To avoid or not to avoid: impact of self-compassion on safety behaviors in social situations.

BACKGROUND/OBJECTIVES: Safety behaviors are commonly used to decrease anxiety in social settings but maintain anxiety. Self-compassion has been shown to reduce anxiety and rumination, but the impact on safety behaviors has not been examined. For the present studies, it was hypothesized that inducing self-compassion would lead to lower safety behaviors compared to controls. METHODS: In Study 1 (N = 390), participants with elevated social anxiety recalled a distressing social situation, were randomly assigned to a self-compassionate (n = 186) or control (n = 204) writing exercise, and then reported predicted self-compassion and safety behaviors for a future situation. In Study 2 (N = 114), the impact of self-compassionate (n = 56) or control writing (n = 58) on safety behaviors was investigated during a Zoom interaction. RESULTS/CONCLUSIONS: In Study 1, as hypothesized, the self-compassion condition reported fewer expected avoidance behaviors compared to controls. In Study 2, state self-compassion and safety behaviors did not differ between conditions. In both studies, distress significantly mediated the relationship between condition and safety behaviors, such that the self-compassion condition reported significantly lower distress, which was associated with lower safety behaviors. Future research can examine whether reduced distress and safety behaviors allow for greater social connection.

Baseline Severity as a Moderator of the Waiting List-Controlled Association of Cognitive Behavioral Therapy With Symptom Change in Social Anxiety Disorder: A Systematic Review and Individual Patient Data Meta-analysis.

Importance: Social anxiety disorder (SAD) can be adequately treated with cognitive behavioral therapy (CBT). However, there is a large gap in knowledge on factors associated with prognosis, and it is unclear whether symptom severity predicts response to CBT for SAD. Objective: To examine baseline SAD symptom severity as a moderator of the association between CBT and symptom change in patients with SAD. Data Sources: For this systematic review and individual patient data meta-analysis (IPDMA), PubMed, PsycInfo, Embase, and the Cochrane Library were searched from January 1, 1990, to January 13, 2023. Primary search topics were social anxiety disorder, cognitive behavior therapy, and randomized controlled trial. Study Selection: Inclusion criteria were randomized clinical trials comparing CBT with being on a waiting list and using the Liebowitz Social Anxiety Scale (LSAS) in adults with a primary clinical diagnosis of SAD. Data Extraction and Synthesis: Authors of included studies were approached to provide individual-level data. Data were extracted by pairs of authors following the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline, and risk of bias was assessed using the Cochrane tool. An IPDMA was conducted using a 2-stage approach for the association of CBT with change in LSAS scores from baseline to posttreatment and for the interaction effect of baseline LSAS score by condition using random-effects models. Main Outcomes and Measures: The main outcome was the baseline to posttreatment change in symptom severity measured by the LSAS. Results: A total of 12 studies including 1246 patients with SAD (mean [SD] age, 35.3 [10.9] years; 738 [59.2%] female) were included in the meta-analysis. A waiting list-controlled association between CBT and pretreatment to posttreatment LSAS change was found (b = -20.3; 95% CI, -24.9 to -15.6; P < .001; Cohen d = -0.95; 95% CI, -1.16 to -0.73). Baseline LSAS scores moderated the differences between CBT and waiting list with respect to pretreatment to posttreatment symptom reductions (b = -0.22; 95% CI, -0.39 to -0.06; P = .009), indicating that individuals with severe symptoms had larger waiting list-controlled symptom reductions after CBT (Cohen d = -1.13 [95% CI, -1.39 to -0.88] for patients with very severe SAD; Cohen d = -0.54 [95% CI, -0.80 to -0.29] for patients with mild SAD). Conclusions and Relevance: In this systematic review and IPDMA, higher baseline SAD symptom severity was associated with greater (absolute but not relative) symptom reductions after CBT in patients with SAD. The findings contribute to personalized care by suggesting that clinicians can confidently offer CBT to individuals with severe SAD symptoms.

What is the evidence in evidence-based mindfulness programs for children?

