-consciousness (speech). Hence, PEP as assessed on the day after a social situation seems to be mainly determined by state variables. Trait social anxiety and dysfunctional self-consciousness also significantly contribute to PEP depending on the type of social situation. The present findings support dysfunctional cognitions as a core cognitive mechanism for the maintenance of SAD. Implications for treatment are discussed.
Clark and Wells (1995) developed a cognitive model of social anxiety, in which a number of cognitive processes are proposed to be related to the development and maintenance of social anxiety. Previous studies have consistently found an association between two of the most extensively studied components of this model, self-focused attention and post-event processing. The purpose of the current study was to examine potential moderators of this association using a moderated moderation model, in which maladaptive self-beliefs and social anxiety were hypothesized to moderate the association between self-focused attention and post-event processing. Based on responses to self-report measures completed by a large, non-referred sample, support was found for the moderated moderation model. As expected, negative self-beliefs moderated this association, with social anxiety emerging as a secondary moderator. Interestingly, the model also applied to the association between self-focused attention and anticipatory processing. Overall, the findings provide insight into the cognitive processes associated with engagement in post-event processing and may inform clinicians working with individuals with social anxiety.
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.
Research suggests that state anxiety and in-situation safety behaviors are associated with post-event processing (PEP) in social anxiety. Past research has obtained mixed results on whether one or both factors contribute to PEP. The current investigation evaluated state anxiety and in-situation safety behaviors (including subtypes of in-situation safety behaviors) simultaneously to determine their relative contributions to PEP.
A prospective study assessed social anxiety, state anxiety, in-situation safety behaviors, PEP, and depression in the context of a speech stressor.
Consistent with theory, in-situation safety behaviors were uniquely associated with greater PEP. State anxiety was not uniquely associated with PEP. Furthermore, restricting and active subtypes of in-situation safety behaviors showed specificity to PEP.
Limitations of the present study include the use of a nonclinical analog sample and retrospective reporting of PEP.
These findings highlight the importance of research on in-situation safety behaviors as a potential contributor to PEP.
Post-event processing refers to negative and repetitive thinking following anxiety provoking social situations. Those who engage in post-event processing may lack self-compassion in relation to social situations. As such, the primary aim of this research was to evaluate whether those high in self-compassion are less likely to engage in post-event processing and the specific self-compassion domains that may be most protective. In study 1 (N = 156 undergraduate students) and study 2 (N = 150 individuals seeking help for social anxiety and shyness), participants completed a battery of questionnaires, recalled a social situation, and then rated state post-event processing. Self-compassion negatively correlated with post-event processing, with some differences depending on situation type. Even after controlling for self-esteem, self-compassion remained significantly correlated with state post-event processing. Given these findings, self-compassion may serve as a buffer against post-event processing. Future studies should experimentally examine whether increasing self-compassion leads to reduced post-event processing.
Socially anxious individuals tend to have elevated levels of perfectionism and engage in excessive rumination following social situations. The present research aimed to examine perfectionism, in both state and trait forms, as a predictor of post-event rumination. Socially anxious students (N = 104) completed measures of trait perfectionism prior to, and state perfectionism following, an anxiety inducing speech task. Post-event rumination was assessed 2 days later. State and trait perfectionism were significant predictors of post-event rumination (2 days later), while controlling for baseline social anxiety, depression and state anxiety. These results support the need to target perfectionism in treatments for social anxiety disorder.
Social anxiety disorder (SAD) is a psychological disorder characterised by an excessive and persistent fear of social or performance situations, which interferes with daily functioning. Cognitive models of SAD (Clark & Wells, 1995; Hofmann, 2007; Rapee & Heimberg, 1997) emphasise the importance of negative pre- and post-event rumination as a maintaining factor in the cycle of SAD. While the link between negative rumination and SAD is well supported by empirical research, little is understood about this cognitively important process; thus, research investigating the predictors of negative rumination in SAD is important to consider. Within the current literature, performance appraisal appears to be the most likely unique cognitive predictor of post-event rumination. There is limited research into cognitive predictors of pre-event rumination. Treatments targeting this maintaining factor are important to consider. Suggestions for future research examining the cognitive models of SAD by experimentally manipulating perceived social standards in order to examine the impact of high and low perceived social standard on appraisal processes (i.e., threat appraisal and performance appraisal), state social anxiety, and negative pre-event and post-event rumination, are proposed. Implications for theoretical models and efficacious treatments for SAD are discussed.
