Letting go of yesterday: Effect of distraction on post-event processing and anticipatory anxiety in a socially anxious sample

According to cognitive models, post-event processing (PEP) is a key factor in the maintenance of social anxiety. Given that decreasing PEP can be challenging for socially anxious individuals, it is important to identify potentially useful strategies. Although distraction may help to decrease PEP, the findings have been equivocal. The primary purpose of this study was to examine whether a brief distraction period immediately following a speech would lead to less PEP the next day. The secondary aim was to examine the effect of distraction following an initial speech on anticipatory anxiety for a second speech, via reductions in PEP. Participants (N = 77 undergraduates with elevated social anxiety; 67.53% female) delivered a speech and were randomly assigned to a distraction, rumination, or control condition. The following day, participants reported levels of PEP in relation to the first speech, as well as anxiety regarding a second, upcoming speech. As expected, those in the distraction condition reported less PEP than those in the rumination and control conditions. Additionally, distraction following the first speech was indirectly related to anticipatory anxiety for the second speech, via PEP. Distraction may represent a potentially useful strategy for reducing PEP and other maladaptive processes that may maintain social anxiety.     

Mental Imagery and Post-Event Processing in Anticipation of a Speech Performance Among Socially Anxious Individuals

The present study investigated whether post-event processing (PEP) involving mental imagery about a past speech is particularly detrimental for socially anxious individuals who are currently anticipating giving a speech. One hundred fourteen high and low socially anxious participants were told they would give a 5 min impromptu speech at the end of the experimental session. They were randomly assigned to one of three manipulation conditions: post-event processing about a past speech incorporating imagery (PEP-Imagery), semantic post-event processing about a past speech (PEP-Semantic), or a control condition, (n = 19 per experimental group, per condition [high vs low socially anxious]). After the condition inductions, individuals’ anxiety, their predictions of performance in the anticipated speech, and their interpretations of other ambiguous social events were measured. Consistent with predictions, high socially anxious individuals in the PEP-Imagery condition displayed greater anxiety than individuals in the other conditions immediately following the induction and before the anticipated speech task. They also interpreted ambiguous social scenarios in a more socially anxious manner than socially anxious individuals in the control condition. High socially anxious individuals made more negative predictions about their upcoming speech performance than low anxious participants in all conditions. The impact of imagery during post-event processing in social anxiety and its implications are discussed.     

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.     

Social anxiety and vulnerability for problematic drinking in college students: the moderating role of post-event processing

Socially anxious college students are at increased risk for engaging in problematic drinking (i.e. heavy or risky drinking) behaviors that are associated with the development of an alcohol use disorder. The present study examined whether post-event processing (PEP), repeatedly thinking about and evaluating one’s performance in a past social situation, strengthens the association between social anxiety and vulnerability to problematic drinking among college students. Eighty-three college drinkers with high or low social anxiety participated in a social interaction task and were exposed to a manipulation that either promoted or inhibited PEP about the social interaction. Among participants randomized to the PEP promotion condition, those with high social anxiety exhibited a greater urge to use alcohol after the social interaction and greater motivation to drink to cope with depressive symptoms over the week following the manipulation than did those with low social anxiety. These findings suggest that targeting PEP in college drinking intervention programs may improve the efficacy of such programs for socially anxious students.     

Mindfulness and the Attenuation of Post-Event Processing in Social Phobia: An Experimental Investigation

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.     

