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01-06-2018 | Original Article

Modelling the Relationship Between Changes in Social Anxiety and Rumination Before and After Treatment

Authors: Matthew Modini, Ronald M. Rapee, Daniel S. J. Costa, Maree J. Abbott

Published in: Cognitive Therapy and Research | Issue 3/2018

Abstract

Pre- and post-event rumination have been proposed to be key processes involved in the maintenance of social anxiety disorder. While the importance of addressing rumination in treatment is becoming increasingly clear, factors that mediate the relationship between changes in social anxiety and changes in rumination have yet to be investigated. Individuals with social anxiety disorder (N = 82) completed measures that assessed key cognitive and attentional processes of social anxiety, including pre- and post-event rumination, before and after cognitive behavioural treatment. Following treatment there were significant reductions in pre- and post-event rumination in addition to other cognitive and attentional aspects of social anxiety. Mediation analyses revealed that changes in state anxiety and performance and threat appraisals mediated the relationship between changes in social anxiety and pre-event rumination, while only changes in threat appraisals mediated the relationship between changes in social anxiety and post-event rumination. It appears that key cognitive and attentional processes have differing importance when anticipating feared social situations and when reflecting on it afterwards. This suggests that treatment that aims to reduce the role of pre-event rumination needs to consider multiple factors, while threat appraisals particularly need to be addressed when addressing post-event rumination.

Heimberg et al. (2010) is an update to the Rapee and Heimberg (1997) model.

In the literature ‘pre-event rumination’ is often used interchangeability with the term ‘anticipatory processing’ and in earlier papers (i.e., Clark and Wells 1995) post-event rumination was termed the ‘post-mortem.’ In this paper ‘pre-event rumination’ and ‘post-event rumination’ are used for consistency.

Abbott, M. J., & Rapee, R. M. (2004). Post-event rumination and negative self-appraisal in social phobia before and after treatment. Journal of Abnormal Psychologyl, 113(1), 136–144. https://doi.org/10.1037/0021-843X.113.1.136.CrossRef

American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: American Psychiatric Association.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorder (5th ed.). Arlington, VA: American Psychiatric Publishing.CrossRef

Barrera, T. L., & Norton, P. J. (2009). Quality of life impairment in generalized anxiety disorder, social phobia, and panic disorder. Journal of Anxiety Disorders, 23(8), 1086–1090. https://doi.org/10.1016/j.janxdis.2009.07.011.CrossRefPubMedPubMedCentral

Brozovich, F., & Heimberg, R. G. (2008). An analysis of post-event processing in social anxiety disorder. Clinical Psychology Review, 28(6), 891–903. https://doi.org/10.1016/j.cpr.2008.01.002.CrossRefPubMed

Brozovich, F. A., & Heimberg, R. G. (2013). Mental imagery and post-event processing in anticipation of a speech performance among socially anxious individuals. Behavior Therapy, 44(4), 701–716.CrossRefPubMed

Bruch, M. A., Fallon, M., & Heimberg, R. G. (2003). Social phobia and difficulties in occupational adjustment. Journal of Counseling Psychology, 50(1), 109–117. https://doi.org/10.1037//0022-0167.50.1.109.CrossRef

Clark, D. M., & Wells, A. A. (1995). A cognitive model of social phobia. In R. G. Heimberg, M. R. Liebowitz, D. A. Hope & F. R. Schneier (Eds.), Social Phobia: Diagnosis, assessment and treatment (pp. 69–93). New York: Guildford Press.

Crome, E., Grove, R., Baillie, A. J., Sunderland, M., Teesson, M., & Slade, T. (2014). DSM-IV and DSM-5 social anxiety disorder in the Australian community. Australian and New Zealand Journal of Psychiatry, 49(3), 227–235. https://doi.org/10.1177/0004867414546699.CrossRefPubMed

DiNardo, P. A., Brown, T. A., & Barlow, D. H. (1994). Anxiety disorders interview schedule for DSM-IV: Lifetime version (ADIS-IV-L). New York: Oxford University Press.

