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Hauffe V, Vierrath V, Tuschen-Caffier B, Schmitz J. Daily-life reactivity and emotion regulation in children with social anxiety disorder. J Anxiety Disord 2024; 106:102907. [PMID: 39059189 DOI: 10.1016/j.janxdis.2024.102907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 06/01/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024]
Abstract
Prominent models of adult social anxiety disorder emphasize the role of hyperreactivity and emotion regulation (ER) difficulties. However, it is unclear whether these factors are relevant in childhood, a critical period for the development of this disorder. We used ecological momentary assessment with mobile phones to assess daily-life emotional reactivity and use and effectiveness of ER strategies in children aged 10-13 years. We compared three groups: Social anxiety disorder (n = 29), clinical controls with mixed anxiety disorders (n = 27) and healthy controls (n = 31). We also investigated long-term effects of ER on trait social anxiety 12 months later. Hierarchical linear modelling revealed higher emotional reactivity and more use of suppression in children with social anxiety disorder compared to clinical and healthy controls. Contrary to our expectations, children with social anxiety disorder reported more use of avoidance and reappraisal compared to clinical, but not healthy, controls. The groups did not differ in subjective effectiveness of ER strategies. Use of suppression, avoidance, and rumination each predicted an increase in social anxiety 12 months later. Taken together, our results extend previous findings from lab and questionnaire studies and illustrate the role of maladaptive ER for child social anxiety disorder.
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Affiliation(s)
- Vera Hauffe
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Freiburg University, Germany.
| | - Verena Vierrath
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Freiburg University, Germany
| | - Brunna Tuschen-Caffier
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Freiburg University, Germany
| | - Julian Schmitz
- Department of Clinical Child and Adolescent Psychology, Institute of Psychology, Leipzig University, Germany; Leipzig Research Center for Early Child Development, Leipzig University, Germany
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2
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Gavric D, Cameron D, Waechter S, Moscovitch DA, McCabe RE, Rowa K. Just do something: An experimental investigation of brief interventions for reducing the negative impact of post-event processing in social anxiety disorder. J Anxiety Disord 2023; 98:102744. [PMID: 37478698 DOI: 10.1016/j.janxdis.2023.102744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 06/02/2023] [Accepted: 07/12/2023] [Indexed: 07/23/2023]
Abstract
Post-Event Processing (PEP) is prevalent and problematic in Social Anxiety Disorder (SAD) but is typically not a direct target in evidence-based treatments such as cognitive behavioural therapy (CBT) for SAD. The primary aim of the current study was to examine the impact of several theoretically and empirically derived interventions for PEP in SAD, including concrete thinking, abstract thinking, and distraction in comparison to a control (i.e., do nothing) condition. Based on prior research, we hypothesized that the concrete and distract conditions would be associated with positive benefits, including reductions in PEP and improvements in self-perception, whereas the abstract and control conditions would not. The second aim of the study was to identify baseline variables that predict the trajectory of change in PEP over time. Participants (N=92) with a principal diagnosis of SAD completed a social stress task and were randomly assigned to one of four conditions. Participants completed measures at baseline, post-intervention/control, and at 1-week, and 1-month follow-up. Contrary to hypotheses, all three active conditions were similarly effective at reducing PEP and improving self-perceptions relative to the control condition. In the absence of an intervention, engagement in PEP remained high up to a month following the social stress task. Higher levels of baseline state anxiety, intolerance of uncertainty, and use of safety behaviours predicted greater PEP, even in the presence of an intervention. These results highlight the benefits of relatively brief interventions that disrupt the course of PEP for people with SAD. Such interventions can be easily incorporated into CBT protocols for SAD to enhance their effects.
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Affiliation(s)
- Dubravka Gavric
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 3K7, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L8S 4L8, Canada.
| | - Duncan Cameron
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 3K7, Canada
| | - Stephanie Waechter
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 3K7, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - David A Moscovitch
- Department of Psychology and Centre for Mental Health Research and Treatment, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Randi E McCabe
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 3K7, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Karen Rowa
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 3K7, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L8S 4L8, Canada
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Kane L, Ashbaugh AR. Ecological momentary assessment of post-event processing in between two speech tasks: Relationships with cognitive and affective factors involved in the maintenance of social anxiety. Behav Res Ther 2022; 159:104208. [PMID: 36252291 DOI: 10.1016/j.brat.2022.104208] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/17/2022] [Accepted: 10/05/2022] [Indexed: 12/14/2022]
Abstract
Socially anxious individuals tend to review past distressing social situations, a process called post-event processing. The goal of this 4-day study was to investigate how PEP evolved over time in between two speech tasks in a sample of 101 students using ecological momentary assessment (EMA). In addition, we examined the relationships between post-event processing and other cognitive and affective processes involved in social anxiety, including anticipatory processing, anxiety, performance appraisals, and memory. Results from EMA showed that post-event and anticipatory processing decreased over time. Higher anxiety during the speech and poorer performance appraisals predicted more post-event processing, though post-event processing was unrelated to changes in performance appraisals over time. Post-event processing the day following the first speech was positively associated with anticipatory processing the day before the second speech. Participants who engaged in more post-event processing also remembered the first speech differently (e.g., more negative and emotionally intense). Implications for the cognitive-behavioural treatment of social anxiety are discussed.
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Affiliation(s)
- Leanne Kane
- University of Ottawa, School of Psychology, 136 Jean-Jacques Lussier Private, Ottawa, ON, Canada, K1N 6N5.
| | - Andrea R Ashbaugh
- University of Ottawa, School of Psychology, 136 Jean-Jacques Lussier Private, Ottawa, ON, Canada, K1N 6N5.
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Kampa M, Finke J, Stalder T, Bucher L, Klapperich H, Mertl F, Zimmer C, Geiger C, Hassenzahl M, Klucken T. Facilitating relaxation and stress reduction in healthy participants through a virtual reality intervention: study protocol for a non-inferiority randomized controlled trial. Trials 2022; 23:380. [PMID: 35534868 PMCID: PMC9082920 DOI: 10.1186/s13063-022-06307-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 04/12/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Repeated or chronic stress is considered a major source of disease, in terms of both somatic and mental illnesses. The prevention of stress-related disease by interventions for relaxation has thus increased societal relevance. In this randomized controlled non-inferiority trial, we will compare a newly developed virtual reality (VR) environment for relaxation to an active control group applying a freely chosen relaxation method. To test if our VR environment supports relaxation in a situation of acute stress, a standardized stress induction protocol will precede the relaxation phase. METHODS One hundred healthy participants will be recruited from the University of Siegen and randomly assigned to the VR or the active control group that will be free to choose their own relaxation strategy. The multi-sensory VR includes visual, acoustic, and haptic features to induce a strong feeling of presence. The laboratory testing will comprise a baseline measurement, a stress induction, a relaxation intervention, and a recovery measurement. The primary outcomes are self-reported stress and relaxation measured with a visual analog scale (VAS) at pre- and post-baseline, at the start, middle, and end of the stress induction, at pre- and post-relaxation, at pre- and post-recovery, and in the evening of testing. Secondary outcomes are the physiological parameters, namely heart rate and heart rate variability, tonic skin conductance level as well as the number of non-specific skin conductance responses, systolic and diastolic blood pressure and respiratory rate recorded during the four experimental phases as well as state mood, and state rumination assessed at four time points (pre- and post-stress, post-relaxation, and in the evening of testing). Finally, post-event processing will be assessed after relaxation and in the evening of testing. Repeated measures ANOVAs will be performed to test for statistical effects of group, time, and group × time interaction. DISCUSSION The newly developed, multi-sensory VR offers an intervention for relaxation without prior training. Its immersive character might increase efficacy compared to other relaxation methods, especially in situations of acute stress. Future directions could be the development of a mobile version of the VR to enhance accessibility for users. To achieve a transfer of training effects to real life, VR components should successively be eliminated until relaxation is practiced without guidance by the VR. TRIAL REGISTRATION ISRCTN Registry ISRCTN11162338 . Retrospectively registered on January 22, 2021.
