Mediators of the relationship between social anxiety and post-event rumination

Abstract

A variety of cognitive and attentional factors are hypothesised to be associated with post-event rumination, a key construct that has been proposed to contribute to the maintenance of social anxiety disorder (SAD). The present study aimed to explore factors contributing to post-event rumination following delivery of a speech in a clinical population. 121 participants with SAD completed measures of trait social anxiety a week before they undertook a speech task. After the speech, participants answered several questionnaires assessing their state anxiety, self-evaluation of performance, perceived focus of attention and probability and cost of expected negative evaluation. One-week later, participants completed measures of negative rumination experienced over the week. Results showed two pathways leading to post-event rumination: (1) a direct path from trait social anxiety to post-event rumination and (2) indirect paths from trait social anxiety to post-event rumination via its relationships with inappropriate attentional focus and self-evaluation of performance. The results suggest that post event rumination is at least partly predicted by the extent to which socially anxious individuals negatively perceive their own performance and their allocation of attentional resources to this negative self-image. Current findings support the key relationships among cognitive processes proposed by cognitive models.

Introduction

Post-event processing refers to a tendency for socially anxious individuals to engage in a repetitive, detailed review of negative aspects of their performance after they encounter anxiety-provoking social situations. This process is seen as a core maintaining factor of the anxiety experienced by people with social anxiety disorder (SAD) by consolidating the individual's negative beliefs about themselves and the social world (Clark & Wells, 1995). According to Clark and Wells (1995), following a social event, a socially anxious individual undertakes a detailed mental rehearsal of that event. The mental rehearsal is dominated by the individual's anxious feelings and negative self-appraisals that were processed during the event and this enhances the salience of the individual's negative beliefs. Consequently, the further consolidation of these beliefs contributes to increased anticipatory anxiety, negative affect and negative interpretations of social situations. As a result, the fear of social situations is maintained. The term post-event rumination has also been used for the same phenomenon (Abbott and Rapee, 2004, Edwards et al., 2003).

To date, studies have demonstrated that people with SAD engage in elevated levels of post-event rumination (Abbott and Rapee, 2004, Rachman et al., 2000; for a review see Brozovich & Heimberg, 2008). Previous studies have also shown that post-event rumination is associated with more negative self appraisals of performance and more intense social anxiety (Abbott and Rapee, 2004, Dannahy and Stopa, 2007, Rapee and Abbott, 2007). However, most research on cognitive processes in SAD has examined processes in isolation rather than assessing the interactions among key processes (Hirsch, Mathews, & Clark, 2007). Understanding how post-event processing is related to other aspects of cognitive models of SAD and how it maintains social anxiety awaits further examination (Brozovich and Heimberg, 2008, Kocovski and Rector, 2008).

To date, little is known about how other processes posited by cognitive models (Clark and Wells, 1995, Rapee and Heimberg, 1997) interact with post-event processing to maintain social anxiety. Most research has provided correlational support for specific aspects of the models but an integrative perspective is lacking. To our knowledge, only one study has examined the relationships between cognitive processes in social anxiety disorder from an integrative perspective (Rapee & Abbott, 2007). In this study investigating mediators between characteristic (trait) social anxiety and performance recall in response to a speech, it was found that cognitive processes such as perception of speech performance, perceived negative consequences and negative rumination mediated the relationship between trait social anxiety and performance recall (Rapee & Abbott, 2007). However, this study focused on the factors that impact situational anxiety and associated performance recall a week later; questions remain regarding the factors that contribute to post-event rumination in maintaining social anxiety.