Effect of brief mindfulness and relaxation inductions on anxiety,affect and brain activation in athletes

The mindfulness-based intervention and psychological skills training are often used for maintaining the mental health or reducing undesirable mental states in athletes. However, their differences in acute effects on mental health and underlying neural mechanism are not well understood. Therefore, the purpose of the current study was to examine the differential effects of brief mindfulness induction (MI) and relaxation induction (RI) on state anxiety, affect and brain activation. Thirty-five track and field athletes were recruited for this study. Using a within-subjects crossover design, participants underwent three conditions that incorporated two 30-min experimental conditions (i.e., MI or RI) and a control condition. State anxiety and affect were assessed before and after intervention, and brain activation (i.e., theta, alpha bands) were recorded by electroencephalography (EEG) during each 30-min condition. Repeated measures analysis of variance revealed that MI and RI similarly reduced state anxiety and negative affect from pre-test to post-test compared to the control condition. In terms of positive affect, there were no significant differences among the three conditions across times. Furthermore, participants exhibited higher frontal theta power during the MI and RI than control condition, whereas no differences in alpha power were observed among conditions. The current study provides initial evidence from an electrophysiological perspective that brief MI and RI both improve the negative psychological states in individual sport athletes through similar neural mechanisms. Nevertheless, the moderating effects of training experiences and long-term interventions on mental state and EEG activity in athletes need further investigation in future studies.     

Mindfulness and the attenuation of post-event processing in social phobia: an experimental investigation

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.     

The relationship of post-event processing to self-evaluation of performance in social anxiety

Socially anxious and control participants engaged in a social interaction with a confederate and then wrote about themselves or the other person (i.e., self-focused post-event processing [SF-PEP] vs. other-focused post-event processing [OF-PEP]) and completed several questionnaires. One week later, participants completed measures concerning their evaluation of their performance in the social interaction and the degree to which they engaged in post-event processing (PEP) during the week. Socially anxious individuals evaluated their performance in the social interaction more poorly than control participants, both immediately after and 1 week later. Socially anxious individuals assigned to the SF-PEP condition displayed fewer positive feelings about their performance compared to the socially anxious individuals in the OF-PEP condition as well as controls in either condition. Also, the trait tendency to engage in PEP moderated the effect of social anxiety on participants' evaluation of their performance in the interaction, such that high socially anxious individuals with high trait PEP scores evaluated themselves in the interaction more negatively at the later assessment. These results suggest that PEP and other self-evaluative processes may perpetuate the cycle of social anxiety.     

Predicting post-event processing in social anxiety disorder following two prototypical social situations: State variables and dispositional determinants

This study investigated self-reported state (anxiety, physical symptoms, cognitions, internally focused attention, safety behaviors, social performance) and trait (social anxiety, depressive symptoms, dysfunctional self-consciousness) predictors of post-event processing (PEP) subsequent to two social situations (interaction, speech) in participants with a primary diagnosis of social anxiety disorder (SAD) and healthy controls (HC). The speech triggered significantly more intense PEP, especially in SAD. Regardless of the type of social situation, PEP was best predicted by situational anxiety and dysfunctional cognitions among the state variables. If only trait variables were considered, PEP following both situations was accounted for by trait social anxiety. In addition, dysfunctional self-consciousness contributed to PEP-speech. If state and trait variables were jointly considered, for both situations, situational anxiety and dysfunctional cognitions were confirmed as the most powerful PEP predictors above and beyond trait social anxiety (interaction) and dysfunctional self-consciousness (speech). Hence, PEP as assessed on the day after a social situation seems to be mainly determined by state variables. Trait social anxiety and dysfunctional self-consciousness also significantly contribute to PEP depending on the type of social situation. The present findings support dysfunctional cognitions as a core cognitive mechanism for the maintenance of SAD. Implications for treatment are discussed.     

Performance perceptions and self-focused attention predict post-event processing after a real-life social performance situation

Background and Objectives: Cognitive approaches to social anxiety suggest that an excessive brooding about one's performance in a social situation (post-event processing; PEP) is involved in the maintenance of anxiety. To date, most studies investigating PEP were conducted in laboratory settings. The present study sought to replicate previous findings on predictors of PEP after a naturalistic social performance situation. Methods: Sixty-five students, who had to give an evaluated presentation for credits, completed measures of trait social anxiety. Immediately after their presentation, participants rated state anxiety and attentional focus during the presentation, and provided an overall evaluation of their performance. One week after the presentation, they rated PEP during the preceding week, and reappraised their performance. Results: Regression analyses demonstrated that the performance ratings after and self-focused attention during the presentation were unique predictors of PEP over and above the effects of trait and state anxiety. There was no evidence that PEP was associated with a biased recall of individual performance evaluations. Conclusions: The results support cognitive theories that emphasize the importance of negative self-perceptions in the development of social anxiety and related processes, and underline self-focused attention and self-evaluative processes as important targets during treatment.     

