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

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Abstract

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.

Highlights

► We examine post-event processing and performance ratings in high and low socially anxious children. ► All children were exposed to a social performance situation. ► High anxious children reported more negative post-event processing after 2.5 h and after one week. ► Self-appraisals of performance worsened across one week only in high anxious children. ► Post-event processing may be an important factor for the maintenance of social fears in children.

Introduction

Social phobia (SP) refers to a persistent fear of humiliation by others, leading to the avoidance of social performance and social interaction situations (American Psychiatric Association, 1994). SP is one of the most common mental disorders in children and adolescents with prevalence rates up to 7% (Chavira, Stein, Bailey, & Stein, 2004) and a potential risk to normal social and emotional development when occurring young in age (Ollendick & Hirshfeld-Becker, 2002). SP in childhood often follows a chronic course and is frequently associated with other comorbid disorders such as depression and other anxiety disorders (Beidel, 1998). Despite its high clinical relevance, to date, no empirically validated aetiological model of childhood SP exists (Hodson, McManus, Clark, & Doll, 2008). Cognitive models of adult SP assume that social fears are maintained through a distorted cognitive processing of social information (Clark and Wells, 1995, Rapee and Heimberg, 1997). Beside exaggerated negative self-beliefs, safety behaviors, and an attentional bias for negative social feedback, these models delineate that, following social situations, individuals with the diagnosis of SP engage into a detailed review (“post-mortem”) of the past social situation (Clark & Wells, 1995). During this so called post-event processing (PEP), SPs focus on the negative aspects of the social situation (e.g. “How anxious did I look?”; “What part of my presentation was boring?”) and re-experience negative feelings of anxiety. In their model, Clark and Wells (1995) assume a direct relationship between appraisal of one’s own performance and subsequent PEP – the more negatively SPs evaluate their performance during a social task, the more frequent their PEP. Importantly, this negative PEP is thought to lead to degraded negative self-appraisals through the reinforcement of negative self-beliefs. Rachman, Grüter-Andrew, and Shafran (2000) argue that PEP is highly intrusive, interferes with the individuals’ concentration and can be interpreted as the reoccurrence of self-focused dysfunctional attention as seen during social interactions, with comparable damaging effects on self-evaluation.

Numerous empirical studies have investigated PEP in both clinical and non-clinical samples of adults with high levels of social anxiety (for a detailed review, see Brozovich & Heimberg, 2008), and individuals with high levels of social fears are frequently reported to show more negative PEP but not less positive PEP1 following social situations (Abbott and Rapee, 2004, Edwards et al., 2003, Kocovski and Rector, 2007, Rachman et al., 2000).1 Further, negative PEP is found to be stable up to four weeks, and seems to be associated with the retrieval of more negative social feedback, more negative autobiographical memories, and decreased self-evaluations over time (Cody and Teachman, 2010, Dannahy and Stopa, 2007, Morgan and Banerjee, 2008).

While there is substantial empirical evidence that cognitive models of SP apply to socially anxious adults (Clark & McManus, 2002), to date, their validity for socially anxious children is mostly unclear (Hodson et al., 2008). Several studies have found cognitive distortions in socially anxious children when compared to non-anxious controls (e.g. Cartwright-Hatton et al., 2005, Spence et al., 1999, Tuschen-Caffier et al., 2011), but others have partially failed to do so (e.g. Alfano et al., 2006, Beidel, 1991, Bögels and Zigterman, 2000, In-Albon et al., 2009). In addition, the question of to which extent negative PEP may play a role in the maintenance of childhood social anxiety has not been fully answered yet.

One of the first studies that investigated PEP in a sample of children comes from Hodson et al. (2008). In their study, Hodson and colleagues assessed PEP using the Post-event Processing Questionnaire (PEPQ; Rachman et al., 2000) in a group of 11–14 year old school pupils, classified as either high, medium or low socially anxious. As expected by the authors, high socially anxious children reported more negative PEP following social stress than the two other groups. While these results support the relevance of PEP already in socially anxious children, the study suffers from several methodological shortcomings such as the lack of experimental control of the social situation, and the use of a measure that was developed for the assessment of PEP in adults.