The prevalence of "mindfulness" in popular media, academia, and professional circles is difficult to miss. Newspapers, magazines, online articles, clinical programs, podcasts, scholarly and professional meetings, sports organizations, and many other outlets focus on the benefits of mindfulness. Despite the intense focus on mindfulness in Western society, it is astonishing that the evidence base (i.e., documented, scholarly, peer-reviewed evaluations) for these programs is woefully inadequate. Varying definitions of what mindfulness is, what it entails, what specific benefits to psychological functioning are observed (if any), and inadequate scientific testing all contribute to a lean knowledge base. Evaluation of potential benefits of mindful practice with children is even more difficult because children are a more heterogeneous group than adults; the differing developmental levels are likely to have profound effects on the efficacy of mindfulness-based programming with children. We review these issues and provide an explanation of the strength of different kinds of evidence, with suggestions for (a) researchers who study mindfulness with children and (b) clinical professionals and educators interested in developing mindful attitudes and techniques with children.

Self-Help for Social Anxiety: Randomized Controlled Trial Comparing a Mindfulness and Acceptance-Based Approach With a Control Group.

There are many barriers to the delivery of evidence-based treatment, including geographical location, cost, and stigma. Self-help may address some of these factors but there is a paucity of research on the efficacy of self-help for many problems, including social anxiety. The present research evaluated the efficacy of a mindfulness and acceptance-based self-help approach for the treatment of social anxiety. Individuals seeking help for social anxiety or shyness were recruited from the community. Participants (N = 117) were randomly assigned to a book (n = 58) or wait-list control condition (n = 59) on a 1:1 ratio. Hierarchical linear modelling results supported the efficacy of the self-help condition with between-group effect sizes on social anxiety outcomes ranging from .74 to .79. Significant change was also observed on self-compassion, mindfulness, acceptance, and depression. Some variables, including social anxiety and acceptance, were assessed weekly for those in the book condition. Additional participants (n = 35) were recruited for the book condition increasing the sample size to 93 for the latent change score modelling analyses. A unidirectional model was supported: increases in acceptance were associated with subsequent decreases in social anxiety. Overall these results support the use of a mindfulness and acceptance-based self-help approach for social anxiety.

Confirmatory factor analysis of the post-event processing inventory in a community sample seeking self-help for social anxiety.

BACKGROUND: Post-event processing (PEP) refers to negative rumination following anxiety-inducing social situations. The Post-Event Processing Inventory (PEPI; Blackie & Kocovski, 2017, Development and validation of the trait and state versions of the post-event processing inventory. Anxiety, Stress, & Coping, 30, 202-218.) consists of both trait and state forms. Although the psychometric properties of the PEPI have been very good in past research, the factor structure of the scale was examined with student samples only. OBJECTIVES: The primary purpose of the present study was to confirm the factor structure of the PEPI with a sample of individuals seeking self-help for social anxiety and shyness. DESIGN AND METHOD: Individuals interested in receiving self-help (N = 155) completed a battery of questionnaires, including the trait and state forms of the PEPI. RESULTS: On each version of the scale, we confirmed that a second-order factor (global PEP) could be inferred from three first-order factors (frequency, intensity, and self-judgment). CONCLUSIONS: The hierarchical factor structure of the PEPI in the present study is consistent with previous research. The findings from the present study illustrate the utility of the PEPI amongst a community sample of individuals seeking self-help for social anxiety.

Mindfulness-based cognitive therapy in patients with depression: current perspectives.

Mindfulness-based cognitive therapy (MBCT) was developed to prevent relapse in individuals with depressive disorders. This widely used intervention has garnered considerable attention and a comprehensive review of current trends is warranted. As such, this review provides an overview of efficacy, mechanisms of action, and concludes with a discussion of dissemination. Results provided strong support for the efficacy of MBCT despite some methodological shortcomings in the reviewed literature. With respect to mechanisms of action, specific elements, such as mindfulness, repetitive negative thinking, self-compassion and affect, and cognitive reactivity have emerged as important mechanisms of change. Finally, despite a lack of widespread MBCT availability outside urban areas, research has shown that self-help variations are promising. Combined with findings that teacher competence may not be a significant predictor of treatment outcome, there are important implications for dissemination. Taken together, this review shows that while MBCT is an effective treatment for depression, continued research in the areas of efficacy, mechanisms of action, and dissemination are recommended.