Background:
Post-event processing (PEP) refers to negative and prolonged rumination following anxiety provoking social situations. Although there are scales to assess PEP, they are situation-specific, some targeting only public speaking situations. Furthermore, there are no trait measures to assess the tendency to engage in PEP.
Objectives:
The purpose of this research was to create a new measure of PEP, the Post-Event Processing Inventory (PEPI), which can be employed following all types of social situations and includes both trait and state forms.
Design and method:
Over two studies (study 1, N = 220; study 2, N = 199), we explored and confirmed the factor structure of the scale with student samples.
Results:
For each form of the scale, we found and confirmed that a higher-order, general PEP factor could be inferred from three sub-domains (intensity, frequency, and self-judgment). We also found preliminary evidence for the convergent, concurrent, discriminant/divergent, incremental, and predictive validity for each version of the scale. Both forms of the scale demonstrated excellent internal consistency and the trait form had excellent two-week test-retest reliability.
Conclusion:
Given the utility and versatility of the scale, the PEPI may provide a useful alternative to existing measures of PEP and rumination.
Excessive post-mortem processing after social situations, a core symptom of social anxiety disorder (SAD), is thought to contribute to the perpetuation of social anxiety by consolidating negative self-schemata. Empirical findings on actual mechanisms underlying this so-called Post-Event Processing (PEP) are still scarce. The present study sought to identify variables associated with the experience of PEP after real-life social situations in a sample of 49 individuals diagnosed with SAD. Using an ambulatory assessment approach, individuals were asked to report on each distressing social event experienced during one week. A total of 192 events were captured. Hierarchical linear modeling indicated that next to trait social anxiety, the type of social situation (performance vs. interaction situations), self-focused attention, safety behavior use, and negative affect predicted levels of PEP after social situations. These findings add to the growing literature that emphasizes the importance of situational factors for the experience of PEP, and highlight potential venues to prevent it.
The study investigated the relationship between self-focused attention (SFA) and post-event processing (PEP) in social anxiety. SFA is the process of directing attention to internal stimuli during a social interaction. PEP is a detailed review of performance following an interaction. Highly socially anxious students (N = 82) were randomly assigned to a high SFA (n = 40) or low SFA condition (n = 42) and completed baseline measures of social anxiety, depression, trait SFA, and trait rumination. After SFA was manipulated via instructions, participants engaged in a 5-min unstructured conversation with a confederate, followed by a manipulation check. PEP was assessed the next day online. The high SFA group reported a similar amount of positive PEP but more frequent negative PEP over the 24-h period compared to the low SFA group. These results provide support for a causal relationship between SFA and PEP and have important applications for the development of effective cognitive-behavioural interventions.
The correlation between social anxiety, as measured by the Social Phobia Scale, and negative post-event processing of socially distressing events, as measured by a diary record, was studied in a sample of 62 undergraduate students (mean age 27.98 yrs) during a 1-wk period. Of the participants, 55 individuals reported the experience of at least 1 socially distressing event during this time; only 24 of the participants, however, reported distressing events of a negative-evaluational character during the recording week. Although the Social Phobia Scale did not correlate with post-event processing of socially distressing events in general, it showed moderate to strong correlations with post-event processing of negative-evaluational events both on the same day and on the following day. Furthermore, the degree of negative post-event processing that was reported the same day was strongly predictive of the degree of such processing that was reported the following day. The results confirm that negative post-event processing is a real phenomenon with regard to socially distressing situations, and that high social anxiety is associated with higher degrees of such post-event processing of negative-evaluational events. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The psychometric adequacy of the Social Interaction Anxiety Scale (SIAS; R. P. Mattick & J. C. Clark, 1989), a measure of social interaction anxiety, and the Social Phobia Scale (SPS; R. P. Mattick & J. C. Clark, 1989), a measure of anxiety while being observed by others, was evaluated in anxious patients and normal controls. Social phobia patients scored higher on both scales and were more likely to be identified as having social phobia than other anxious patients (except for agoraphobic patients on the SPS) or controls. Clinician-rated severity of social phobia was moderately related to SIAS and SPS scores. Additional diagnoses of mood or panic disorder did not affect SIAS or SPS scores among social phobia patients, but an additional diagnosis of generalized anxiety disorder was associated with SIAS scores. Number of reported feared social interaction situations was more highly correlated with scores on the SIAS, whereas number of reported feared performance situations was more highly correlated with scores on the SPS. These scales appear to be useful in screening, designing individualized treatments, and evaluating the outcomes of treatments for social phobia. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