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Affiliation(s)
- Miriam Kampa
- Department of Clinical Psychology and Psychotherapy, University of Siegen, Obergraben 23, 57072, Siegen, Germany.
- Bender Institute of Neuroimaging, Justus Liebig University, Giessen, Otto-Behaghel-Str. 10 H, 35394, Giessen, Germany.
| | - Johannes Finke
- Department of Clinical Psychology and Psychotherapy, University of Siegen, Obergraben 23, 57072, Siegen, Germany
| | - Tobias Stalder
- Department of Clinical Psychology and Psychotherapy, University of Siegen, Obergraben 23, 57072, Siegen, Germany
| | - Leandra Bucher
- Department of Clinical Psychology and Psychotherapy, University of Siegen, Obergraben 23, 57072, Siegen, Germany
| | - Holger Klapperich
- Ubiquitous Design/Experience and Interaction, University of Siegen, Kohlbettstraße 15, 57072, Siegen, Germany
| | - Fabian Mertl
- Mixed Reality and Visualization (MIREVI), Faculty of Media, University of Applied Sciences Düsseldorf [M1], Münsterstraße 156, 40476, Düsseldorf, Germany
| | - Christian Zimmer
- Mixed Reality and Visualization (MIREVI), Faculty of Media, University of Applied Sciences Düsseldorf [M1], Münsterstraße 156, 40476, Düsseldorf, Germany
| | - Christian Geiger
- Mixed Reality and Visualization (MIREVI), Faculty of Media, University of Applied Sciences Düsseldorf [M1], Münsterstraße 156, 40476, Düsseldorf, Germany
| | - Marc Hassenzahl
- Ubiquitous Design/Experience and Interaction, University of Siegen, Kohlbettstraße 15, 57072, Siegen, Germany
| | - Tim Klucken
- Department of Clinical Psychology and Psychotherapy, University of Siegen, Obergraben 23, 57072, Siegen, Germany
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5
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Laicher H, Int-Veen I, Torka F, Kroczek A, Bihlmaier I, Storchak H, Velten-Schurian K, Dresler T, Täglich R, Fallgatter AJ, Ehlis AC, Rosenbaum D. Trait rumination and social anxiety separately influence stress-induced rumination and hemodynamic responses. Sci Rep 2022; 12:5512. [PMID: 35365678 PMCID: PMC8976084 DOI: 10.1038/s41598-022-08579-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 03/07/2022] [Indexed: 12/03/2022] Open
Abstract
We aimed to investigate stress-reactive rumination in response to social stress and its association with social anxiety and trait rumination. From previous investigations we know that people with a certain vulnerability to rumination show increased stress-reactive rumination. However, up to date the possible influence of social anxiety on this relationship is still unclear. Therefore, we reanalyzed the data of two of our previous studies assessing healthy low and high trait ruminators and depressed patients performing the Trier Social Stress Test (TSST). We measured cortical oxygenation using functional Near-Infrared Spectroscopy (fNIRS) as well as different behavioral outcome measures (subjective stress levels, negative affect, state rumination). On a behavioral level, we found an influence of both, social anxiety and trait rumination, on state rumination, even when correcting for the other factor, respectively, implying two potentially independent factors of influence. On a neural level, we observed reduced activation in brain regions of the cognitive control network (CCN) for higher social anxiety and trait rumination, which might be a result of reduced cognitive and attentional control. Results indicate a specific role of social anxiety, at least on a behavioral level, and therefore implicate a crucial factor to be considered in the treatment of depression.
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Affiliation(s)
- Hendrik Laicher
- Department of Psychiatry and Psychotherapy, Tuebingen Center for Mental Health, University Hospital of Tuebingen, Calwerstraße 14, 72076, Tuebingen, Germany.
| | - Isabell Int-Veen
- Department of Psychiatry and Psychotherapy, Tuebingen Center for Mental Health, University Hospital of Tuebingen, Calwerstraße 14, 72076, Tuebingen, Germany
- Department of Psychology, University of Tuebingen, Tuebingen, Germany
| | - Florian Torka
- Department of Psychology, University of Tuebingen, Tuebingen, Germany
| | - Agnes Kroczek
- Department of Psychiatry and Psychotherapy, Tuebingen Center for Mental Health, University Hospital of Tuebingen, Calwerstraße 14, 72076, Tuebingen, Germany
| | - Isabel Bihlmaier
- Department of Psychiatry and Psychotherapy, Tuebingen Center for Mental Health, University Hospital of Tuebingen, Calwerstraße 14, 72076, Tuebingen, Germany
| | - Helena Storchak
- Department of Psychiatry and Psychotherapy, Tuebingen Center for Mental Health, University Hospital of Tuebingen, Calwerstraße 14, 72076, Tuebingen, Germany
| | - Kerstin Velten-Schurian
- Department of Psychiatry and Psychotherapy, Tuebingen Center for Mental Health, University Hospital of Tuebingen, Calwerstraße 14, 72076, Tuebingen, Germany
| | - Thomas Dresler
- Department of Psychiatry and Psychotherapy, Tuebingen Center for Mental Health, University Hospital of Tuebingen, Calwerstraße 14, 72076, Tuebingen, Germany
- LEAD Graduate School & Research Network, University of Tuebingen, Tuebingen, Germany
| | - Ramona Täglich
- Department of Psychiatry and Psychotherapy, Tuebingen Center for Mental Health, University Hospital of Tuebingen, Calwerstraße 14, 72076, Tuebingen, Germany
| | - Andreas J Fallgatter
- Department of Psychiatry and Psychotherapy, Tuebingen Center for Mental Health, University Hospital of Tuebingen, Calwerstraße 14, 72076, Tuebingen, Germany
- LEAD Graduate School & Research Network, University of Tuebingen, Tuebingen, Germany
| | - Ann-Christine Ehlis
- Department of Psychiatry and Psychotherapy, Tuebingen Center for Mental Health, University Hospital of Tuebingen, Calwerstraße 14, 72076, Tuebingen, Germany
- LEAD Graduate School & Research Network, University of Tuebingen, Tuebingen, Germany
| | - David Rosenbaum
- Department of Psychiatry and Psychotherapy, Tuebingen Center for Mental Health, University Hospital of Tuebingen, Calwerstraße 14, 72076, Tuebingen, Germany
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6
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Löffler-Stastka H, Dietrich D, Sauter T, Fittner M, Steinmair D. Simulating the mind and applications – a theory-based chance for understanding psychic transformations in somatic symptom disorders. World J Meta-Anal 2021; 9:474-487. [DOI: 10.13105/wjma.v9.i6.474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/15/2021] [Accepted: 12/24/2021] [Indexed: 02/06/2023] Open
Abstract
With the new category of somatic symptom disorder/bodily distress disorder in ICD-11, research into pathogenetic and therapeutic pathways is stimulated. By turning away from the definition of somatoform disorders as “the lack of something physical explaining everything”, this new classification might offer a way to put the focus on the individual patient’s psychodynamic balance and conflicts and their condensation in the symptom. Modelling and simulation have a long history in science to gain insight also into complex phenomena. Considering the evolution of precision medicine many different parameters are meanwhile operationalised and ready for consequent process research. Calculation models have to fit to the complexity of this disorder category. In an interdisciplinary discourse between computer and medical/psychoanalytic scientists a multilayer, fine grained calculation model is elaborated. Starting from a clinical case history, within iterative discussion, by acknowledging the demand for interdisciplinary synergy and cooperation in science, psychoanalytic theory served as the basis for computer-scientific information technique. A parallelisation with the Mealy model helped to establish a meaningful calculation possibility for further process research. How psychic transformations can be understood properly in order to provide meaningful treatments, the respective training, and to conduct appropriate process- and outcome-research is established in simulating the mind and applications.