Using a more experimental approach and a child friendly measure for PEP, we recently examined negative and positive PEP as well as self-rated performance 2.5 h after a social evaluative task in a sample of SP and control children, aged 8–12 years (Schmitz, Krämer, Blechert, & Tuschen-Caffier, 2010). As expected, the SP group reported more negative PEP in the aftermath of social stress than controls. Further, negative PEP was related to trait social anxiety and self-rated performance within the tasks, independent of comorbid depression. The latter aspect is important because a ruminative cognitive response style is commonly found in individuals suffering from depression (Thomsen, 2006). Contrary to research with adults, control children in our study reported more positive PEP than children in the SP group. Unexpectedly, performance ratings in SP children remained unaltered over the 2.5 h after the experimental session, presumably as a result of the short interval between social tasks and the follow-up rating.

While these two studies are important in demonstrating that children with social fears already suffer from negative post-event processing immediately after social stress, it is unclear how persistent negative PEP is over time in this age group, since PEP was either assessed on the same day social stress occurred, or the way the study was designed did not include assessment of the exact time frame. Related to this, it remains unexplored whether a longer persistence of negative PEP in anxious children may lead to a decrease of self-rated performance in the aftermath of social stress, a central claim in the Clark and Wells’ (1995) model.

Therefore, the aim of the current study was to replicate and extend the results of previous research by exposing a group of high socially anxious (HSA) and low socially anxious children (LSA; both n = 20), aged 10–12 years, to a social performance situation and to assess negative and positive PEP, as well as self-rated performance at 2.5 h and one week after the experimental session. According to current theory and previous research in adults and children with social anxiety, we hypothesized that: (1) Children of the HSA group would report higher levels of negative PEP and lower levels of positive PEP 2.5 h and 1 week after the experimental session, independent of levels of depression (Schmitz et al., 2010); (2) Performance ratings in HSA children would worsen over the course of one week and remain stable in LSA children (Dannahy & Stopa, 2007); (3) More frequent negative PEP would be associated with negative performance ratings obtained immediately after the social tasks, and higher trait social anxiety. More negative performance ratings one week after the experimental session are related to more frequent negative PEP (Abbott and Rapee, 2004, Dannahy and Stopa, 2007, Schmitz et al., 2010).

Section snippets

Participants

A total of 108 families responded to four advertisements in local newspapers and 1200 information flyers in primary and secondary schools as well as psychological and medical treatment facilities offering €35 (US$41) for participation in a study on shy and non-shy children. After having received detailed written information about the aim and procedure of the study, and the Social Anxiety Scale for Children revised (SASC-R; La Greca & Stone, 1993), 73 of these 108 families mailed back the

Demographics

HSA and LSA children were successfully matched on all demographic variables (Table 1). HSA children showed higher scores on the CBCL, and on the internalizing scale of the CBCL. There were no significant group differences between HSA and LSA children in CDI-depression scores or on the externalizing scale of the CBCL.

Manipulation check

Subjective anxiety ratings at baseline and during social stress (mean anxiety score for both tasks) were compared between HSA and LSA children using independent sample t-tests.

Discussion

The aim of the current study was to replicate and extend previous research on PEP and its relation to self-rated performance in childhood social anxiety. In line with our hypotheses, we found that: (1) Children of the HSA group reported higher levels of negative PEP 2.5 h and 1 week after two social evaluative tasks, independent of levels of depression; (2) Self-rated performance in HSA children worsened over the course of one week but remained stable in LSA children; (3) More frequent negative

Acknowledgments

This research was supported by a stipend of the Friedrich-Ebert-Foundation (FES) granted to first author. We would like to thank two anonymous reviewers for their helpful comments on an earlier version of the manuscript.

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