Post-event processing in social anxiety

A psychometric study was conducted in order to collect basic information about post-event processing in social anxiety. It was found that such processing occurs commonly after an anxiety-evoking or embarrassing social event and post-event processing scores were significantly correlated (r = 0.40) with social anxiety. The recollections of the social event tended to be recurrent and intrusive, interfering with concentration. Post-event processing was associated with the avoidance of similar social situations. The results are discussed in terms of the Clark and Wells model of social phobia.     

Social Anxiety–Linked Attention Bias to Threat Is Indirectly Related to Post-Event Processing Via Subjective Emotional Reactivity to Social Stress

Attention bias to threat (e.g., disgust faces) is a cognitive vulnerability factor for social anxiety occurring in early stages of information processing. Few studies have investigated the relationship between social anxiety and attention biases, in conjunction with emotional and cognitive responses to a social stressor. Elucidating these links would shed light on maintenance factors of social anxiety and could help identify malleable treatment targets. This study examined the associations between social anxiety level, attention bias to disgust (AB-disgust), subjective emotional and physiological reactivity to a social stressor, and subsequent post-event processing (PEP). We tested a mediational model where social anxiety level indirectly predicted subsequent PEP via its association with AB-disgust and immediate subjective emotional reactivity to social stress. Fifty-five undergraduates (45% female) completed a passive viewing task. Eye movements were tracked during the presentation of social stimuli (e.g., disgust faces) and used to calculate AB-disgust. Next, participants gave an impromptu speech in front of a video camera and watched a neutral video, followed by the completion of a PEP measure. Although there was no association between AB-disgust and physiological reactivity to the stressor, AB-disgust was significantly associated with greater subjective emotional reactivity from baseline to the speech. Analyses supported a partial mediation model where AB-disgust and subjective emotional reactivity to a social stressor partially accounted for the link between social anxiety levels and PEP.     

To be sure, to be sure: intolerance of uncertainty mediates symptoms of various anxiety disorders and depression

The Intolerance of Uncertainty Model was initially developed as an explanation for worry within the context of generalized anxiety disorder. However, recent research has identified intolerance of uncertainty (IU) as a possible transdiagnostic maintaining factor across the anxiety disorders and depression. The aim of this study was to determine whether IU mediated the relationship between neuroticism and symptoms related to various anxiety disorders and depression in a treatment-seeking sample (N=328). Consistent with previous research, IU was significantly associated with neuroticism as well as with symptoms of social phobia, panic disorder and agoraphobia, obsessive-compulsive disorder, generalized anxiety disorder, and depression. Moreover, IU explained unique variance in these symptom measures when controlling for neuroticism. Mediational analyses showed that IU was a significant partial mediator between neuroticism and all symptom measures, even when controlling for symptoms of other disorders. More specifically, anxiety in anticipation of future uncertainty (prospective anxiety) partially mediated the relationship between neuroticism and symptoms of generalized anxiety disorder (i.e. worry) and obsessive-compulsive disorder, whereas inaction in the face of uncertainty (inhibitory anxiety) partially mediated the relationship between neuroticism and symptoms of social anxiety, panic disorder and agoraphobia, and depression. Sobel's test demonstrated that all hypothesized meditational pathways were associated with significant indirect effects, although the mediation effect was stronger for worry than other symptoms. Potential implications of these findings for the treatment of anxiety disorders and depression are discussed.     

Negative post-event processing and decreased self-appraisals of performance following social stress in childhood social anxiety: an experimental study

Cognitive models of social phobia (SP) assume that following social evaluative stress, individuals with SP engage into dysfunctional post-event processing (PEP), a detailed negative review of the past event. While previous research has already shown, that children with high levels of social fears suffer from more frequent negative PEP, it remains unclear how stable PEP is across time in this age group and whether it leads to degraded self-appraisals of performance. Therefore in the present study we exposed a group of high (HSA) and low socially anxious children (LSA; both n = 20), aged 10–12 years, to a social evaluative situation and assessed negative and positive PEP as well as self-rated performance at 2.5 h and one week after the task. Our results revealed that HSA children reported more negative PEP than LSA children, independent of levels of depression. Moreover, negative PEP was related to measures of social anxiety and performance ratings within the tasks. Only the performance ratings in HSA children worsened over the course of the following week and were related to more negative PEP. Thus, these results speak for the high clinical relevance dysfunctional PEP may have for the maintenance of social fears already in childhood.     