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Affiliation(s)
| | | | - Thilo Sauter
- Institute of Computer Technology, TU Wien, Vienna 1040, Austria
- Center for Integrated Sensor Systems, Danube University Krems, Wiener Neustadt 2700, Austria
| | - Martin Fittner
- Institute of Computer Technology, TU Wien, Vienna 1040, Austria
| | - Dagmar Steinmair
- Department of Psychoanalysis and Psychotherapy, Medical University Vienna, Vienna 1090, Austria
- University Hospital St. Pölten, Karl Landsteiner University of Health Sciences, St. Pölten 3100, Austria
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7
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Kraft JD, Grant DM, White EJ, Taylor DL, Frosio KE. Cognitive mechanisms influence the relationship between social anxiety and depression among college students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2021; 69:245-251. [PMID: 31518208 DOI: 10.1080/07448481.2019.1661844] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 10/05/2018] [Accepted: 08/05/2019] [Indexed: 06/10/2023]
Abstract
Social anxiety and depression are commonly comorbid and cause significant impairment in college students. Past research suggests that both poor attentional control and increased rumination are related to these disorders and independently mediate their relationship. Theory suggests that social anxiety loads working memory, thus decreasing attentional control, which influences rumination and depression. The current study aimed to investigate the potential combined influence of attention control and rumination on social anxiety and depression. Participants: Participants (80) were recruited from a large Midwestern university in September 2017. Methods: Participants completed questionnaires regarding social anxiety, attentional control, rumination, and depression and data were analyzed using bias-corrected bootstrapping analyses. Results: Results demonstrate a significant indirect relationship between social anxiety and depression through attentional control and rumination. Conclusions: Results indicated that college students with social anxiety may be at risk for depression due to decreased attentional control and increased rumination. Clinical implications are discussed.
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Affiliation(s)
- Jacob D Kraft
- Department of Psychology, Oklahoma State University, Stillwater, OK, USA
| | - DeMond M Grant
- Department of Psychology, Oklahoma State University, Stillwater, OK, USA
| | - Evan J White
- Department of Psychology, Oklahoma State University, Stillwater, OK, USA
| | - Danielle L Taylor
- Department of Psychology, Oklahoma State University, Stillwater, OK, USA
| | - Kristen E Frosio
- Department of Psychology, Oklahoma State University, Stillwater, OK, USA
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8
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Social Anxiety, Fear of Negative Evaluation, and Distress in a Virtual Reality Environment. BEHAVIOUR CHANGE 2021. [DOI: 10.1017/bec.2021.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractAccording to cognitive theories of social anxiety, fear of negative evaluation (FNE) may be the mechanism whereby social anxiety induces distress. However, studying this can be challenging, as individuals with social anxiety may be reluctant to enter anxiety-provoking social situations, such as speaking in front of others. The present study used virtual reality (VR) to examine if giving a presentation in front of a virtual audience induced distress among undergraduate students and to test the hypothesis that FNE would mediate the relationship between social anxiety and distress. University students (N = 58, 70% female) entered a VR environment where they stood in front of a virtual audience and gave a short, impromptu presentation about their university. Participants also completed self-report measures of social anxiety, FNE, and distress (estimated before, during, and after VR). Distress and FNE had positive relationships with social anxiety and FNE fully mediated the relationship between social anxiety and distress. As far as we are aware, this is the first VR study to show this effect. The findings indicate that FNE could be a useful treatment target to reduce distress when presenting in front of an audience, either in VR or in person.
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9
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Wong QJ. Anticipatory Processing and Post‐Event Processing in Social Anxiety Disorder: An Update on the Literature. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12189] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Quincy Jj Wong
- Centre for Emotional Health, Department of Psychology, Macquarie University,
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10
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Kaplan DM, Palitsky R, Carey AL, Crane TE, Havens CM, Medrano MR, Reznik SJ, Sbarra DA, O'Connor MF. Maladaptive repetitive thought as a transdiagnostic phenomenon and treatment target: An integrative review. J Clin Psychol 2018; 74:1126-1136. [DOI: 10.1002/jclp.22585] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 11/13/2017] [Accepted: 11/20/2017] [Indexed: 01/15/2023]
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11
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Letzring TD, Rone CC, Colman DE. Implications of fear of negative evaluation, state anxiety, and implied level of target-dominance on perceptions of personality traits. The Journal of Social Psychology 2016; 156:581-593. [PMID: 26757355 DOI: 10.1080/00224545.2016.1140117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Fear of negative evaluation (FNE), state anxiety (SA), and dominance have consequences for social functioning. The present study assessed how FNE, SA, and a target's dominance-relevant label are related to perceptions of personality. One hundred seventy-eight participants who scored high or low on FNE underwent a laboratory manipulation of SA, viewed a photograph of a target with a high or low dominance-relevant label, and rated the target on the Big Five personality traits and dominance. FNE and SA were unrelated to perceptions, but the high-dominance label was associated with perceptions of higher dominance, conscientiousness, and openness. In conclusion, judges did use information about others when making initial judgments of personality, but these judgments were not impacted by trait or state psychological distress.
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12
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Buckner JD, Dean KE. Social anxiety and post-event processing among African-American individuals. ANXIETY STRESS AND COPING 2016; 30:219-227. [PMID: 27576610 DOI: 10.1080/10615806.2016.1220549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Social anxiety is among the most prevalent psychiatric conditions, yet little attention has been paid to whether putative cognitive vulnerability factors related to social anxiety in predominantly White samples are related to social anxiety among historically underrepresented groups. DESIGN We tested whether one such vulnerability factor, post-event processing (PEP; detailed review of social event that can increase state social anxiety) was related to social anxiety among African-American (AA; n = 127) persons, who comprise one of the largest underrepresented racial groups in the U.S. Secondarily, we tested whether AA participants differed from non-Hispanic White participants (n = 127) on PEP and social anxiety and whether race moderated the relation between PEP and social anxiety. METHOD Data were collected online among undergraduates. RESULTS PEP was positively correlated with social anxiety among AA participants, even after controlling for depression and income, pr = .30, p = .001. AA and White participants did not differ on social anxiety or PEP, β = -1.57, 95% CI: -5.11, 1.96. The relation of PEP to social anxiety did not vary as a function of race, β = 0.00, 95% CI: -0.02, 0.02. CONCLUSIONS PEP may be an important cognitive vulnerability factor related to social anxiety among AA persons suffering from social anxiety.