In the present investigation, an inductive measurement technique was employed to test some of the shared assertions made by theories of emotional behavior and behavior change. Specifically, the effects of heterosocial anxiety and anonymity on self-statements and self-evaluation by men were investigated. It was found that the anticipation of a discussion with an unfamiliar woman resulted in (a) the spontaneous generation of more negative self-statements and self-evaluation by high than by low heterosocially anxious men, (b) high and low heterosocially anxious men emitting their self-statements, which were clearly distinguishable; and (c) the anonymity of the impending discussion affecting neither the self-statements nor the self-evaluation of high and low heterosocially anxious men. These results provide evidence that an individual's idiosyncratic cognitive responses can be assessed objectively and easily, and that the nature of the self-statements is affected by individual differences even though the individuals involved may be unaware of these effects.
Probability and emotional impact estimates of intense positive and negative social events were examined in individuals with generalized social phobia (GSPs), obsessive compulsive disorder (OCDs), and nonanxious controls (NACs). Participants completed a questionnaire containing 20 event descriptions. For each event, they indicated the probability that the event would happen to them and rated aspects of their reactions to the event: magnitude, duration, self-esteem change, and strength of bodily reaction. Compared to NACs, GSPs estimated positive events as less likely and negative events as more likely to happen to them. GSPs rated the impact of both negative and positive social events higher than did NACs. Moreover, GSPs anticipated experiencing more frequent and intense negative reactions to positive social events than did NACs. On most measures, GSPs also differed from OCDs. Although evaluation biases of social events may be more characteristic of anxious individuals than of nonanxious individuals, they appear to be particularly related to social phobia.
While there has been considerable concern for the assessment, correlates, and treatment of public speaking anxiety, little attention has been paid to why dispositional public speech anxiety detrimentally affects public speaking performances. In this study we test the notion that high public speaking anxiety is associated with excessive attention to self, leading to less effective public presentations. Results indicate that highly anxious speakers tend to pay less attention to their environments and have more negative, self-focused cognitions about their performances than low anxious speakers. This increase in attention to self is correlated with poorer speaking performances and lower self-evaluations.
Reports the specification of a construct of social anxiety, the subsequent development of 2 scales, and validational studies. The Fear of Negative Evaluation Scale (FNE) and the Social Avoidance and Distress Scale (SAD) were given to 358 undergraduates. 3 experiments and other correlational data are presented. People high in SAD tended to avoid social interactions, preferred to work alone, reported that they talked less, were more worried and less confident about social relationships, but were more likely to appear for appointments. Those high in FNE tended to become nervous in evaluative situations, and worked hard either to avoid disapproval or gain approval. Certain convergent and discriminant relationships had been part of the construct of social anxiety, and the correlational data support these differentiations. (17 ref.)
Self-focused attention has been linked to social anxiety and poor social performance, but the causal direction of this relationship has not been established. For this study, focus of attention was manipulated during a speech task, conducted in pairs for 38 individuals with generalized social phobia. Results indicated that intensifying self-focused attention increased anticipated anxiety and anxious appearance, regardless of whether the individual was giving a speech or passively standing before the audience. The self-focus manipulation also increased self-reported anxiety during the task, but only for individuals assigned to a passive role. Contrary to expectation, self-focused attention did not affect any measure of social performance. These results indicate that self-focused attention may play a causal role in exacerbating social anxiety.
Social phobia has become a focus of increased research since its inclusion in DSM-III. However, assessment of social phobia has remained an underdeveloped area, especially self-report assessment. Clinical researchers have relied on measures that were developed on college populations, and these measures may not provide sufficient coverage of the range of situations feared by social phobic individuals. There is a need for additional instruments that consider differences in the types of situations (social interaction vs. situations involving observation by others) that may be feared by social phobics and between subgroups of social phobic patients. This study provides validational data on two instruments developed by Mattick and Clarke (1989): the Social Interaction Anxiety Scale (SIAS), a measure of anxiety in social interactional situations, and the Social Phobia Scale (SPS), a measure of anxiety in situations involving observation by others. These data support the use of the SIAS and SPS in the assessment of individuals with social phobia.
