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|کد مقاله||سال انتشار||مقاله انگلیسی||ترجمه فارسی||تعداد کلمات|
|32969||2007||12 صفحه PDF||سفارش دهید||5652 کلمه|
Publisher : Elsevier - Science Direct (الزویر - ساینس دایرکت)
Journal : Journal of Behavior Therapy and Experimental Psychiatry, Volume 38, Issue 1, March 2007, Pages 11–22
In their model of social phobia, Clark and Wells [1995. A cognitive model of social phobia. In R. G. Heimberg, M. Liebowitz, D. A. Hope & F. Schneier (Eds.), Social phobia: Diagnosis, assessment, and treatment (pp. 69–93). New York, London: The Guilford Press] introduced a process called “post-event processing” (PEP), which is characterized by prolonged rumination about past social situations. The present study examined to what extent PEP is specific for (a) social anxiety or (b) social situations. In a cross-sectional study, 217 participants reported about a social and a phobic event followed by negative thinking. PEP as well as its potential predictors such as social anxiety, general anxiety, and depression were measured by questionnaires. Results showed that social events were followed more often and by more intense PEP. Further confirming specificity, the fear of negative evaluation as an aspect of social anxiety was significantly associated with PEP for social but not for phobic situations, and vice versa; general anxiety predicted PEP only after phobic but not after social situations. Furthermore, PEP was elevated particularly for interaction (as opposed to performance) situations, indicating that the ambiguity of the situation may be an important predictor for prolonged processing.
Social phobia is one of the most frequent anxiety disorders, and subthreshold expressions of social anxiety are a part of many individuals’ lives (Fehm, Pélissolo, Furmark, & Wittchen, 2005; Wittchen & Fehm, 2003). Innovative models explaining the development and maintenance of the disorder have been proposed, some of which favor a cognitive view, namely those by Rapee and Heimberg (1997) and Clark and Wells (1995). Whereas processes within the situation are similarly delineated in both models, only the model by Clark and Wells explicitly postulates biased cognitive processes before as well as after the situation. The latter has been named “post-event processing” (PEP) or “post-mortem thinking” (Clark & Wells, 1995, p. 85). PEP includes repetitive, detailed reviews of the situation and an increased focus on the negative aspects of the situation. Negative self-perceptions and recollections of unfavorable aspects of the situation are likely to occur more and more frequently, as well as recollections of similar situations that are perceived as a failure. These processes may be so strong that a situation originally judged as satisfactory might be evaluated as a complete flop later on. In recent works, the term post-event rumination has been introduced (Abbott & Rapee, 2004; Edwards, Rapee, & Franklin, 2003), but as PEP also includes cognitive processes other than rumination (e.g., biased memory retrieval) we will adhere to the term “post-event processing” in this article. Post-event processes are of particular interest for the cognitive view of social phobia as they might contribute to the explanation why people with social anxiety do not experience a reduction of anxiety during repeated exposure to social situations, although they are part of everyday life. As the actual course of a situation is replaced by an increasingly distorted view of this situation, any corrective information will be less influential in comparison with the negative information subjectively fitting well with the person's negative self-image. Furthermore, PEP may partially account for anticipatory anxiety, which occurs often and intensely in advance of social situations. In spite of the prominent role that retrospective negative evaluations of the self in social situations may have for the understanding of the development and maintenance of social anxiety, systematic research on PEP only begins to emerge. Studies empirically addressing PEP demonstrated that PEP can be measured with high internal consistency (Edwards et al., 2003; Lundh & Sperling, 2002; Rachman, Grüter-Andrew, & Shafran, 2000), high stability (Lundh & Sperling, 2002), and high factorial validity (Rachman et al., 2000) when questionnaire measures are used. Especially the relation between social anxiety and PEP has been explored. In several studies, significantly higher levels of PEP for high compared to low socially anxious individuals have been reported (Edwards et al., 2003; Mellings & Alden, 2000; Rachman et al., 2000). Similar results were found among patients with social phobia (Abbott & Rapee, 2004). Scores for social anxiety and PEP were significantly positively correlated (r=.40r=.40 in Rachman et al., 2000; .45<r<.66.45<r<.66 for different measures