Examining the Role of Perfectionism and Intolerance of Uncertainty in Postevent Processing in Social Anxiety Disorder

Postevent processing (PEP) is proposed to be a key maintenance factor of social anxiety disorder (SAD; e.g., Clark and Wells 1995). The goal of the current study was to examine the independent roles of two transdiagnostic variables, namely perfectionism and intolerance of uncertainty (IU), as unique predictors of PEP in SAD above and beyond social anxiety and depressive symptoms. Fifty-six adults with SAD and high levels of speech anxiety completed measures of perfectionism, IU, social anxiety, and depression. They gave an impromptu speech to induce PEP, and completed measures assessing degree of PEP and its associated distress. Significant positive correlations were found between perfectionism and negative PEP degree and distress, as well as between IU and negative PEP distress. The perfectionism subscales of parental expectations and parental criticism significantly predicted negative PEP degree and distress over and above social anxiety and depressive symptoms. Perfectionism, as well as IU, were significantly and positively correlated with positive PEP distress, and significantly predicted positive PEP distress above and beyond social anxiety and depressive symptoms. The study design was cross-sectional; hence, experimental and longitudinal studies are needed to further understand the roles of perfectionism and IU as they relate to PEP. Individuals with SAD who are high in perfectionism or IU appear to be more prone to engaging in, or experiencing distress associated with, negative PEP. Specific strategies for decreasing negative PEP in this vulnerable population, especially for those high in perfectionism, may be necessary for optimal treatment outcome.     

Patterns of personality pathology in patients with generalized anxiety disorder, panic disorder with and without agoraphobia, and social phobia

The relationship between co-occurring personality disorders and anxiety disorders (panic disorder with or without agoraphobia, social phobia, and generalized anxiety disorder) was examined, taking into account the effect of major depression. This article describes findings for 622 participants in the Harvard/Brown Anxiety Research Project, a longitudinal follow-up study of DSM-III-R-defined anxiety disorders. A total of 24% of participants had at least one personality disorder, with avoidant, obsessive compulsive, dependent, and borderline most common. Generalized anxiety disorder, social phobia, and major depression were positively associated with the occurrence of one or more personality disorders, whereas panic disorder with agoraphobia was not associated. Major depression was associated in particular with dependent, borderline, histrionic, and obsessive compulsive personality disorders and social phobia was associated with avoidant personality disorder. Whereas some of our findings confirm results from earlier studies, others are somewhat inconsistent with previous results and indicate the need for further investigation.     

Post-event Processing in Children with Social Phobia

In the aftermath of a distressing social event, adults with social phobia (SP) engage in a review of this event with a focus on its negative aspects. To date, little is known about this post-event processing (PEP) and its relationship with perceived performance in SP children. We measured PEP in SP children (n = 24) and healthy controls (HC; n = 22), aged from 8 to 12 years, after the Trier Social Stress Test for Children (TSST-C). Children also rated their performance immediately after the TSST-C and 2.5 h later. SP children reported more negative and less positive PEP than controls. Regression analyses indicated that negative PEP was associated with social anxiety and perceived task performance independent of comorbid depression. The SP group rated their performance immediately after the TSST-C as worse compared to HCs and ratings remained stable over the following 2.5 h. Results are discussed in relation to current theories of SP.     