The development and validation of the Social Phobia Scale (SPS) and the Social Interaction Anxiety Scale (SIAS) two companion measures for assessing social phobia fears is described. The SPS assesses fears of being scrutinised during routine activities (eating, drinking, writing, etc.), while the SIAS assesses fears of more general social interaction, the scales corresponding to the DSM-III-R descriptions of Social Phobia—Circumscribed and Generalised types, respectively. Both scales were shown to possess high levels of internal consistency and test–retest reliability. They discriminated between social phobia, agoraphobia and simple phobia samples, and between social phobia and normal samples. The scales correlated well with established measures of social anxiety, but were found to have low or non-significant (partial) correlations with established measures of depression, state and trait anxiety, locus of control, and social desirability. The scales were found to change with treatment and to remain stable in the face of no-treatment. It appears that these scales are valid, useful, and easily scored measures for clinical and research applications, and that they represent an improvement over existing measures of social phobia.
examine depression and anxiety from an interpersonal perspective in an attempt to delineate the interpersonal features specific to each condition / focus more on social anxiety and clinical disorders characterized by social anxiety than on general anxiety
examine various cognitive and behavioral theories that address interpersonal aspects of depression and social anxiety and survey the empirical literature that addresses this issue / focus primarily on the depressed and anxious person's cognitive and behavioral reactions to social situations: that is, how depressed and anxious people process social information and what they do in social situations / examine the extent to which depression and anxiety are associated with distinct cognitive-behavioral patterns in interpersonal situations (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Cognitive theorists propose that each anxiety disorder is associated with a specific tendency to overestimate the danger inherent in particular situations or internal states. Studies comparing anxious patients with non-patient controls have shown that several anxiety disorders are associated with elevated subjective estimates of the likelihood (probability) and cost of negative events. The present study focuses on social phobia and extends previous findings by: a) including a control group of equally anxious patients with another anxiety disorder and b) investigating the effects of successful cognitive and drug treatments on patients' probability and cost estimates. In line with cognitive theory, the results indicate that social phobia is associated with a specific elevation in subjective estimates of both the probability and cost of potentially negative social events. Reductions in overestimation occurred in successful cognitive and drug treatment and were closely related to the degree of symptomatic improvement in both treatments. Contrary to previous findings, there was no evidence that reductions in cost were more important than reductions in probability.
Recent research indicates the apparent paradox that social anxiety may be associated with both self-focused attention and selective attention to external social threat cues. A naturalistic paradigm was designed to explore both processes. High and low socially anxious individuals were asked to make a speech to a monitor displaying six people whom they believed to be watching them live. Two audience members exhibited only positive behaviours, two only neutral ones and two only negative behaviours. In contrast to the low social anxiety group who selectively discriminated positive audience members, the high social anxiety group selectively discriminated the negative individuals, yet they were no more accurate at discriminating the negative behaviours the audience members had performed and they reported more self-focused attention than the low social anxiety group. The effects remained while covarying for differences in dysphoria. The results indicate that socially anxious individuals base their judgements of being disapproved by others on limited processing of their social environment.
This paper discusses the viability of an analogue research design for studying key processes in social phobia
by comparing individuals who score high and low on the Fear of Negative Evaluation Scale (FNE: Watson & Friend,
1969). Research indicates remarkable consistency in the processes that distinguish patients with social phobia from
controls and high FNE volunteers from low FNE volunteers. Unfortunately, all existing FNE norms are based on
North American populations. The present paper presents British student norms and suggests possible cut-off points for
defining groups for analogue research. Advantages of the analogue strategy include rapid piloting of new paradigms
and the use of more complex experimental designs that require substantial sample sizes. Limitations of analogue
research are also highlighted.