of social anxiety in Edwards et al., 2003). Note that Rachman and colleagues instructed their participants to remember “a social situation … during the past few months” (Rachman et al., 2000, p. 613) but did not control whether those recollections were definitely characterized by negative evaluation or rather by other negative emotions in social situations such as guilt or anger. According to Lundh and Sperling (2002), a number of emotions other than evaluative anxiety are prompted by social situations, which could explain the smaller correlations than those found by Edwards et al. (2003). The relation between social anxiety and PEP was found to remain significant even after the effects of depression were controlled for (Edwards et al., 2003; Rachman et al., 2000). Thus, PEP after social situations can be differentiated from depressive ruminative thinking. In three studies, the course of post-event processes has been investigated with a quasi-experimental longitudinal design. Mellings and Alden (2000) assessed ruminative thinking directly after an interaction situation as well as 1 day later. Higher levels of PEP were significantly associated with a better recall of negative self-related information and a stronger negative bias in self-judgments. Note, however, that the significant relation disappeared when the bias score for the first date (the day of the interaction) was entered as a control variable. This indicates that these variables and the associations among them were merely a consequence of social phobic bias. Lundh and Sperling (2002) asked 62 students to monitor situations eliciting social anxiety over a 1-week period in a diary. They found even higher associations between PEP scores and social anxiety (r=.56r=.56 at the day of the distressing event, r=.38r=.38 for the next day), although this significant association emerged only for situations of a negative-evaluational character but not for social situations followed by feelings of guilt or anger. Edwards et al. (2003) selected high and low socially anxious students on the basis of a prior screening, and participants had to deliver an impromptu speech. One week later, the frequencies of negative as well as positive thoughts about the speech were assessed. High socially anxious individuals had significantly higher levels of negative thoughts about the situation but did not differ from low socially anxious individuals with regard to positive thoughts. However, negative evaluation was not assessed directly after the speech. Consequently, whether participants gained a more negative attitude towards their performance during that week or only maintained their negative attitude remains unclear. In the only clinical study, patients with social phobia were invited to deliver an impromptu speech, and, among other variables, the level of post-event rumination 1 week later was assessed (Abbott & Rapee, 2004). PEP was significantly related to a more negative rating of the performance during the speech. When possible predictors for negative PEP were examined with a regression analysis, social anxiety and the self-rated speech performance emerged as significant predictors, whereas age, gender, and depression did not explain significant portions of variance. After a cognitive-behavioral treatment (mean pre-post interval: 12 weeks), participants showed significant reductions in their degree of negative post-event ruminations, although the patients’ scores were still higher than those of non-patient samples. Summarizing, Rachman et al.'s (2000) question whether PEP occurs can clearly be answered positively and can be supported by empirical data. There is also strong evidence that higher levels of social anxiety are associated with higher levels of PEP. The latter is associated with stronger judgmental biases against a socially threatening situation, but the causal relation of these processes is unclear. Furthermore, PEP can be significantly reduced by a cognitive-behavioral therapy. But, apart from the functional role within Clark and Wells’ model, it remains unclear to what extent the psychopathological processes are exclusive for social anxiety: the specificity of the process has still to be established. Are other anxiety-provoking situations followed by similar cognitive processes, or is PEP specifically linked to social situations? Do highly anxious persons fearing situations other than social ones experience comparable processes? Which factors determine the degree of negative PEP after social and other situations? These questions were addressed in the present study. To examine specificity, a comparable but non-social situation had to be identified in which PEP seemed also plausible and which shared at least some important features with social situations. This was the major aim of a pilot study, whereas specificity was directly addressed in the main study.