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Affiliation(s)
- Julia D Buckner
- a Department of Psychology , Louisiana State University , Baton Rouge , LA , USA
| | - Kimberlye E Dean
- a Department of Psychology , Louisiana State University , Baton Rouge , LA , USA
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13
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Post-event processing in social anxiety disorder after real-life social situations - An ambulatory assessment study. Behav Res Ther 2016; 84:27-34. [PMID: 27442226 DOI: 10.1016/j.brat.2016.07.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 05/30/2016] [Accepted: 07/11/2016] [Indexed: 02/05/2023]
Abstract
Excessive post-mortem processing after social situations, a core symptom of social anxiety disorder (SAD), is thought to contribute to the perpetuation of social anxiety by consolidating negative self-schemata. Empirical findings on actual mechanisms underlying this so-called Post-Event Processing (PEP) are still scarce. The present study sought to identify variables associated with the experience of PEP after real-life social situations in a sample of 49 individuals diagnosed with SAD. Using an ambulatory assessment approach, individuals were asked to report on each distressing social event experienced during one week. A total of 192 events were captured. Hierarchical linear modeling indicated that next to trait social anxiety, the type of social situation (performance vs. interaction situations), self-focused attention, safety behavior use, and negative affect predicted levels of PEP after social situations. These findings add to the growing literature that emphasizes the importance of situational factors for the experience of PEP, and highlight potential venues to prevent it.
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14
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Helbig-Lang S, Poels V, Lincoln TM. Performance perceptions and self-focused attention predict post-event processing after a real-life social performance situation. ANXIETY STRESS AND COPING 2016; 29:708-15. [DOI: 10.1080/10615806.2016.1157168] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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15
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Self-Focused Cognition in Social Anxiety: A Review of the Theoretical and Empirical Literature. BEHAVIOUR CHANGE 2016. [DOI: 10.1017/bec.2016.2] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Social anxiety disorder (SAD) is characterised by a marked and persistent fear of social or performance situations. Cognitive models suggest that self-focused cognitive processes play a crucial role in generating and maintaining social anxiety, and that self-focused cognition occurs prior to, during, and following social situations (Clark & Wells, 1995; Rapee & Heimberg, 1997). There is a substantial body of empirical evidence demonstrating that socially anxious individuals engage in self-focused cognition during and following a social or performance situation. A smaller but growing body literature suggests that a similar process occurs prior to such situations, and that these three processes are interdependent. Furthermore, the vast majority of research to date indicates that self-focused cognitive processes are detrimental, and that they generate and maintain social anxiety in a variety of ways. However, there remains considerable scope for research to further explicate the role of these processes in the maintenance of SAD, and to enhance interventions designed to ameliorate their negative effects.
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16
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Can I Really Do This? An Examination of Anticipatory Event Processing in Social Anxiety Disorder. J Cogn Psychother 2016; 30:94-104. [PMID: 32755909 DOI: 10.1891/0889-8391.30.2.94] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Clark and Wells (1995) posit that anticipatory processing before a social situation serves to maintain social anxiety. More specifically, ruminative processes similar to post-event processing (PEP) may occur in anticipation of anxiety provoking social events, and in this article, we have labelled this type of anticipatory rumination anticipatory event processing (AnEP). Participants (n = 75) with social anxiety disorder (SAD) completed measures of anticipatory event processing, trait anxious rumination, social anxiety, state anxiety, and PEP, in the context of completing videotaped exposures twice as part of manual-based group cognitive behavioral therapy. AnEP was significantly positively associated with trait anxious rumination and social anxiety and was associated with state anxiety during the first videotaping. AnEP at the two time points was significantly correlated and decreased across the two taped exposures. Greater AnEP at the first taping was associated with greater PEP the following week. PEP after the first videotaped exposure then significantly related to AnEP for the second videotaped exposure several weeks later. Discussion focuses on the similarities between PEP and AnEP as well as implications for cognitive models and treatment of SAD.
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Post-Event Processing across Multiple Anxiety Presentations: Is it Specific to Social Anxiety Disorder? Behav Cogn Psychother 2015; 44:568-79. [PMID: 26639672 DOI: 10.1017/s1352465815000697] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Post-event processing (PEP) occurs when individuals engage in cognitive rumination following an event or interaction. Although the relation between PEP and social anxiety has been clearly demonstrated, it remains unclear whether PEP is limited to individuals with elevated social anxiety, or if it is also problematic among people with other anxiety presentations. AIMS The present study assessed PEP after the first session of group cognitive behavioural therapy (CBT) in individuals with a variety of anxiety presentations. METHOD Participants with a principal diagnosis of SAD (N = 25), those diagnosed with a principal other anxiety disorder with comorbid SAD (N = 18), and those with principal other anxiety diagnoses with no SAD (N = 43) completed baseline measures of social anxiety severity and state anxiety at their first session of CBT and measures of PEP one week later. RESULTS Participants with a principal diagnosis of SAD experienced the most PEP in the week following the first CBT session, while those with no comorbid SAD experienced the least. Those with comorbid SAD experienced intermediate levels of PEP. The strongest predictor of PEP was state anxiety during the first session. CONCLUSIONS Results suggest that PEP is more problematic for clients with SAD as part of their clinical presentation. Clinical and theoretical implications are discussed.
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Is post-event processing a social anxiety specific or transdiagnostic cognitive process in the anxiety spectrum? Behav Cogn Psychother 2015; 42:706-17. [PMID: 25413026 DOI: 10.1017/s135246581300074x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Research on post-event processing (PEP), where individuals conduct a post-mortem evaluation of a social situation, has focused primarily on its relationship with social anxiety. AIMS The current study examined: 1) levels of PEP for a standardized event in different anxiety disorders; 2) the relationship between peak anxiety levels during this event and subsequent PEP; and 3) the relationship between PEP and disorder-specific symptom severity. METHOD Participants with primary DSM-IV diagnoses of social anxiety disorder (SAD), obsessive compulsive disorder (OCD), panic disorder with/without agoraphobia (PD/A), or generalized anxiety disorder (GAD) completed diagnosis specific symptom measures before attending group cognitive behavioural therapy (CBT) specific to their diagnosis. Participants rated their peak anxiety level during the first group therapy session, and one week later rated PEP in the context of CBT. RESULTS The results indicated that all anxiety disorder groups showed heightened and equivalent PEP ratings. Peak state anxiety during the first CBT session predicted subsequent level of PEP, irrespective of diagnostic group. PEP ratings were found to be associated with disorder-specific symptom severity in SAD, GAD, and PD/A, but not in OCD. CONCLUSIONS PEP may be a transdiagnostic process with relevance to a broad range of anxiety disorders, not just SAD.