Examining the Relationships Among Self-Compassion, Social Anxiety, and Post-Event Processing.

Post-event processing refers to negative and repetitive thinking following anxiety provoking social situations. Those who engage in post-event processing may lack self-compassion in relation to social situations. As such, the primary aim of this research was to evaluate whether those high in self-compassion are less likely to engage in post-event processing and the specific self-compassion domains that may be most protective. In study 1 ( N = 156 undergraduate students) and study 2 ( N = 150 individuals seeking help for social anxiety and shyness), participants completed a battery of questionnaires, recalled a social situation, and then rated state post-event processing. Self-compassion negatively correlated with post-event processing, with some differences depending on situation type. Even after controlling for self-esteem, self-compassion remained significantly correlated with state post-event processing. Given these findings, self-compassion may serve as a buffer against post-event processing. Future studies should experimentally examine whether increasing self-compassion leads to reduced post-event processing.

Development and validation of the trait and state versions of the Post-Event Processing Inventory.

BACKGROUND: Post-event processing (PEP) refers to negative and prolonged rumination following anxiety-provoking social situations. Although there are scales to assess PEP, they are situation-specific, some targeting only public-speaking situations. Furthermore, there are no trait measures to assess the tendency to engage in PEP. OBJECTIVES: The purpose of this research was to create a new measure of PEP, the Post-Event Processing Inventory (PEPI), which can be employed following all types of social situations and includes both trait and state forms. DESIGN AND METHOD: Over two studies (study 1, N = 220; study 2, N = 199), we explored and confirmed the factor structure of the scale with student samples. RESULTS: For each form of the scale, we found and confirmed that a higher-order, general PEP factor could be inferred from three sub-domains (intensity, frequency, and self-judgment). We also found preliminary evidence for the convergent, concurrent, discriminant/divergent, incremental, and predictive validity for each version of the scale. Both forms of the scale demonstrated excellent internal consistency and the trait form had excellent two-week test-retest reliability. CONCLUSION: Given the utility and versatility of the scale, the PEPI may provide a useful alternative to existing measures of PEP and rumination.

Self-focused attention and safety behaviors across group therapies for social anxiety disorder.

BACKGROUND: Self-focused attention (SFA) and safety behaviors are two variables implicated in the maintenance of social anxiety disorder (SAD). DESIGN: The present study examined SFA and safety behaviors across two therapies for SAD, cognitive behavioral group therapy (CBGT) and mindfulness and acceptance-based group therapy (MAGT). METHOD: Participants with symptoms meeting criteria for SAD (N = 137) were randomly assigned to the 12-week-treatment groups (n = 53 for each condition) or a waitlist control (n = 31). Variables were assessed at baseline, midtreatment, posttreatment, and a 3-month follow-up. RESULTS: Both treatment conditions reported significantly lower SFA and safety behaviors compared to control, but did not differ from one another at posttreatment. Mediation analyses supported the following models: (1) safety behaviors mediating the relationship between SFA and social anxiety, and (2) SFA mediating the relationship between safety behaviors and social anxiety. These models were supported for both treatment groups. CONCLUSIONS: Both treatments may have the potential to reduce the SFA and safety behaviors that serve to maintain SAD.

Mindfulness-based cognitive therapy for depression: trends and developments.

Mindfulness-based cognitive therapy (MBCT) was developed as a psychological intervention for individuals at risk of depressive relapse. Possible mechanisms of change for this intervention are in line with its theoretical underpinnings, and include increases in mindfulness and/or decreases in negative repetitive thoughts. This review provides an overview of current trends in MBCT research, including efficacy and questions regarding the specific effects of MBCT in light of recent comparisons with structurally equivalent control conditions, mechanisms of change, and moderators of treatment outcome. In addition, future directions are discussed, such as challenges with training an adequate number of therapists and disseminating this therapy.

Letting go of yesterday: Effect of distraction on post-event processing and anticipatory anxiety in a socially anxious sample.