Edwards, S. L., Rapee, R. M., & Franklin, J. (2003). Post-event rumination and recall bias for a social performance event in high and low socially anxious individuals. Cognitive Therapy and Research, 27, 603–617. https://doi.org/10.1023/A:1026395526858.CrossRef

Hayes, A. F. (2013). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. New York: Guilford Publications.

Hedman, E., Mortberg, E., Hesser, H., Clark, D. M., Lekander, M., Andersson, E., & Ljotsson, B. (2013). Mediators in psychological treatment of social anxiety disorder: Individual cognitive therapy compared to cognitive behavioral group therapy. Behaviour Research and Therapy, 51(10), 696–705. https://doi.org/10.1016/j.brat.2013.07.006.CrossRefPubMed

Heimberg, R. G., Brozovich, F. A., & Rapee, R. M. (2010). A cognitive behavioural model of social anxiety: Update and extension. In G. Hofmann & P. M. Dibartolo (Eds.), Social anxiety clinical, developmental, and social perspectives (pp. 395–422). New York: Academic Press.

Hofmann, S. G. (2004). Cognitive mediation of treatment change in social phobia. Journal of Consulting and Clinical Psychology, 72(3), 393–399. https://doi.org/10.1037/0022-006X.72.3.393.CrossRefPubMedPubMedCentral

Hofmann, S. G. (2007). Cognitive factors that maintain social anxiety disorder: A comprehensive model and its treatment implications. Cognitive Behaviour Therapy, 36(4), 193–209. https://doi.org/10.1080/16506070701421313.CrossRefPubMedPubMedCentral

Kazdin, A. E. (2007). Mediators and mechanisms of change in psychotherapy research. Annual Review of Clinical Psychology, 3, 1–27. https://doi.org/10.1146/annurev.clinpsy.3.0.CrossRefPubMed

Kenny, D. A. (2015). Measuring model fit. Retrieved on July 11, 2016, from http://davidakenny.net/cm/fit.htm.

Lochner, C., Mogotsi, M., du Toit, P. L., Kaminer, D., Niehaus, D. J., & Stein, D. J. (2003). Quality of life in anxiety disorders: A comparison of obsessive-compulsive disorder, social anxiety disorder, and panic disorder. Psychopathology, 36(5), 255–262. https://doi.org/10.1159/000073451.CrossRefPubMed

Mattick, R. P., & Clarke, J. (1998). Development and validation of measures of social phobia scrutiny fear and social interaction anxiety. Behaviour Research and Therapy, 36(4), 455–470. https://doi.org/10.1016/S0005-7967(97)10031-6.CrossRefPubMed

McEvoy, P. M., Mahoney, A., Perini, S. J., & Kingsep, P. (2009). Changes in post-event processing and metacognitions during cognitive behavioral group therapy for social phobia. Journal of Anxiety Disorders, 23(5), 617–623. https://doi.org/10.1016/j.janxdis.2009.01.011.CrossRefPubMed

McEvoy, P. M., & Perini, S. J. (2009). Cognitive behavioral group therapy for social phobia with or without attention training: A controlled trial. Journal of Anxiety Disorders, 23(4), 519–528. https://doi.org/10.1016/j.janxdis.2008.10.008.CrossRefPubMed

Modini, M., & Abbott, M. J. (2017). Negative rumination in social anxiety: A randomized trial investigating the effects of a brief intervention on cognitive processes before, during and after a social situation. Journal of Behavior Therapy and Experimental Psychiatry, 55, 73–80. https://doi.org/10.1016/j.jbtep.2016.12.002.CrossRefPubMed

Modini, M., Abbott, M. J., & Hunt, C. (2015). A systematic review of the psychometric properties of trait social anxiety self-report measures. Journal of Psychopathology and Behavioral Assessment, 37(4), 645–662. https://doi.org/10.1007/s10862-015-9483-0.CrossRef