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Wong QJJ, McEvoy PM., Rapee RM. A Comparison of Repetitive Negative Thinking and Post-Event Processing in the Prediction of Maladaptive Social-Evaluative Beliefs: A Short-Term Prospective Study. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2015. [DOI: 10.1007/s10862-015-9506-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Tester-Jones M, O’Mahen H, Watkins E, Karl A. The impact of maternal characteristics, infant temperament and contextual factors on maternal responsiveness to infant. Infant Behav Dev 2015; 40:1-11. [DOI: 10.1016/j.infbeh.2015.02.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 02/09/2015] [Accepted: 02/10/2015] [Indexed: 02/05/2023]
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Campbell CG, Bierman KL, Molenaar PCM. Individual Day-to-Day Process of Social Anxiety in Vulnerable College Students. APPLIED DEVELOPMENTAL SCIENCE 2015. [DOI: 10.1080/10888691.2015.1026594] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Mitchell MA, Schmidt NB. General in-situation safety behaviors are uniquely associated with post-event processing. J Behav Ther Exp Psychiatry 2014; 45:229-33. [PMID: 24309066 DOI: 10.1016/j.jbtep.2013.11.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 08/15/2013] [Accepted: 11/04/2013] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND OBJECTIVES Research suggests that state anxiety and in-situation safety behaviors are associated with post-event processing (PEP) in social anxiety. Past research has obtained mixed results on whether one or both factors contribute to PEP. The current investigation evaluated state anxiety and in-situation safety behaviors (including subtypes of in-situation safety behaviors) simultaneously to determine their relative contributions to PEP. METHODS A prospective study assessed social anxiety, state anxiety, in-situation safety behaviors, PEP, and depression in the context of a speech stressor. RESULTS Consistent with theory, in-situation safety behaviors were uniquely associated with greater PEP. State anxiety was not uniquely associated with PEP. Furthermore, restricting and active subtypes of in-situation safety behaviors showed specificity to PEP. LIMITATIONS Limitations of the present study include the use of a nonclinical analog sample and retrospective reporting of PEP. CONCLUSIONS These findings highlight the importance of research on in-situation safety behaviors as a potential contributor to PEP.
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Affiliation(s)
- Melissa A Mitchell
- Department of Psychology, Florida State University, Tallahassee, FL 32306-4301, USA
| | - Norman B Schmidt
- Department of Psychology, Florida State University, Tallahassee, FL 32306-4301, USA.
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Holzman JB, Valentiner DP, McCraw KS. Self-Focused Attention and Post-Event Processing: Relevance to Social Performance Anxiety and Social Interaction Anxiety. J Cogn Psychother 2014; 28:72-82. [DOI: 10.1891/0889-8391.28.1.72] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study examined the roles of self-focused attention and post-event processing in social performance anxiety and social interaction anxiety. College students (N = 101) completed measures of social performance anxiety, social interaction anxiety, self-focused attention, post-event processing, and beliefs related to social anxiety. Interoceptive self-focused attention and post-event processing predicted social performance anxiety after controlling for social interaction anxiety. The associations with social interaction anxiety were not significant after controlling for social performance anxiety. Associations of behavioral self-focused attention with social performance anxiety and social interaction anxiety were not significant after controlling for interoceptive self-focused attention. No evidence of an interaction between self-focused attention and post-event processing in the prediction of social anxiety was found. This study found no evidence that the associations of interoceptive self-focused attention and post-event processing with social performance anxiety were statistically mediated by high standards, conditional beliefs about self, and unconditional beliefs about self. These results and their theoretical implications are discussed.
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Drinking and Thinking: Alcohol Effects on Post-event Processing in Socially Anxious Individuals. COGNITIVE THERAPY AND RESEARCH 2013. [DOI: 10.1007/s10608-013-9574-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Nilsson JE, Lundh LG, Viborg G. Effects of Analytical and Experiential Self-focus on Rumination After a Stress Induction in Patients with Social Anxiety Disorder: A Pilot Study. Cogn Behav Ther 2012; 41:310-20. [DOI: 10.1080/16506073.2012.682088] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Predicting post-event processing in social anxiety disorder following two prototypical social situations: State variables and dispositional determinants. Behav Res Ther 2012; 50:617-26. [DOI: 10.1016/j.brat.2012.06.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Revised: 04/03/2012] [Accepted: 06/12/2012] [Indexed: 02/05/2023]
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Self-perception and rumination in social anxiety. Behav Res Ther 2012; 50:250-7. [DOI: 10.1016/j.brat.2012.01.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2010] [Revised: 01/17/2012] [Accepted: 01/24/2012] [Indexed: 02/05/2023]
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Cassin SE, Rector NA. Mindfulness and the attenuation of post-event processing in social phobia: an experimental investigation. Cogn Behav Ther 2012; 40:267-78. [PMID: 22060249 DOI: 10.1080/16506073.2011.614275] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The present experimental study examined the ability of metacognitive strategies to reduce the distress associated with post-event processing (PEP). Individuals with DSM-IV generalized social phobia (N = 57) were randomly allocated to receive brief training in mindfulness, distraction, or no training (control group). Next, they underwent an experimental PEP induction. Following the induction, they were instructed to apply the metacognitive strategy (mindfulness or distraction) they were taught or to continue thinking about the social event the way they typically would following such an event (control). Participants rated their distress on a visual analogue scale prior to the PEP induction, and then every minute for 5 min while applying the metacognitive strategy. They also rated their affect immediately after applying the metacognitive strategy. Results suggest that mindfulness reduces distress significantly over the post-event period and results in significantly more positive affect than when receiving no training. In contrast, distraction does not reduce distress over the post-event period performs comparable to receiving no training. The results of this experimental investigation suggest that mindfulness has the potential to reduce distress associated with PEP and provide further support for the clinical utility of mindfulness in the treatment of generalized social phobia.
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Affiliation(s)
- Stephanie E Cassin
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Gaydukevych D, Kocovski NL. Effect of self-focused attention on post-event processing in social anxiety. Behav Res Ther 2012; 50:47-55. [DOI: 10.1016/j.brat.2011.10.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 10/12/2011] [Accepted: 10/25/2011] [Indexed: 02/05/2023]
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Laposa JM, Rector NA. A prospective examination of predictors of post-event processing following videotaped exposures in group cognitive behavioural therapy for individuals with social phobia. J Anxiety Disord 2011; 25:568-73. [PMID: 21330099 DOI: 10.1016/j.janxdis.2011.01.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2010] [Revised: 01/14/2011] [Accepted: 01/14/2011] [Indexed: 02/05/2023]
Abstract
Following social events, individuals with social phobia engage in post-event processing (PEP), namely a post-mortem detailed analysis of a social situation. This study aimed to examine cognitive and symptom correlates of PEP, as well as stability of PEP, in the context of videotaped exposures that occurred during treatment at sessions four and eight. Before treatment, 75 individuals with DSM-IV diagnosed social phobia completed measures of social anxiety, anxious rumination, fear of causing discomfort to others, and negative interpretation of positive social events. They rated their peak anxiety during the taped exposure. Then, they completed a measure of PEP one week after each videotaped exposure exercise. Results revealed that baseline social anxiety symptoms, state anxiety during the videotaping, anxious rumination, fear of causing discomfort to others, and negative interpretation of positive social events were all positively associated with PEP for the first taped exposure. Regression analyses demonstrated that unique predictors of PEP over and above baseline social anxiety were state social anxiety during the exposure, and anxious coping-focused rumination. This was largely replicated in the second taped exposure. In addition, PEP following two videotaped exposures separated by four weeks showed a moderate-to-large positive correlation. These findings highlight symptom and cognitive correlates of PEP, and underscore importance of state anxiety in social situations, as well as general anxiety focused rumination in social phobia.
