February 20, 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 for social anxiety. This month’s update focuses on the role of rumination in social anxiety.

This recent study (Modini et al., 2018) is very useful study for clinicians who are constantly fine tuning application of CBT strategies to improve outcome when treating social anxiety disorder (SAD).

Pre-event and post event rumination has been identified as a key factor that operates to maintain the vicious cycle of social anxiety. The authors in this study have focused on identifying the cognitive and attentional processes that mediate the relationship between social anxiety and pre-event rumination as well as social anxiety and post-event rumination in two different SAD clinical samples of 239 and 216 respectively.

The results of the study were broadly consistent with cognitive models of SAD where several interrelated processes have been posited to mediate the relationship between social anxiety and pre-and post-event rumination. The results indicate that negative self-focused attention directly mediates the relationship between social anxiety and post-event rumination, while anticipated biased performance appraisals directly mediate the relationship between social anxiety and pre-event rumination. Threat appraisals that are woven into pre- and post-event ruminations were also noted to play an imperative role in mediating the relationship between SAD and negative ruminations both prior to the social event and also after the event.

The results of the study suggest that it would be helpful for clinicians to keep in mind these aspects in the process of conceptualizing cases of SAD and most importantly targeting them during treatment so that the negative role of rumination in maintaining social anxiety is mitigated. The authors make a case for clinicians ‘enhancing’ traditional CBT to ensure that processes that play a role in maintaining SAD are effectively addressed.

What interventions do you utilize specifically for pre- and/or post-event rumination?

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. doi:10.1016/j.brat.2018.01.009

Suma Chand, PhD
Clinical Psychologist

Representative of NSAC – St. Louis
(Cognitive Behavior Therapy Program of SLUCare Adult Psychiatry Services)