Perfectionism and its relationship with anticipatory processing in social anxiety

Cognitive‐behavioural models suggest that perfectionistic beliefs and anticipatory processing are key maintaining factors of social anxiety. The present study examined the moderating and mediating role that anticipatory processing has on the relationship between perfectionism and social anxiety. The sample consisted of 245 individuals from the general community who completed an online questionnaire package comprising depression, perfectionism, and social anxiety measures. Participants also rated their levels of anticipatory processing in response to vignettes describing an upcoming social interaction and performance situation. Results showed that maladaptive perfectionism and maladaptive anticipatory processing were positively associated with social anxiety. Furthermore, maladaptive anticipatory processes (stagnant deliberation and outcome fantasy) remained significantly and positively associated with social anxiety even after controlling for depression and maladaptive perfectionism, whereas adaptive anticipatory processes (plan rehearsal and problem analysis) were not significantly associated with social anxiety. These findings support current classifications of anticipatory processing in social anxiety. Contrary to predictions, maladaptive anticipatory processing did not moderate the relationship between maladaptive perfectionism and social anxiety. An exploratory analysis indicated that maladaptive anticipatory processing mediated the relationship between maladaptive perfectionism and social anxiety. Implications for therapeutic intervention are discussed.     

Social anxiety and post-event processing among African-American individuals

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.     

Assessing post-event processing after social situations: a measure based on the cognitive model for social phobia

In their cognitive model of social phobia, Clark and Wells (1995) described a process called post-event processing that is characterized by prolonged ruminative and negative thinking about a past social event. Referring to this concept, Rachman and colleagues (2000) developed a questionnaire that has been used in several studies subsequently (Post-Event Processing Questionnaire (PEPQ)). Our aim was to examine a German version of the PEPQ and, where necessary, modify this measure. In Study 1 (N=130 students), we inspected the psychometric properties of the German version of the PEPQ. According to the item analyses, problematic items were identified and eliminated or reformulated. To map aspects of post-event processing that were missing in the original questionnaire, new items were developed. In Study 2, the psychometric properties of the revised instrument were analyzed in a sample of students (N=268).The revised instrument showed excellent internal consistency and a meaningful pattern of correlations with anxiety, depression, and dysfunctional self-consciousness. With regard to the factorial structure of the construct, our data suggest that a four-factorial model may be more appropriate than the one-dimensional structure proposed by Rachman and colleagues.     

Effect of self-focused attention on post-event processing in social anxiety

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.     

Social anxiety and the effects of negative self-imagery on emotion, cognition, and post-event processing

Numerous studies have shown that social phobia patients experience negative self-impressions or images during social situations. Clark and Wells (1995) posited that such negative self-images are involved in the maintenance of social phobia. Thus, the present study investigated the effects of negative self-imagery on cognition and emotion during and following a brief social situation. Specifically, high and low socially anxious participants (N = 77) were instructed to hold either a negative or control self-image as they engaged in a brief speech. Participants then rated their anxiety, performance, cognitions, and focus of attention. Twenty-four hours later, they returned to the laboratory and completed questionnaires assessing the amount of post-event processing (PEP) they engaged in. The results showed that, irrespective of the level of social anxiety or depressive symptoms, participants that held the negative self-image experienced higher levels of anxiety, were more self-focused, experienced more negative thoughts, rated their anxiety as more visible, appraised their performance more negatively, and engaged in more negative and less positive PEP than participants that held the control self-image. Collectively the results indicate that negative imagery is causally involved in the maintenance of social phobia, as well as in the generation of social anxiety among non-anxious individuals.     

Repetitive Thinking in Social Anxiety Disorder: Are Anticipatory Processing and Post-Event Processing Facets of an Underlying Unidimensional Construct?