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Kocovski NL, MacKenzie MB, Rector NA. Rumination and Distraction Periods Immediately Following a Speech Task: Effect on Postevent Processing in Social Anxiety. Cogn Behav Ther 2011; 40:45-56. [DOI: 10.1080/16506073.2010.526631] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Collimore KC, Carleton RN, Hofmann SG, Asmundson GJG. Posttraumatic stress and social anxiety: the interaction of traumatic events and interpersonal fears. Depress Anxiety 2010; 27:1017-26. [PMID: 20721907 DOI: 10.1002/da.20728] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Revised: 06/12/2010] [Accepted: 06/16/2010] [Indexed: 02/05/2023] Open
Abstract
Posttraumatic stress disorder (PTSD) and social anxiety disorder (SAD) are frequently comorbid among veteran and community samples. Several studies have demonstrated significant comorbidity between trauma, PTSD, and social anxiety (SA), and a growing number of studies have explored the nature of this association. Although a diagnosis of either PTSD or SAD alone can result in significant impairment in social and occupational functioning, these difficulties are often magnified in persons suffering from both disorders. This review describes the current state-of-the-art regarding the co-occurrence of trauma, PTSD, and SA. First, we provide an overview of empirical data on the prevalence of co-occurring trauma, PTSD, and SAD. Second, we describe possible explanatory models of the co-occurrence, with a specific focus on the shared vulnerability model. Third, we review the available empirical data addressing the postulates of this model, including both genetic and psychological vulnerabilities. Fourth, we describe additional factors-guilt, shame, and depressive symptoms-that may help to explain the co-occurrence of PTSD and SA. A better understanding of this complex relationship will improve the efficacy of treatment for individuals suffering from both disorders. We conclude with key areas for future research.
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Affiliation(s)
- Kelsey C Collimore
- The Anxiety and Illness Behaviours Laboratory, Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
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Osman A, Bagge CL, Freedenthal S, Gutierrez PM, Emmerich A. Development and evaluation of the Social Anxiety and Depression Life Interference-24 (SADLI-24) inventory. J Clin Psychol 2010; 67:82-98. [PMID: 20939019 DOI: 10.1002/jclp.20728] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We describe the development of a new self-report instrument, the Social Anxiety and Depression Life Interference-24 (SADLI-24) inventory. We initially retained 30 content specific items for the instrument (Study 1). In Study 2 (N = 438), we established a 2-factor solution, Social Anxiety Life Interference-12 (SALI-12) and Depression Life Interference-12 (DLI-12). We also examined estimates of known-groups and concurrent validity. Confirmatory factor analysis in Study 3 (N = 430) provided support for the oblique two-factor structure. In Study 4 (N = 179), we provided additional support for estimates of known-groups validity. In Study 5 (N = 63), we evaluated estimates of test-retest reliability. Both SADLI-24 scale scores showed good estimates of internal consistency.
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Affiliation(s)
- Augustine Osman
- Department of Psychology, The University of Texas at San Antonio, TX 78249-0641, USA.
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Grant DM, Beck JG. What predicts the trajectory of rumination?: A prospective evaluation. J Anxiety Disord 2010; 24:480-6. [PMID: 20381304 PMCID: PMC2867041 DOI: 10.1016/j.janxdis.2010.03.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Revised: 03/09/2010] [Accepted: 03/10/2010] [Indexed: 10/19/2022]
Abstract
The current report aimed to document individual differences that predict the trajectory of post-event rumination following an evaluative event. In this study, 127 undergraduate students were assessed over a 5-day period preceding and following a mid-term exam. Participants completed measures of anticipatory processing, trait test anxiety, trait tendency to ruminate, negative affect, and post-event rumination. Hierarchical linear modeling was used to examine predictors of post-evaluative rumination. Results suggested that individuals who reported high levels of anticipatory processing and trait test anxiety tended to experience prolonged amounts of rumination following the exam, even when controlling for negative affect, relative to those who scored low on these measures. These results suggest that specific individual difference factors impact the amount and trajectory of rumination beyond levels of general negative affect. Implications for understanding risk factors for heightened rumination are discussed, with particular attention to the larger rumination literature.
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Affiliation(s)
- DeMond M. Grant
- Corresponding author, Present Address: DeMond M. Grant, Ph.D., Department of Psychology, Oklahoma State University, Stillwater, OK 74078, Telephone: 405 774 6983, Fax: 405 774 8067,
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McEvoy PM, Mahoney AEJ, Moulds ML. Are worry, rumination, and post-event processing one and the same? Development of the repetitive thinking questionnaire. J Anxiety Disord 2010; 24:509-19. [PMID: 20409676 DOI: 10.1016/j.janxdis.2010.03.008] [Citation(s) in RCA: 181] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Revised: 02/26/2010] [Accepted: 03/19/2010] [Indexed: 02/05/2023]
Abstract
Accumulating evidence suggests that repetitive negative thinking (RNT) is a transdiagnostic phenomenon. However, various forms of RNT such as worry, rumination, and post-event processing have been assessed using separate measures and have almost exclusively been examined within the anxiety, depression, and social phobia literatures, respectively. A single transdiagnostic measure of RNT would facilitate the identification of transdiagnostic maintaining factors of RNT, and would be more efficient than administering separate measures for each disorder. Items from three existing measures of RNT were modified to remove diagnosis-specific content and administered to a sample of undergraduate students (N=284). Exploratory factor analysis yielded two factors labeled Repetitive Negative Thinking and Absence of Repetitive Thinking (ART). The RNT scale demonstrated high internal reliability and was associated with anxiety, depression, anger, shame, and general distress. Moreover, the RNT scale was associated with constructs that are theoretically related to engagement in RNT, including positive and negative metacognitions, cognitive avoidance, thought suppression, and thought control strategies. The ART scale had little predictive utility. Theoretical and clinical implications are discussed.
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Affiliation(s)
- Peter M McEvoy
- Centre for Clinical Interventions, Perth, Western Australia 6003, Australia.