Issues in the cognitive assessment of extreme social anxiety in adults were explored, with a major focus on the relationship between and utility of structured questionnaire and protocol analysis methods. The assessment of underlying cognitive factors associated with concerns over evaluation by others was also of interest, as were the affective and behavioral correlates of cognitive variables. Reports of negative thoughts on a thought listing prior to an actual conversation were found to be related to negative self-statements on a structured questionnaire (Social Interaction Self-Statement Test) filled out after the interaction, and both measures showed an asymmetric preponderance of negative over positive thoughts. Thoughts on the SISST were related to irrational beliefs and fear of negative evaluation, social anxiety, and global behavioral ratings of the interaction made by both partners and judges. The lack of significant correlations between thoughts on the SISST and microbehavior ratings, and between thought listings and other cognitive, affective, and behavioral measures, underscores the utility of structured self-statement measures and global behavioral assessment strategies.
Socially anxious and nonanxious men participated in a practice interaction with an experimental assistant, ostensibly in preparation for a second interaction with another student. The success of the practice interaction was varied by manipulating the assistant's behavior and the experimenter's feedback about the subject's performance. Subjects then rated their perceived social ability (i.e., self-efficacy), their personal standard, and their perception of others' standards for evaluating their social performance for an upcoming interaction. Nonanxious men expected their ability to match or exceed both their own and others' standards of evaluation in all feedback conditions. Socially anxious men, on the other hand, believed their ability would fall short of what others expected in all three conditions. Unlike nonanxious men, socially anxious men who experienced a successful social interaction believed others would expect more from them in upcoming interactions than did anxious men who experienced social failure.
This study tested D. M. Clark and A. Wells’ (1995) proposition that negative post-event rumination is produced by negative self perceptions formed by socially phobic individuals during anxiety-provoking events. A socially phobic group and a nonanxious control group performed an impromptu speech, and appraised their performance immediately afterwards. One week later, participants were assessed as to how frequently they had had negative thoughts about the speech, how much they engaged with these thoughts, how distressing these thoughts were, and how much control they felt they had over the thoughts. The socially phobic group engaged in more negative rumination than controls on each of these levels, and perceived their performance as worse than controls immediately after the speech. Perception of performance was found to mediate the relationship between social anxiety and post-event rumination, providing support for Clark and Wells’ model.
Many individuals with social phobia experience anxiety and negative cognitions in more than one social situation, yet few studies have considered the role of situational factors when assessing the cognitive content of those with social phobia. The present study, using the Social Interaction Self-Statement Test (SISST), examined the thoughts of 60 individuals diagnosed with social phobia across three social situations: a same-sex interaction; a different-sex interaction; and an impromptu speech. Results emphasize the importance of considering the type of situation when assessing thoughts of socially phobic individuals during social interactions. Most notable were differences found when comparing cognitions of different subgroups (generalized vs. nongeneralized social phobia) in the speech situation with their thought patterns in the social interaction situations. These findings suggest that a cognitive assessment that includes a range of behavioral tasks may be most helpful in diagnosis and treatment plan development. Results also offer support for the utility of the SISST negative subscale in both social interaction and speech situations.
Maladaptive interpretations of negative social events are considered to be an important cognitive feature of social phobia. The present study sought to investigate the content-specificity of interpretative biases in social phobia, and to examine the influence of concurrent depressive symptoms on the interpretation of different types of events. Individuals with social phobia were compared with non-clinical controls in terms of the degree to which they believed different interpretations of hypothetical social or non-social situations with either positive or negative outcomes. The effect of including scores on a measure of depression as a covariate in analyses was also examined. The results showed that individuals with social phobia were more likely than controls to believe negative interpretations of negative social events, regardless of their level of concurrent depression. Negative interpretative biases were also evident for other types of events when depression was not included as a covariate, although the majority of these biases were no longer evident when depression was controlled. Results are discussed in terms of their implications regarding cognitive differences between social anxiety and depression.
The specificity of the Social Interaction Self-Statement Test (SISST) was evaluated in sample of 277 patients seeking treatment for anxiety. Both the positive and negative scales significantly discriminated between patients diagnosed with social phobia and other anxiety disorder patients. Patients with social phobia scored significantly higher on the negative scale and significantly lower on the positive scale as compared with other treatment-seeking anxiety disorder patients. Negative SISST scores were significantly correlated with the Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI). The positive scale was significantly correlated with the BDI. Despite this relationship, differences in BAI and BDI scores did not account for SISST findings. The present study provides further support for the use of the SISST with clinical populations.