Modini, M., Rapee, R. M., & Abbott, M. J. (2018). Processes and pathways mediating the experience of social anxiety and negative rumination. Behaviour Research and Therapy, 103, 24–32. https://doi.org/10.1016/j.brat.2018.01.009.CrossRefPubMed

Penney, E. S., & Abbott, M. J. (2014). The impact of perceived standards on state anxiety, appraisal processes, and negative pre- and post-event rumination in social anxiety disorder. Cognitive Therapy and Research, 39, 162–177. https://doi.org/10.1007/s10608-014-9639-3.CrossRef

Preacher, K. J., & Kelley, K. (2011). Effect size measures for mediation models: Quantitative strategies for communicating indirect effects. Psychological Methods, 16(2), 93–115. https://doi.org/10.1037/a0022658.CrossRefPubMed

Price, M., & Anderson, P. L. (2011). The impact of cognitive behavioral therapy on post event processing among those with social anxiety disorder. Behaviour Research and Therapy, 49(2), 132–137. https://doi.org/10.1016/j.brat.2010.11.006.CrossRefPubMed

Rapee, R. M. (1998). Overcoming shyness & social phobia: A step-by-step guide. Killara: Lifestyle Press.

Rapee, R. M., & Abbott, M. J. (2007). Modelling relationships between cognitive variables during and following public speaking in participants with social phobia. Behaviour Research and Therapy, 45(12), 2977–2989. https://doi.org/10.1016/j.brat.2007.08.008.CrossRefPubMed

Rapee, R. M., Abbott, M. J., Baillie, A. J., & Gaston, J. E. (2007). Treatment of social phobia through pure self-help and therapist-augmented self-help. British Journal of Psychiatry, 191, 246–252. https://doi.org/10.1192/bjp.bp.106.028167.CrossRefPubMed

Rapee, R. M., Gaston, J. E., & Abbott, M. J. (2009). Testing the efficacy of theoretically derived improvements in the treatment of social phobia. Journal of Consulting and Clinical Psychology, 77(2), 317–327. https://doi.org/10.1037/a0014800.CrossRefPubMed

Rapee, R. M., & Heimberg, R. G. (1997). A cognitive-behavioral model of anxiety in social phobia. Behaviour Research and Therapy, 35(8), 741–756. https://doi.org/10.1016/S0005-7967(97)00022-3.CrossRefPubMed

Rapee, R. M., & Lim, L. (1992). Discrepancy between self- and observer ratings of performance in social phobics. Journal of Abnormal Psychology, 101(4), 728–731. https://doi.org/10.1037/0021-843X.101.4.728.CrossRefPubMed

Wong, Q. J. J., Gregory, B., McLellan, L. F., Kangas, M., Abbott, M. J., Carpenter, L., … Rapee, R. M. (2017). Anticipatory processing, maladaptive attentional focus, and postevent processing for interactional and performance situations: Treatment response and relationships with symptom change for individuals with social anxiety disorder. Behavior Therapy, 48, 651–663.CrossRefPubMed

Wong, Q. J. J., & Rapee, R. M. (2016). The aetiology and maintenance of social anxiety disorder: A synthesis of complimentary theoretical models and formulation of a new integrated model. Journal of Affective Disorders, 203, 84–100. https://doi.org/10.1016/j.jad.2016.05.069.CrossRefPubMed

Title: Modelling the Relationship Between Changes in Social Anxiety and Rumination Before and After Treatment
Authors: Matthew Modini
Ronald M. Rapee
Daniel S. J. Costa
Maree J. Abbott
Publication date: 01-06-2018
Publisher: Springer US
Published in: Cognitive Therapy and Research / Issue 3/2018
Print ISSN: 0147-5916
Electronic ISSN: 1573-2819
DOI: https://doi.org/10.1007/s10608-018-9895-8

At a glance: The STEP trials

Springer Medicine

Modelling the Relationship Between Changes in Social Anxiety and Rumination Before and After Treatment

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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