Anticipatory Processing and Post‐Event Processing in Social Anxiety Disorder: An Update on the Literature

Two repetitive thinking processes that have been proposed in prominent maintenance models of social anxiety disorder (SAD) are anticipatory processing and post‐event processing. Research into these two processes has steadily increased over the last 20 years. This review highlights the main lines of existing research on anticipatory processing and post‐event processing, including studies on the nature of these processes, their association with social anxiety, the predictors, and consequences of these processes, as well as how these processes respond to treatments for SAD. The review also highlights some of the conceptual and methodological issues that have prevented the literature on anticipatory processing and post‐event processing from being more integrated and focused. Finally, the review draws together some new directions in terms of theory and research to further advance the field.     

Onset of Illness and Developmental Factors in Social Anxiety Disorder: Preliminary Findings from a Retrospective Interview

Although many advances have been made in the treatment of Social Anxiety Disorder (SAD), less is known about its onset and factors related to its course and severity. The current study aimed to investigate developmental factors (e.g., onset of illness, behavioral inhibition, socially traumatic experiences) that research has suggested are related to the course and severity of SAD in a sample of adults diagnosed with generalized SAD. Results showed behavioral inhibition to be the only consistent predictor of current severity. Results for age of onset were consistent with previous studies suggesting an early childhood and later adolescent pattern. In addition, an earlier age of onset negatively impacted improvement in cognitive behavior therapy for SAD, but no other developmental factors were related to treatment outcome. Future research using longitudinal designs and multiple informants is needed to confirm findings from retrospective reports.

The effects of different types of goal pursuit on experience and performance during a stressful social task

Researchers have recently suggested that anxiety research may benefit from the examination of motivational factors, such as the difference between approach and avoidance goals. This suggestion is consistent with the literature on self-regulation, which indicates that affect serves as feedback for goal pursuit, with anxiety primarily providing feedback regarding avoidance. However, no data are available on participant goals for a task that generates social anxiety. Data from 120 speech anxious participants who engaged in a public speaking task were used to test the following hypotheses: (1) avoidance goals would be more specific than approach goals; (2) goals regarding social anxiety would have a negative impact on public speaking experience and performance; and (3) participants would tend to organize approach and avoidance goals not as separate goals, but as opposite poles of the same overarching goal. Hypotheses (1) and (3) were fully supported and hypothesis (2) was partially supported. The results highlight the possibility that approach goals may be particularly important to anxiety reduction.     

Post-event processing in social anxiety

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.     

Attention focusing versus distraction during exposure in dental phobia

A survey of the discrepant findings regarding the effects of attention focusing and distraction on exposure suggested that subjective measures of anxiety and avoidance respond better to the latter condition, and heart rate (HR) reaction responds to the former. To test this hypothesis, 63 dental phobics were recruited who had not visited a dentist for a mean of 6.6 (1.5-25) years. Participants received a 1-h exposure session with either attention focusing or distraction. Subjective anxiety and HR to phobia-related pictures were assessed before and after the treatment session and again after 1 week. Avoidance was recorded in terms of adherence to the dental treatment schedule in the following 6 months. Contrary to expectation, state anxiety showed a greater decrease in the attention focusing than the distraction condition after 1 week. Both treatment conditions were similarly effective with regard to HR and avoidance. HR habituated in both groups after exposure and 73% of followed-up patients adhered to the dental treatment schedule. Comparison of the present with previous results suggests that the differences between attentional conditions tend to be more pronounced during shorter exposure sessions than were employed in the present study.     

In the absence of rose-colored glasses: Ratings of self-attributes and their differential certainty and importance across multiple dimensions in social phobia

Sixty-seven individuals with social phobia (social anxiety disorder) and 60 healthy controls rated their perceived standing relative to others on 13 self-attribute dimensions, their level of certainty concerning those standings, and the importance of each dimension. As expected, individuals with social phobia provided self-ratings that were significantly more negative than controls across all dimensions. In addition, positive self-views were equated with higher levels of certainty and importance for controls, but not for individuals with social phobia. Thus, whereas reports of control participants reflected a healthy, positive framing of self-views, the ratings of clinical participants demonstrated an orientation toward self-framing that was neither positive nor negative. Together, these novel findings shed light on the nature of self-appraisals in social anxiety. Implications of these results are discussed in terms of contemporary cognitive-behavioral models of social phobia.     

Forced choice reaction time paradigm in children with separation anxiety disorder, social phobia, and nonanxious controls

Cognitive distortions refer to cognitive processes that are biased and therefore yield dysfunctional and maladaptive products (e.g., interpretation bias). Automatic aspects of information processing need to be considered and investigating these aspects requires forms of assessment other than self-report. Studies focussing on the specificity of cognitive biases across different types of anxiety disorders in childhood are rare. Thus, a forced choice reaction time paradigm with picture stimuli was used to assess the interpretation bias in anxious children online. The study investigated disorder-specific interpretation bias in 71 children with separation anxiety disorder (SAD), 31 children with social phobia, and 42 children without mental disorders, aged 5–13 years. Results indicated that children with SAD rated ambiguous separation pictures as significantly more unpleasant and more arousing than nonanxious children. However, no support was found that children with SAD and social phobia interpret ambiguous separation or social pictures in a more negative way than nonanxious children. Furthermore, no group differences were found in reaction times to all picture categories.     

日本拒绝上学概念的演变和原因探讨

拒绝上学指学生不是由于家庭贫困或生病,而是由于某种心理、情绪、身体或社会的原因而不去学校的现象。欧美最早进行研究,日本进行了五十多年的研究。该文介绍日本此现象的称呼从“学校恐怖症”、“拒绝上学”到“不去上学”的演变;日本学者从家庭、学校、社会方面对此现象进行的归因;拒绝上学的行为机制,如分离焦虑、情绪障碍、家庭关系不良;还介绍了日本教育部使用的小泉英二的分类。最后提示该现象在我国发展的可能性     

Social anxiety modulates visual exploration in real life – but not in the laboratory

In clinical reports, individuals high on social anxiety are often described to avoid gaze at other people, whereas several experimental studies employing images of persons yielded conflicting results. Here, we show that gaze avoidance crucially depends on the possibility of social interactions. We examined gaze behaviour in individuals with varying degrees of social anxiety in real-life and in a second group of participants using a closely matched laboratory condition. In the real-life situation, individuals with a higher degree of social anxiety had a reduced bias to look at near persons compared to individuals with a lower degree of social anxiety, while gaze behaviour in the laboratory group was not modulated by social anxiety. This effect was specific to social attention since there was no corresponding effect regarding fixations on objects. The presence of anxiety effects in real-life but not in the laboratory condition, where participants do not expect to be evaluated by gazed-at conspecifics, points to critical deficits of current laboratory research paradigms in eliciting authentic social attentional mechanisms, possibly leading to spurious results.