The recent emphasis on cognitive factors in the treatment of emotional problems has stimulated the development of cognitive assessment techniques. This paper presents the development and initial validation of an instrument to assess self-statements about social interactions. The 30-item questionnaire contains 15 positive (facilitative) and 15 negative (inhibitory) self-statements that were derived from subjects who listed thoughts while imagining difficult social situations. Item selection was accomplished by using judges' ratings of those thoughts. Validity studies with two samples compared scores on the self-statement measure with self-report, judges' and confederates' ratings of skill and anxiety following taped role-play and face-to-face interactions, and with questionnaire measures of social anxiety and skill. The measure appears to be a reliable, valid measure of cognitions associated with social anxiety. Research directions in cognitive assessment are suggested.
Current theories predict that following a social–evaluative performance, people high in social anxiety will ruminate about the negative features of the event and, in turn, will show a bias toward recalling the negative aspects of the event. In this study participants presented an impromptu speech and were then provided with half positive and half negative feedback on their performance. A free-recall task was used to test immediate recall for the feedback. Participants returned 1 week later and were again tested on recall for the feedback as well as completing a questionnaire indicating the extent to which they engaged in both positive and negative rumination regarding the speech task during the preceding week. Evidence for a negative memory bias in the high socially anxious group (HI) was found at both times, however this negative bias did not increase over time. The hypothesis that the HI group would spend more time than the low socially anxious group ruminating over perceived negative aspects of the speech task was also supported. Social anxiety and depression scores were both uniquely associated with negative rumination, however when controlling for depression the Group Rumination–Valence interaction became nonsignificant. The HI group did engage in greater levels of overall rumination however, even when depression scores were statistically controlled. There was no significant relationship shown between negative recall bias and negative rumination.
The convergent and discriminant validity of the Social Interaction Self-Statement Test (SISST) were evaluated in a sample of men and women awaiting treatment for fear and avoidance of social interactions. Partial correlations revealed that negative, but not positive, self-statement scores were generally related to self-report measures of anxiety and depression. Heart rate and subjective anxiety ratings derived from a behavioral simulation of a personally relevant anxiety-provoking situation were unrelated to SISST scores. However, subjects' reports of negative thoughts obtained via the thought-listing procedure were related to the SISST negative self-statement scores, suggesting that the negative subscale of the SISST and the thought-listing procedure tap similar dimensions. Finally, the negative subscale of the SISST discriminated between social phobics whose primary fear involved social interactions and social phobics whose anxiety was confined to public-speaking situations. The findings support the use of the SISST with clinically socially anxious patients.
This study examined the discrepancy between self-established standards and self-efficacy in social situations. Socially anxious and nonanxious men rated a series of standards for judging the adequacy of their performance in an upcoming social interaction; subjects also rated their social self-efficacy, or perceived ability to handle the interaction. Nonanxious subjects expected their ability to equal or exceed all standards of evaluation. Anxious subjects expected their ability to equal that of the average subject and also believed their performance would match their personal standard. However, anxious subjects believed their social behavior would fall short of what they believed the experimenter expected of them. No support was found for the idea that socially anxious men establish perfectionistic standards. Rather, they believed that others held standards for them that they could not achieve. The results are congruent with cognitive theories of social anxiety.
This study examined perfectionism and standard-setting within a self-regulation framework and systematically compared the
roles of both factors in dysphoria and social anxiety. Four groups of subjects representing all combinations of social anxiety
and dysphoria completed measures of self-oriented and socially prescribed perfectionism. They then rated three aspects of
self-regulation (standard-setting, frequency of self-appraisal, and self-efficacy) in the context of a social task. Socially
prescribed perfectionism was associated with frequent self-appraisal during the interaction, but not with standard-setting.
Self-oriented perfectionism was associated with establishing goals that exceeded one's perceived social ability and with importance
of meeting personal goals. The extent to which either type of perfectionism was associated with dysphoria or social anxiety
was dependent on social self-efficacy.