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Does Rumination Predict the Strength of Maladaptive Self-Beliefs Characteristic of Social Anxiety Over Time? COGNITIVE THERAPY AND RESEARCH 2010. [DOI: 10.1007/s10608-010-9316-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Impact of rumination versus distraction on anxiety and maladaptive self-beliefs in socially anxious individuals. Behav Res Ther 2009; 47:861-7. [DOI: 10.1016/j.brat.2009.06.014] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Revised: 06/26/2009] [Accepted: 06/26/2009] [Indexed: 02/05/2023]
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Battista SR, Kocovski NL. Exploring the Effect of Alcohol on Post-Event Processing Specific to a Social Event. Cogn Behav Ther 2009; 39:1-10. [DOI: 10.1080/16506070902767613] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
| | - Nancy L. Kocovski
- Department of Psychology, Wilfrid Laurier University , Waterloo, Ontario, Canada
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McEvoy PM, Mahoney A, Perini SJ, Kingsep P. Changes in post-event processing and metacognitions during cognitive behavioral group therapy for social phobia. J Anxiety Disord 2009; 23:617-23. [PMID: 19250799 DOI: 10.1016/j.janxdis.2009.01.011] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2008] [Revised: 01/20/2009] [Accepted: 01/20/2009] [Indexed: 02/05/2023]
Abstract
This study examined changes in post-event processing (PEP), metacognitions, and symptoms of social anxiety and depression following cognitive behavioral group therapy for social phobia (N=61). Social anxiety, depression symptoms and PEP all significantly reduced following treatment. Reductions in PEP were associated with reductions in symptoms of social anxiety, but not depression. Metacognitions were also less strongly endorsed following treatment, with the exception of positive metacognitions. Interestingly, however, changes in metacognitions were generally associated with reductions in depression and not social anxiety. Theoretical and clinical implications as well as future research directions are discussed.
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Affiliation(s)
- Peter M McEvoy
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, School of Psychiatry, University of New South Wales, 299 Forbes Street, Darlinghurst, Sydney, 2010, Australia.
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Social Anxiety Disorder: Recent Developments in Psychological Approaches to Conceptualization and Treatment. Aust N Z J Psychiatry 2009. [DOI: 10.1080/00048670903179111] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The aim of the present study was to identify and synthesize recent research findings in the aetiology and psychological treatment of social anxiety disorder and consider how these might improve outcome through more effective intervention. The electronic databases Medline, EMBASE and PsychInfo were searched for January 2000–December 2008. Publications of interest referred to in relevant articles were also reviewed. Case reports and publications not in English were excluded. The greatest variance in social anxiety disorder is accounted for by temperamental and personality factors and these may be associated with significant heritability. The environmental contribution is smaller and mainly due to non-shared factors, with a small contribution from shared environmental factors. Epidemiological research confirms that social anxiety disorder is chronic, and among the anxiety disorders has the lowest rates of treatment seeking, receipt of evidence-based treatments and recovery. Effective psychological treatments have been available for some time, and the research emphasis is on increasing the efficacy of treatments through innovations in programme content and delivery. Cognitive science research has contributed a better understanding of cognitive factors that maintain social anxiety disorder and informed enhancement of the cognitive elements of therapy. Internet-based programmes show promise as a novel way to deliver and improve access to effective therapy. Genetic, personality and temperamental factors contribute to the risk for social anxiety disorder. Given the associated comorbidity and disability, energy needs to be directed towards early recognition and treatment, and to increasing engagement and retention in effective therapy. Ongoing professional education is required to ensure that the disorder is recognized and evidence-based treatments received by patients who do seek help. Current cognitive behavioural treatments are being enhanced as the results of cognitive science research are being applied, and novel forms of treatment delivery show promise in increasing access.
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A roadmap to rumination: a review of the definition, assessment, and conceptualization of this multifaceted construct. Clin Psychol Rev 2008; 29:116-28. [PMID: 19128864 DOI: 10.1016/j.cpr.2008.10.003] [Citation(s) in RCA: 397] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2008] [Revised: 10/28/2008] [Accepted: 10/30/2008] [Indexed: 12/24/2022]
Abstract
Rumination has been widely studied and is a crucial component in the study of cognitive vulnerabilities to depression. However, rumination means different things in the context of different theories, and has not been uniformly defined or measured. This article aims to review models of rumination, as well as the various ways in which it is assessed. The models are compared and contrasted with respect to several important dimensions of rumination. Guidelines to consider in the selection of a model and measure of rumination are presented, and suggestions for the conceptualization of rumination are offered. In addition, rumination's relation to other similar constructs is evaluated. Finally, future directions for the study of ruminative phenomena are presented. It is hoped that this article will be a useful guide to those interested in studying the multi-faceted construct of rumination.
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An analysis of post-event processing in social anxiety disorder. Clin Psychol Rev 2008; 28:891-903. [DOI: 10.1016/j.cpr.2008.01.002] [Citation(s) in RCA: 167] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2007] [Revised: 01/13/2008] [Accepted: 01/17/2008] [Indexed: 02/05/2023]
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Oaten M, Williams KD, Jones A, Zadro L. The Effects of Ostracism on Self–Regulation in the Socially Anxious. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2008. [DOI: 10.1521/jscp.2008.27.5.471] [Citation(s) in RCA: 136] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Hofmann SG. Cognitive factors that maintain social anxiety disorder: a comprehensive model and its treatment implications. Cogn Behav Ther 2008; 36:193-209. [PMID: 18049945 DOI: 10.1080/16506070701421313] [Citation(s) in RCA: 579] [Impact Index Per Article: 34.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Social anxiety disorder (SAD) is a common, distressing and persistent mental illness. Recent studies have identified a number of psychological factors that could explain the maintenance of the disorder. These factors are presented here as part of a comprehensive psychological maintenance model of SAD. This model assumes that social apprehension is associated with unrealistic social standards and a deficiency in selecting attainable social goals. When confronted with challenging social situations, individuals with SAD shift their attention toward their anxiety, view themselves negatively as a social object, overestimate the negative consequences of a social encounter, believe that they have little control over their emotional response, and view their social skills as inadequate to effectively cope with the social situation. In order to avoid social mishaps, individuals with SAD revert to maladaptive coping strategies, including avoidance and safety behaviors, followed by post-event rumination, which leads to further social apprehension in the future. Possible disorder-specific intervention strategies are discussed.
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Affiliation(s)
- Stefan G Hofmann
- Department of Psychology, Boston University, Boston, MA 02215-2002, USA.
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Post-Event Processing in Social Anxiety Disorder: Idiosyncratic Priming in the Course of CBT. COGNITIVE THERAPY AND RESEARCH 2007. [DOI: 10.1007/s10608-007-9152-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Abstract
Post-event processing is the cognitive rumination that follows social events in cognitive models of social anxiety. The aim of this study was to examine factors that may predict the extent to which individuals engage in post-event processing. Anxious rumination, social anxiety, anxiety sensitivity and post-event processing related to a recent anxiety-provoking social event were assessed in a college student sample (n = 439). Social anxiety and anxious rumination, but not anxiety sensitivity, significantly predicted the extent to which the participants engaged in post-event processing related to an anxiety-provoking social event. Factors that appear to impact on the post-event period include the nature of the social situation and the ethnicity of the participant. It appears that both general rumination over anxious symptoms, and specific rumination related to social events are relevant for cognitive models of social anxiety.
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Affiliation(s)
- Nancy L Kocovski
- Department of Psychology, Wilfrid Laurier University, Waterloo, Ontario, Canada.