According to cognitive models, post-event processing (PEP) is a key factor in the maintenance of social anxiety. Given that decreasing PEP can be challenging for socially anxious individuals, it is important to identify potentially useful strategies. Although distraction may help to decrease PEP, the findings have been equivocal. The primary purpose of this study was to examine whether a brief distraction period immediately following a speech would lead to less PEP the next day. The secondary aim was to examine the effect of distraction following an initial speech on anticipatory anxiety for a second speech, via reductions in PEP. Participants (N = 77 undergraduates with elevated social anxiety; 67.53% female) delivered a speech and were randomly assigned to a distraction, rumination, or control condition. The following day, participants reported levels of PEP in relation to the first speech, as well as anxiety regarding a second, upcoming speech. As expected, those in the distraction condition reported less PEP than those in the rumination and control conditions. Additionally, distraction following the first speech was indirectly related to anticipatory anxiety for the second speech, via PEP. Distraction may represent a potentially useful strategy for reducing PEP and other maladaptive processes that may maintain social anxiety.

Social anxiety and its psychosocial impact on the lives of people with epilepsy.

Little is known about social anxiety among people with epilepsy (PWE), although PWE are more likely to be diagnosed with social anxiety disorder than the general population. The purpose of this study was to determine which psychosocial and seizure-related variables are associated with social anxiety. It was hypothesized that social anxiety would be positively correlated with perceived seizure severity, stigma, impact of epilepsy, fear of negative evaluation, and experiential avoidance. Further, social anxiety would be negatively correlated with epilepsy knowledge and disclosure of epilepsy. Finally, if a seizure occurred in public and others were unaware of the epilepsy, participants would report greater judgment, anxiety, and rumination compared with those in a situation where others were aware of the epilepsy. A total of 101 individuals with epilepsy participated in this online study. Social anxiety was found to correlate with both psychosocial and seizure-related variables in the expected directions. Further, social anxiety predicted significant variance in stigma and disclosure beyond known predictors of stigma. Participants in both conditions (disclosed diagnosis of epilepsy versus undisclosed diagnosis of epilepsy) were equally distressed by having a seizure in public. These findings provide an initial basis for discerning how to best assess and support PWE with social anxiety.

Mindfulness and acceptance-based group therapy and traditional cognitive behavioral group therapy for social anxiety disorder: Mechanisms of change.

The present study investigated mechanisms of change for two group treatments for social anxiety disorder (SAD): cognitive behavioral group therapy (CBGT) and mindfulness and acceptance-based group therapy (MAGT). Participants were treatment completers (n = 37 for MAGT, n = 32 for CBGT) from a randomized clinical trial. Cognitive reappraisal was the hypothesized mechanism of change for CBGT. Mindfulness and acceptance were hypothesized mechanisms of change for MAGT. Latent difference score (LDS) analysis results demonstrate that cognitive reappraisal coupling (in which cognitive reappraisal is negatively associated with the subsequent rate of change in social anxiety) had a greater impact on social anxiety for CBGT than MAGT. The LDS bidirectional mindfulness model (mindfulness predicts subsequent change in social anxiety; social anxiety predicts subsequent change in mindfulness) was supported for both treatments. Results for acceptance were less clear. Cognitive reappraisal may be a more important mechanism of change for CBGT than MAGT, whereas mindfulness may be an important mechanism of change for both treatments.

Mindfulness and acceptance-based group therapy versus traditional cognitive behavioral group therapy for social anxiety disorder: a randomized controlled trial.

UNLABELLED: Recent research has supported the use of mindfulness and acceptance-based interventions for Social Anxiety Disorder (SAD). OBJECTIVE: The purpose of the present study was to compare mindfulness and acceptance-based group therapy (MAGT) with cognitive behavioral group therapy (CBGT) with respect to outcome. It was hypothesized that MAGT and CBGT would both be superior to a control group but not significantly different from one another. METHOD: Individuals (N = 137, mean age = 34 years, 54% female, 62% White, 20% Asian) diagnosed with SAD were randomly assigned to MAGT (n = 53), CBGT (n = 53) or a waitlist control group (n = 31). The primary outcome was social anxiety symptom severity assessed at baseline, treatment midpoint, treatment completion, and 3-month follow-up. Secondary outcomes were cognitive reappraisal, mindfulness, acceptance, and rumination. Depression, valued living, and group cohesion were also assessed. RESULTS: As hypothesized, MAGT and CBGT were both more effective than the control group but not significantly different from one another on social anxiety reduction and most other variables assessed. CONCLUSIONS: The present research provides additional support for the use of mindfulness and acceptance-based treatments for SAD, and future research should examine the processes by which these treatments lead to change.