Social phobics, anxious controls and non-patient controls took part in a brief videotaped conversation with a stooge in order to investigate the cognitive model of social phobia. Thoughts, behaviour, and attention during the conversation were assessed. Compared to the control groups, social phobics had more negative self-evaluative thoughts, performed less well, and systematically underestimated their performance. There were no differences in attention between the three groups. Content analysis of thought sampling data from the conversation, and from three hypothetical situations, revealed that few of the negative thoughts reported by social phobics explicitly mentioned evaluation by other people. This suggests that social phobics may not closely monitor other people's responses in social situations and hence that their thoughts are not data driven. The results are discussed in relation to the cognitive model of social phobia and suggestions are made for improvements in the treatment of social phobia.
When entering anxiety-provoking social situations, individuals with social phobia tend to shift attention inward, toward the self. This tendency is likely to diminish the potential for exposure to correct negative beliefs and associated anxiety. The present study tested the hypothesis that by shifting to an external attention focus on disconfirmatory information, the effectiveness of brief exposure is increased. This hypothesis was tested in a single-case series of 8 socially phobic patients. Following an initial behavior test, half of the patients received one session of exposure alone followed by one session of exposure plus external attention focus, while the other half of the patients received these sessions in reversed order. Both conditions were rated as equally credible. Exposure plus external attention focus was significantly more effective than exposure alone in reducing within-situation anxiety and belief in feared catastrophes. Moreover, the attention condition produced a shift from an observer to a field perspective in patients' images of the feared social situation. A manipulation-check measure of degree of self-focused attention confirmed that the attention manipulation had influenced self-focus as intended. The role of attention manipulations in the treatment of social phobia is discussed.
Two information processing biases that could maintain social anxiety were investigated. High and low socially anxious individuals encoded positive and negative trait words in one of three ways: public self-referent, private self-referent, and other-referent. Half were then told they would soon have to give a speech. As predicted, compared to low socially anxious individuals, high socially anxious individuals recalled less positive public self-referent words, but only when both groups were anticipating giving a speech. No memory biases were observed for private self-referent or other-referent words. Next all participants gave a speech. Correlational analyses suggested that high socially anxious individuals may use the somatic concomitants of anxiety to overestimate how anxious they appear and underestimate how well they come across.
It has been suggested that social phobia may be characterized by two interpretation biases. First, a tendency to interpret ambiguous social events in a negative fashion. Second, a tendency to interpret unambiguous but mildly negative social events in a catastrophic fashion. To assess this possibility, patients with generalized social phobia, equally anxious patients with another anxiety disorder, and non-patient controls were presented with ambiguous scenarios depicting social and non-social events, and with unambiguous scenarios depicting mildly negative social events. Interpretations were assessed by participants' answers to open-ended questions and by their rankings and belief ratings for experimenter-provided, alternative explanations. Compared to both control groups, patients with generalized social phobia were more likely to interpret ambiguous social events in a negative fashion and to catastrophize in response to unambiguous, mildly negative social events.
One of the puzzles surrounding social phobia is that patients with this problem are often exposed to phobic situations without showing a marked reduction in their fears. It is possible that individuals with social phobia engage in behaviors in the feared situation that are intended to avert feared catastrophes but that also prevent disconfirmation of their fears. This hypothesis was tested in a single case series of eight socially phobic patients. All patients received one session of exposure alone and one session of exposure plus decrease in “safety” behaviors in a counterbalanced within-subject design. Exposure plus decreased safety behaviors was significantly better than exposure alone in reducing within-situation anxiety and belief in the feared catastrophe. Other factors that may moderate exposure effects are also discussed.
Forty-three social phobics were assigned to exposure (EXP), cognitive restructuring without exposure (CR-alone), or to an intervention combining these techniques (COMB), in a wait-list controlled (WLC) trial. Treatment integrity assessment showed compliance with instructions consistent with the treatments. Within-group analyses showed that the COMB and CR-alone groups improved significantly on all variables, whereas the EXP group showed changes on phobia but not attitudinal measures. Between-group analyses indicated COMB to be superior to EXP on two phobia measures. CR-alone was inferior to EXP and COMB on behavioral approach after treatment, but showed continued improvement relative to the exposure groups on this and other variables by follow-up. The relative ability of treatment-induced changes in fear of negative evaluation (FNE), locus of control, and irrational beliefs to predict long-term improvement was assessed. Changes in these variables were predictive of improvement. The change in FNE accounted for the majority of the explained variance.