Existing literature suggests that anticipatory processing and post-event processing—two repetitive thinking processes linked to social anxiety disorder (SAD)—might be better conceptualized as facets of an underlying unidimensional repetitive thinking construct. The current study tested this by examining potential factor structures underlying anticipatory processing and post-event processing. Baseline data from two randomized controlled trials, consisting of 306 participants with SAD who completed anticipatory processing and post-event processing measures in relation to a speech task, were subjected to confirmatory factor analysis. A bifactor model with a General Repetitive Thinking factor and two group factors corresponding to anticipatory processing and post-event processing best fit with the data. Further analyses indicated an optimal model would include only the General Repetitive Thinking factor (reflecting anticipatory processing and a specific aspect of post-event processing) and Post-event Processing group factor (reflecting another specific aspect of post-event processing that is separable), providing evidence against a unidimensional account of repetitive thinking in SAD. Analyses also indicated that the General Repetitive Thinking factor had moderately large associations with social anxiety and life interference (rs = .43 to .47), suggesting its maladaptive nature. The separable Post-event Processing group factor only had small associations with social anxiety (rs = .16 to .27) and was not related to life interference (r = .11), suggesting it may not, in itself, be a maladaptive process. Future research that further characterises the bifactor model components and tests their utility has the potential to improve the conceptualisation and assessment of repetitive thinking in SAD.     

The Relevance of Age of Onset to the Psychopathology of Social Phobia

The present study aimed to examine the relevance of age of onset to the psychopathology of social phobia using a large clinical sample of 210 patients with social phobia. The two most common periods of onset were during adolescence (ages 14–17) and early childhood (prior to age 10). Structural regression modeling was used to test predictions that early onset social phobia would be associated with greater severity of the disorder, stronger current symptoms of depression and anxiety, greater functional impairment, and more pronounced levels of emotional disorder vulnerabilities (e.g., neuroticism/behavioral inhibition, extraversion, perceptions of control). Logistic regression was used to evaluate relationships between age of onset and the presence of acute and chronic stress at the time of onset. Results showed that earlier age of social phobia onset was associated with stronger current psychopathology, functional impairment, and emotional disorder vulnerabilities, and that later age of onset predicted the presence of an acutely stressful event around the time of disorder emergence. These results are discussed in regard to their clinical implications and congruence with prominent etiological models of the emotional disorders.     

Reactivity to Exclusion Prospectively Predicts Social Anxiety Symptoms in Young Adults

Peer victimization leads to negative outcomes such as increased anxiety and depression. The prospective relationship between peer victimization and social anxiety in children and adolescents is well established, and adults with social anxiety disorder (SAD) are more likely than individuals with other anxiety disorders to report a history of teasing. However, a crucial bridge between these findings (peer victimization in young adults) is missing. We manipulated perceptions of peer exclusion in a young adult sample (N = 108) using the Cyberball Ostracism Task. Reactivity to exclusion prospectively predicted social anxiety symptoms at a 2-month follow-up, whereas self-reported teasing during high school and current relational victimization did not. This research suggests that reactions to peer victimization may be a worthwhile target for clinical interventions in young adults. Targeting how young adults react to stressful social interactions such as exclusion may help prevent the development of SAD. Future research should test if reactivity to exclusion plays a role in the relationship between other disorders (e.g., depression) and peer victimization.     

The Impact of Brief Mindfulness Training on Postevent Processing Among Individuals With Clinically Elevated Social Anxiety

Postevent processing (PEP), the engagement in detailed and repetitive self-focused review of one’s performance in social situations, is theorized to maintain pathological social anxiety. However, little is known about interventions that may impact this maintenance factor. The current study examined the impact of brief mindfulness training (BMT) on PEP among socially anxious individuals. There were 77 participants (75.32% female, 63.64% non-Hispanic/Latinx White) with clinically elevated social anxiety who attended one appointment in the laboratory during which they were randomized to receive a brief mindfulness-based training (n = 37) or no training (i.e., thinking as usual control group; n = 40). After the training period, participants underwent a 3-minute social anxiety induction task, after which they were instructed to apply their thinking strategy. Participants were then asked to complete 2 weeks of daily online surveys that included a PEP induction task, instructions to use their thinking strategy following PEP induction, and a measure of state PEP. Individuals in the BMT condition reported a significant reduction in state anxiety posttraining compared to individuals in the control condition. Conditions did not differ on state PEP after the social anxiety induction task. However, compared to those in the control condition, participants in the BMT condition reported significantly greater decreases in state PEP over the 14-day follow-up period. Thus, this brief mindfulness-based strategy may be useful for individuals with clinically elevated social anxiety who engage in PEP, a cognitive vulnerability factor implicated in the maintenance of social anxiety.     