A Comparison of Repetitive Negative Thinking and Post-Event Processing in the Prediction of Maladaptive Social-Evaluative Beliefs: A Short-Term Prospective Study

Theoretical models propose that transdiagnostic and disorder-specific repetitive thinking processes each interact with individual environmental conditions to predict symptoms. The current study aimed to test this hypothesis in the context of social anxiety. Specifically, we aimed to predict future maladaptive social-evaluative beliefs (high standard, conditional, and unconditional beliefs) from: (a) the transdiagnostic tendency to engage in repetitive negative thinking (RNT), (b) the social anxiety-specific tendency to engage in post-event processing (PEP), and (c) the interaction of these repetitive thinking tendencies with the frequency of recent negative social events and social anxiety levels. An initial undergraduate sample (N = 331) was recruited and 215 participants completed measures of the constructs of interest at two time points within an acceptable timeframe (average 8.44 days apart). Using hierarchical linear modelling, significant interactions were only obtained for conditional and unconditional beliefs with a specific component of PEP that focuses on thinking about the past involved in prediction. Follow-up simple slopes analyses indicated mainly no change in these beliefs or decreasing trajectories over time for different combinations of levels on the predictor variables. However, for participants with high social anxiety levels who experienced a high number of recent negative social events, those who reported low levels of thinking about the past exhibited a pattern of increasing trajectories for conditional and unconditional beliefs. These findings indicate that RNT and PEP differ in their ability to predict social-evaluative beliefs, and highlight the importance of research comparing different types of repetitive thinking to better understand these processes.     

Adaptive and Maladaptive Self-Focus: A Pilot Extension Study With Individuals High and Low in Fear of Negative Evaluation

Previous research in depressed participants has supported the differentiation of self-focus into distinct modes of self-attention with distinct functional effects. In particular, Rimes and Watkins (2005) investigated the effects of self-focused rumination on overgeneral thinking and found that analytical, evaluative self-focus increased global negative self-judgments, whereas self-focus low in analytical thinking decreased such judgments in depressed participants. Given that self-focused attention and rumination have been implicated in the maintenance of social anxiety, the present study investigated the effects of these two distinct forms of self-focused attention on global negative self-judgments in an analogue sample for social anxiety (high and low fear of negative evaluation, FNE). Individuals high and low in FNE (n = 41 per group) were randomly allocated to analytic (abstract, evaluative) or experiential (concrete, process-focused) self-focused manipulations. As predicted, in high FNE individuals, the experiential self-focus condition decreased ratings of the self as worthless and incompetent pre- to post-manipulation, whereas the analytical self-focus condition maintained such negative self-judgments. Analytical and experiential self-focus did not differ in their effects on mood. The results suggest that an experiential mode of self-focused rumination may be adaptive in social anxiety.     

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.     

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–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.     

An investigation into the jumping-to-conclusions bias in social anxiety

‘Jumping-to-Conclusions’ (JTC) is a data-gathering bias characterised by hasty decision-making, and is typically seen in individuals with high levels of delusions or paranoia. JTC has also been found in people with high trait and state anxiety. The present study aimed to explore the relationship between JTC and trait social anxiety and state anxiety, given paranoia is common in both social anxiety and psychotic disorders. One-hundred-and-eighty-six undergraduate students were allocated to a manipulation or control condition, and classified as high or low socially anxious. All participants completed the ‘beads task’ to assess JTC, and the State-Trait Anxiety Inventory (state subscale) to assess state anxiety. Participants in the manipulation condition were given an anxiety-inducing situation. Although the manipulation was effective in inducing state anxiety, there was no significant correlation between JTC and trait or state social anxiety. High socially anxious individuals showed more conservative decision-making than controls over time, which was posited to be caused by inhibited working memory resulting from increased state anxiety.     

