October 22, 2019

Dear Colleagues,

The National Social Anxiety Center (NSAC) provides information about relevant and current research in service of disseminating and promoting evidence-based treatment. This month’s summary focuses on changes in post event processing and cognitive behavior therapy.

It is always interesting for clinicians to know if the therapeutic strategies used in helping our clients is having a beneficial impact and exactly how these beneficial changes are occurring. Post event processing (PEP) has been identified as an important component in the maintenance of Social Anxiety Disorder (SAD). Research has demonstrated that broad PEP tendencies decrease from pre to post CBT treatment. Less information is available on how CBT influences clients’ abilities to “decenter” immediately following social interactions, reframe their unhelpful thinking, and engage in less momentary PEP.

No naturalistic studies prior to this study has examined the effect of treatment on momentary PEP levels following social interactions. Studying PEP immediately after day-to-day interactions would provide useful information on the effectiveness of CBT-based skills that the client has acquired through therapy. In their study the authors examined both momentary and general PEP change over the course of treatment, and how such changes predict treatment outcome.

Participants (N = 60) with social anxiety disorder were enrolled in group cognitive-behavioral therapy. All participants completed measures of PEP and social anxiety symptom severity at five time points over treatment. A subset (N = 33) also completed repeated experience sampling measurements of PEP following social interactions across the course of treatment. Both general and momentary PEP decreased over the course of treatment. Therefore, treatment appears to have strengthened participants’ ability to refrain from engaging in PEP patterns of thinking following daily social interactions. While treatment led to a significant decrease in PEP, change in PEP in turn significantly predicted post-treatment social anxiety symptom severity when controlling for pre-treatment symptom severity. These findings support CBT models of social anxiety in which PEP is posited to be one of several factors that help maintain the symptom cycle.

The authors suggest that given the relationship between PEP change and treatment outcome, it would be beneficial to incorporate strategies that directly target PEP or strategies that have been developed to challenge other types of ruminative thought patterns as well.

Have you noted any differences between patients in the degree to which post event processing occurs? Did you note any factors that you think could have contributed to these differences?

Katz, D.E., Cassin, S., Weerasinghe, R., Rector, N.A. (2019). Changes in post-event processing during cognitive behavioral therapy for social anxiety disorder: A longitudinal analysis using post-session measurement and experience sampling methodology. Journal of Anxiety Disorders, 66, Article 102107.

Suma Chand PhD
Representative of NSAC St. Louis;
Professor and Director of Cognitive Behavior Therapy Program,
Department of Psychiatry & Behavioral Neurosciences
St Louis University School of Medicine;
Fellow of the Academy of Cognitive Therapy