A large body of experimental evidence has demonstrated the adverse effects of rumination on depressive mood and cognitions. In contrast, while prominent models of social phobia (Clark & Wells, 1995; Rapee & Heimberg, 1997) have proposed rumination as a key maintaining factor, the effects of rumination in social anxiety have not been extensively explored. In a sample of (N = 93) undergraduates, this study investigated the impact of rumination versus distraction following a social-evaluative task on anxiety and another key component of social phobia: maladaptive self-beliefs. Relative to distraction, rumination maintained anxiety in both high and low socially anxious individuals, and maintained unconditional beliefs in high socially anxious individuals. The results support models of social phobia and also suggest important theoretical extensions. Implications for the treatment of social anxiety are discussed.
Cognitive-behavioral treatments have demonstrated efficacy in the treatment of social phobia. However, such treatments comprise a complex set of procedures, and there has been little investigation of the effects of individual procedures. The current study investigates the effects of two single session procedures that form part of cognitive therapy for social phobia [Clark, D., Ehlers, A., McManus, F., Hackmann, A., Fennell, M., Campbell, H., et al. (2003). Cognitive therapy vs fluoxetine in the treatment of social phobia: A randomised placebo controlled trial. Journal of Consulting and Clinical Psychology, 71, 1058-1067; Clark, D., Ehlers, A., McManus, F., Fennell, M., Grey, N., Waddington, L., et al. (2006). Cognitive therapy versus exposure and applied relaxation in social phobia: A randomised controlled trial. Journal of Consulting and Clinical Psychology, 74, 568-578], namely the "self-focused attention and safety behaviors experiment" and the "video feedback experiment." Results suggest that both procedures are effective in achieving their aims, which are: (i) demonstrating to patients the role of self-focused attention, safety behaviors, and excessively negative self-impressions in maintaining social phobia and (ii) reducing the symptoms of social phobia.
Fifty-two socially-anxious and non-anxious individuals were assessed for indicators of physiological arousal, type of cognitions, and behavioral indicators of skill and anxiety within the context of a series of interpersonal tasks. These assessments included an unstructured interaction with an opposite-sex confederate, a similar interaction with a same-sex confederate and an impromptu speech. Results indicated that physiological reactivity occurred in most social situations in the socially anxious and to some extent in the non-socially anxious. An additional physiological index by which to differentiate the groups appeared to be latency to habituation. Socially-anxious individuals also have an increased number of negative cognitions and fewer positive cognitions. Situational factors appear to mediate the absolute level of reactivity. The results are discussed in terms of the assessment of the socially anxious, the role of physiological arousal, and the effect of situational context.
It has been suggested that neurotic patients engage in 'emotional reasoning', i.e. draw invalid conclusions about a situation on the basis of their subjective emotional response. The present experiment investigated whether anxiety patients infer danger on the basis of their anxious response, whereas normals infer danger only on the basis of objective information. Four groups of anxiety patients (52 spider phobics, 41 panic patients, 38 social phobics, and 31 other anxiety patients) and 24 normal controls made ratings of the danger they perceived in scripts in which information about objective safety vs objective danger, and anxiety response vs non-anxiety response information were systematically varied. As hypothesized, anxiety patients were not only influenced by objective danger information, but also by anxiety response information, whereas normal controls were not. The effect was neither situation-specific, nor specific for panic patients. This tendency to infer danger on the basis of subjective anxiety ('ex-consequentia reasoning') may play a role in the development and maintenance of anxiety disorders.
32 generalized social phobic outpatients and 32 matched nonclinical control subjects participated in a dyadic 'getting acquainted' interaction with an experimental assistant who engaged in either positive or negative social behavior. The accuracy of social phobics' and control subjects' perceptions of themselves and their partners were compared in the two conditions. Relative to observers' ratings, the social phobics displayed a negative bias in their appraisals of some, but not all, aspects of their social performance. These results suggested that social phobics may have particular difficulty gauging the nonverbal aspects of their social behavior. The phobics discounted their social competence to the same extent in the positive interaction, where their behavior was more skillful, as in the negative interaction. The social phobics were also less accurate than nonclinical controls in their appraisals of their partners, however, these phobic subjects displayed a positive bias when appraising their partner's performance.