Research investigating predictors of post-event rumination have provided some suggestions to explain how other factors may impact levels of post-event processing. Studies have consistently revealed that the severity of social anxiety and negative self-appraisals of social performance significantly predict post-event rumination in the week following a social performance (Abbott and Rapee, 2004, Kocovski and Rector, 2008, Laposa and Rector, 2011, Perini et al., 2006). Recent studies have attempted to include broader trait-like and task-based cognitive behavioural variables in order to identify potential factors that impact post-event rumination. Laposa and Rector (2011) examined several potential predictors of post-event processing following videotaped exposures during a cognitive behaviour therapy (CBT) programme for clinical populations with SAD. In addition to severity of social anxiety prior to treatment, state anxiety during the videotaping, anxious rumination, fear of discomfort to others, and the interpretation of positive social events were positively and significantly related to post-event processing. Consistent results were obtained by Makkar and Grisham (2011) who investigated post-event processing following both a speech task and a conversation task. After undertaking both tasks, 40 participants completed a series of questionnaires assessing cognitive, behavioural, and physiological processes that occurred during each task. Twenty-four hours later, post-event processing was assessed in response to both tasks. The results showed that higher levels of post-event processing one day later were correlated with higher levels of trait social anxiety, self-reported state anxiety during the task, greater self-focused attention, more frequent negative thoughts during the speech, and lower performance ratings.

Taken together, these studies demonstrated that in addition to trait social anxiety, state anxiety as well as cognitive processes such as self-appraisals of performance, attentional focus, and negative assumptions about self, others or the world during the social task are factors likely to be associated with post-event processing. However, even though these studies demonstrated that individual variables impact post-event processing, an underlying mechanism explaining the inter-relationship between these factors has yet to be explored.

The present study aims to investigate factors contributing to post-event rumination after a speech task in a clinical population of patients with SAD in order to obtain an integrative perspective on the mechanism underlying this key cognitive process. Specifically, in addition to trait social anxiety, we focus on the role of self-focused attention, situational anxiety, perceptions of speech performance, and the probability and cost of expected negative evaluation in relation to post-event rumination and investigate the extent to which these factors contribute to negative rumination. Fig. 1 shows our proposed model outlining the relationships between these variables. The direction of the paths was hypothesised based on previous research results and temporal relationships (rumination was measured one week after other variables). Apart from specific correlations between these factors and post-event processing (Abbott and Rapee, 2004, Kocovski and Rector, 2008, Laposa and Rector, 2011, Makkar and Grisham, 2011), previous studies have also shown several mediation relationships. For example, Perini et al. (2006) illustrated that perception of performance was a mediator in the relationship between trait social anxiety and post-event rumination. Rapee and Abbott (2007) found that perception of speech performance, perceived focus of attention and perceived negative consequences mediated the relationship between trait social anxiety and state anxiety. In their models, adding a path from inappropriate attentional focus to performance perception demonstrated a better model fit to the data than a model without this path. Furthermore, examination of the indirect paths indicated that inappropriate attentional focus played an important role in predicting state anxiety through performance perception and perceived negative probability and consequences.

Taking these results into account, we hypothesised that (1) trait social anxiety impacts post-event processing directly, (2) trait social anxiety impacts post-event processing through its relationships with inappropriate attentional focus, state anxiety, perception of speech performance, and the probability and cost of negative evaluation. Among these mediators, biased attentional focus was a factor of particular interest. Previous reviews have demonstrated the important role of selective attention in development and maintenance of social anxiety (Bogels and Mansell, 2004, Schultz and Heimberg, 2008, Spurr and Stopa, 2002). In addition, empirical evidence has also supported that biased attention focus (e.g., self-focused attention) can be modified through techniques that focus on redeploying attentional focus (Heeren et al., 2012, Li et al., 2008, Schmidt et al., 2009). Nevertheless, few studies have explored whether and how self-focussed attention impacts post-event processing. To our knowledge, only two studies have examined the impact of self-focused attention on post-event processing (Gaydukevych and Kocovski, 2012, Makkar and Grisham, 2011). However, the results were based on small samples of nonclinical participants. Accordingly, whether and how self-focused attention impacts levels of post-event processing in a clinical population warrants further investigation.