Salutary proximal processes and distal mood and anxiety vulnerability outcomes of mindfulness training: a pilot preventive intervention

The present study evaluated the effect of a brief mindfulness-based preventive intervention on (a) dispositional (MAAS; Brown & Ryan, 2003) and state (SMS; Tanay & Bernstein, 2010) mindfulness; (b) putative proximal factors/processes engendered through the development of mindfulness, including increased decentering (EQ-D; Fresco et al., 2007) and reduced experiential avoidance (AAQ; Hayes et al., 2004); and (c) distal mood and anxiety vulnerability factors, including reduced depression-related dysfunctional attitudes, (DAS; de Graaf, Roelofs, & Huibers, 2009), anxiety sensitivity (ASI-3; Taylor et al., 2007), and negative affectivity (PANAS-NA; Watson, Clark, & Tellegen, 1988) among a university-community sample in Israel. Fifty-three adult participants between the ages of 20 and 52 (M(age)=25.2 years, SD(age)=4.3 years; 65.4% women) were recruited from the Haifa University community. Nineteen participants were randomly assigned to an experimental condition (M(age)=25.3 years, SD(age)=4.3 years; 66% women) and studied prospectively over the course of a four-session (21-day) mindfulness skills training intervention; and 34 participants were randomly assigned to a no-intervention (control) condition (M(age)=24.9 years, SD(age)=2.4years; 64.7% women) and studied prospectively. Findings demonstrate statistically robust and clinically significant relations between mindfulness and the theorized proximal and distal mood and anxiety vulnerability factors. Findings are discussed with respect to their theoretical implications for better understanding mindfulness-psychopathology vulnerability relations, clinical implications for larger-scale universal and selective transdiagnostic prevention efforts, and future directions for this area of research.     

Randomised controlled pilot trial of mindfulness training for stress reduction during pregnancy

This randomised controlled pilot trial tested a six-week mindfulness-based intervention in a sample of pregnant women experiencing high levels of perceived stress and pregnancy anxiety. Forty-seven women enrolled between 10 and 25 weeks gestation were randomly assigned to either a series of weekly Mindful Awareness Practices classes (n = 24) with home practice or to a reading control condition (n = 23). Hierarchical linear models of between-group differences in change over time demonstrated that participants in the mindfulness intervention experienced larger decreases from pre-to post-intervention in pregnancy-specific anxiety and pregnancy-related anxiety (PRA) than participants in the reading control condition. However, these effects were not sustained through follow-up at six weeks post-intervention. Participants in both groups experienced increased mindfulness, as well as decreased perceived stress and state anxiety over the course of the intervention and follow-up periods. This study is one of the first randomised controlled pilot trials of a mindfulness meditation intervention during pregnancy and provides some evidence that mindfulness training during pregnancy may effectively reduce PRA and worry. We discuss some of the dilemmas in pursuing this translational strategy and offer suggestions for researchers interested in conducting mind-body interventions during pregnancy.     

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.     

The impact of cognitive behavioral therapy on post event processing among those with social anxiety disorder

Individuals with social anxiety are prone to engage in post event processing (PEP), a post mortem review of a social interaction that focuses on negative elements. The extent that PEP is impacted by cognitive behavioral therapy (CBT) and the relation between PEP and change during treatment has yet to be evaluated in a controlled study. The current study used multilevel modeling to determine if PEP decreased as a result of treatment and if PEP limits treatment response for two types of cognitive behavioral treatments, a group-based cognitive behavioral intervention and individually based virtual reality exposure. These hypotheses were evaluated using 91 participants diagnosed with social anxiety disorder. The findings suggested that PEP decreased as a result of treatment, and that social anxiety symptoms for individuals reporting greater levels of PEP improved at a slower rate than those with lower levels of PEP. Further research is needed to understand why PEP attenuates response to treatment.