On the hierarchical structure of mood and anxiety disorders: confirmatory evidence and elaboration of a model of temperament markers

The authors examined D. Watson's (2005) proposed reconceptualization of the diagnostic categories for mood and anxiety disorders for the Diagnostic and Statistical Manual of Mental Disorders--Fifth Edition (DSM-V) and tested an elaboration of the 2-factor (positive and negative activation) model of underlying temperament markers that incorporates A. Tellegen, D. Watson, & L. A. Clark's (1999a, 1999b) higher-order dimension of happiness-unhappiness (or demoralization; see A. Tellegen et al., 2003). In Study 1, 502 undergraduate students completed several symptom measures of mood and anxiety disorders and the Minnesota Multiphasic Personality Inventory-2 (J. N. Butcher et al., 2001). Using confirmatory factor analysis, the authors replicated Watson's distress and fear disorder model. Path analyses showed that demoralization was a primary marker of distress disorders, whereas dysfunctional negative emotions was a primary marker of fear disorders. Low positive emotions was a specific marker of depression and social phobia. This 3-factor path model was associated with better fit than was a 2-factor model excluding demoralization. In Study 2, the authors replicated the findings of Study 1 using data from an archival clinical sample of 636 Veterans Affairs hospital outpatients. The authors' findings provide evidence on the important role of demoralization in mood and anxiety disorders.     

Relations Among Symptoms of Social Phobia Subtypes, Avoidant Personality Disorder, Panic, and Depression

This study's primary goal was to examine relations between symptoms of specific social phobia (SSP), generalized social phobia (GSP), avoidant personality disorder (APD), and panic and depression. Past research has suggested a single social phobia continuum in which SSP displays less symptom severity than GSP or APD. We found SSP symptoms correlated less strongly with depression but more strongly with panic relative to both GSP and APD symptoms. These findings challenge a unidimensional model of social phobia, suggesting a multidimensional model may be more appropriate. These findings also inform current research aimed at classifying mood and anxiety disorders more broadly by identifying that the different factors of fear versus distress appear to underlie different subtypes of social phobia.     

The looming maladaptive style in social anxiety

This exploratory study examined the relationship between the looming maladaptive style (i.e., an enduring and traitlike cognitive pattern to appraise threat as rapidly rising in risk, progressively worsening, or actively speeding up and accelerating) and three different aspects of trait social anxiety (i.e., fear of negative evaluation, social interaction anxiety, and public scrutiny fears) as well as general anxiety and depression. A large nonclinical, female-only sample (n = 152) completed the Looming Maladaptive Style Questionnaire–II (Riskind, J. H., Williams, N. L., Theodore, L. G., Chrosniak, L. D., & Cortina, J. M. (2000). The looming maladaptive style: Anxiety, danger, and schematic processing. Journal of Personality and Social Psychology, 79, 837–852), which assesses two types of looming vulnerability: social (i.e., looming appraisals in response to potentially threatening social situations) and physical (i.e., looming appraisals in response to potentially threatening physical stimuli). Multiple regression analyses indicated that social looming uniquely predicted fear of negative evaluation, social interaction anxiety, and public scrutiny fears, accounting for 7%, 4%, and 3% of the variance, respectively. However, social looming did not predict depression. These findings support the looming model of anxiety and encourage further attention to the possible role of social looming as an anxiety-specific vulnerability factor in social anxiety.