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Dannahy L, Stopa L. Post-event processing in social anxiety. Behav Res Ther 2007; 45:1207-19. [PMID: 17112463 DOI: 10.1016/j.brat.2006.08.017] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2006] [Revised: 08/09/2006] [Accepted: 08/23/2006] [Indexed: 02/05/2023]
Abstract
Clark and Wells' [1995. A cognitive model of social phobia. In: R. Heimberg, M. Liebowitz, D.A. Hope, & F.R. Schneier (Eds.) Social phobia: Diagnosis, assessment and treatment (pp. 69-93). New York: Guildford Press.] cognitive model of social phobia proposes that following a social event, individuals with social phobia will engage in post-event processing, during which they conduct a detailed review of the event. This study investigated the relationship between self-appraisals of performance and post-event processing in individuals high and low in social anxiety. Participants appraised their performance immediately after a conversation with an unknown individual and prior to an anticipated second conversation task 1 week later. The frequency and valence of post-event processing during the week following the conversation was also assessed. The study also explored differences in the metacognitive processes of high and low socially anxious participants. The high socially anxious group experienced more anxiety, predicted worse performance, underestimated their actual performance, and engaged in more post-event processing than low socially anxious participants. The degree of negative post-event processing was linked to the extent of social anxiety and negative appraisals of performance, both immediately after the conversation task and 1 week later. Differences were also observed in some metacognitive processes. The results are discussed in relation to current theory and previous research.
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Affiliation(s)
- Laura Dannahy
- Department of Clinical Psychology, University of Southampton, Highfield, Southampton, S017 1BJ, UK.
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Carleton RN, Collimore KC, Asmundson GJG. Social anxiety and fear of negative evaluation: construct validity of the BFNE-II. J Anxiety Disord 2007; 21:131-41. [PMID: 16675196 DOI: 10.1016/j.janxdis.2006.03.010] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2005] [Revised: 03/09/2006] [Accepted: 03/20/2006] [Indexed: 02/05/2023]
Abstract
The Brief Fear of Negative Evaluation Scale [BFNE; Leary, M. R. (1983). A brief version of the Fear of Negative Evaluation Scale. Personality and Social Psychology Bulletin, 9, 371-375] is a self-report measure designed to assess fear of negative evaluation, a characteristic feature of social anxiety disorders [Rapee, R. M., & Heimberg, R. G. (1997). A cognitive-behavioral model of anxiety in social phobia. Behaviour Research and Therapy, 35, 741-756]. Recent psychometric assessments have suggested that a 2-factor model is most appropriate, with the first factor comprising the straightforwardly worded items and the second factor comprising the reverse-worded items [Carleton, R. N., McCreary, D., Norton, P. J., & Asmundson, G. J. G. (in press-a). The Brief Fear of Negative Evaluation Scale, Revised. Depression & Anxiety; Rodebaugh, T. L., Woods, C. M., Thissen, D. M., Heimberg, R. G., Chambless, D. L., & Rapee, R. M. (2004). More information from fewer questions: the factor structure and item properties of the original and brief fear of negative evaluation scale. Psychological Assessment, 2, 169-181; Weeks, J. W., Heimberg, R. G., Fresco, D. M., Hart, T. A., Turk, C. L., Schneier, F. R., et al. (2005). Empirical validation and psychometric evaluation of the Brief Fear of Negative Evaluation Scale in patients with social anxiety disorder. Psychological Assessment, 17, 179-190]. Some researchers recommend the reverse-worded items be removed from scoring [e.g., Rodebaugh, T. L., Woods, C. M., Thissen, D. M., Heimberg, R. G., Chambless, D. L., & Rapee, R. M. (2004). More information from fewer questions: the factor structure and item properties of the original and brief fear of negative evaluation scale. Psychological Assessment, 2, 169-181; Weeks, J. W., Heimberg, R. G., Fresco, D. M., Hart, T. A., Turk, C. L., Schneier, F. R., et al. (2005). Empirical validation and psychometric evaluation of the Brief Fear of Negative Evaluation Scale in patients with social anxiety disorder. Psychological Assessment, 17, 179-190]; however [Carleton, R. N., McCreary, D., Norton, P. J., & Asmundson, G. J. G. (in press-a). The Brief Fear of Negative Evaluation Scale, Revised. Depression & Anxiety; Collins, K. A., Westra, H. A., Dozois, D. J. A., & Stewart, S. H. (2005). The validity of the brief version of the fear of negative evaluation scale. Journal of Anxiety Disorders, 19, 345-359] recommend that these items be reworded to maintain scale sensitivity. The present study examined the reliability and validity of the BFNE-II, a version of the BFNE evaluating revisions of the reverse-worded items in a community sample. A unitary model of the BFNE-II resulted in excellent confirmatory factor analysis fit indices. Moderate convergent and discriminant validity were found when BFNE-II items were correlated with additional independent measures of social anxiety [i.e., Social Interaction Anxiety & Social Phobia Scales; Mattick, R. P., & Clarke, J. C. (1998). Development and validation of measures of social phobia scrutiny fear and social interaction anxiety. Behaviour Research and Therapy, 36, 455-470], and fear [i.e., Anxiety Sensitivity Index; Reiss, S., & McNally, R. J. (1985). The expectancy model of fear. In S. Reiss, R. R. Bootzin (Eds.), Theoretical issues in behaviour therapy (pp. 107--121). New York: Academic Press. and the Illness/Injury Sensitivity Index; Carleton, R. N., Park, I., & Asmundson, G. J. G. (in press-b). The Illness/Injury Sensitivity Index: an examination of construct validity. Depression & Anxiety). These findings support the utility of the revised items and the validity of the BFNE-II as a measure of the fear of negative evaluation. Implications and future research directions are discussed.
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Affiliation(s)
- R Nicholas Carleton
- Anxiety and Illness Behaviours Laboratory, University of Regina, Regina, Sask., Canada S4S 0A2
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Fehm L, Schneider G, Hoyer J. Is post-event processing specific for social anxiety? J Behav Ther Exp Psychiatry 2007; 38:11-22. [PMID: 16730328 DOI: 10.1016/j.jbtep.2006.02.004] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2005] [Revised: 01/03/2006] [Accepted: 02/09/2006] [Indexed: 12/25/2022]
Abstract
In their model of social phobia, Clark and Wells [1995. A cognitive model of social phobia. In R. G. Heimberg, M. Liebowitz, D. A. Hope & F. Schneier (Eds.), Social phobia: Diagnosis, assessment, and treatment (pp. 69-93). New York, London: The Guilford Press] introduced a process called "post-event processing" (PEP), which is characterized by prolonged rumination about past social situations. The present study examined to what extent PEP is specific for (a) social anxiety or (b) social situations. In a cross-sectional study, 217 participants reported about a social and a phobic event followed by negative thinking. PEP as well as its potential predictors such as social anxiety, general anxiety, and depression were measured by questionnaires. Results showed that social events were followed more often and by more intense PEP. Further confirming specificity, the fear of negative evaluation as an aspect of social anxiety was significantly associated with PEP for social but not for phobic situations, and vice versa; general anxiety predicted PEP only after phobic but not after social situations. Furthermore, PEP was elevated particularly for interaction (as opposed to performance) situations, indicating that the ambiguity of the situation may be an important predictor for prolonged processing.
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Affiliation(s)
- Lydia Fehm
- Psychotherapy and Somatopsychology, Humboldt University Berlin, Rudower Chaussee 18, D-12489 Berlin, Germany.
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