Effect of self-focused attention on post-event processing in social anxiety.

The study investigated the relationship between self-focused attention (SFA) and post-event processing (PEP) in social anxiety. SFA is the process of directing attention to internal stimuli during a social interaction. PEP is a detailed review of performance following an interaction. Highly socially anxious students (N = 82) were randomly assigned to a high SFA (n = 40) or low SFA condition (n = 42) and completed baseline measures of social anxiety, depression, trait SFA, and trait rumination. After SFA was manipulated via instructions, participants engaged in a 5-min unstructured conversation with a confederate, followed by a manipulation check. PEP was assessed the next day online. The high SFA group reported a similar amount of positive PEP but more frequent negative PEP over the 24-h period compared to the low SFA group. These results provide support for a causal relationship between SFA and PEP and have important applications for the development of effective cognitive-behavioural interventions.

Rumination and distraction periods immediately following a speech task: effect on postevent processing in social anxiety.

The purpose of this study was to investigate social anxiety and the effect of rumination and distraction periods immediately following a speech task on subsequent postevent processing. A secondary aim was to examine the content of postevent rumination. Participants (N = 114 students) completed measures of social anxiety and depression, delivered a 3-minute speech, and were randomly assigned to complete (1) a rumination form about the speech (guided negative rumination condition) or (2) an anagram form (distraction condition). One week later participants completed measures of postevent processing related to the speech task. It was hypothesized that social anxiety would interact with condition in predicting levels of postevent processing. This hypothesis was supported in the prediction of positive thoughts such that at high levels of social anxiety the distraction condition led to more positive thoughts compared with the guided negative rumination condition, whereas at low levels of social anxiety conditions were similar with respect to positive thoughts. Irrespective of condition, both social anxiety and depression predicted greater postevent rumination and negative thoughts 1 week later. With respect to the content of postevent rumination, socially anxious individuals reported being more concerned about some aspects of the presentation (e.g. poor posture), whereas other concerns were equally noted regardless of social anxiety level (e.g. poor content). The present results highlight the potential clinical utility of distracting from social anxiety to allow for greater access to positive thoughts postevent.

Exploring the effect of alcohol on post-event processing specific to a social event.

Inconsistent findings regarding the relationship between social anxiety and alcohol use suggest that further research is needed to explore how alcohol affects various components of social anxiety. Post-event processing, or rumination after social events, is an element of cognitive models of social anxiety that is related to increased levels of social anxiety. The goal of the current study was to explore the interrelationships among social anxiety, post-event processing, and alcohol use. A sample of 208 university students completed online questionnaires to assess their levels of trait social anxiety and trait depression as well as their alcohol consumption at a specific social event. Participants then completed questionnaires to assess levels of post-event processing specific to the social event they attended. Results revealed that the amount of alcohol individuals consumed at the event predicted increased levels of post-event processing above and beyond levels of trait social anxiety and depression. As such, drinking may lead to increased post-event processing in student samples.

Predictors of post-event rumination related to social anxiety.

Post-event processing is the cognitive rumination that follows social events in cognitive models of social anxiety. The aim of this study was to examine factors that may predict the extent to which individuals engage in post-event processing. Anxious rumination, social anxiety, anxiety sensitivity and post-event processing related to a recent anxiety-provoking social event were assessed in a college student sample (n = 439). Social anxiety and anxious rumination, but not anxiety sensitivity, significantly predicted the extent to which the participants engaged in post-event processing related to an anxiety-provoking social event. Factors that appear to impact on the post-event period include the nature of the social situation and the ethnicity of the participant. It appears that both general rumination over anxious symptoms, and specific rumination related to social events are relevant for cognitive models of social anxiety.

Ruminative coping and post-event processing in social anxiety.

Cognitive models of social anxiety implicate various factors in the initiation and maintenance of socially anxious states, including anticipatory processing, self-focused attention and post-event processing. The present study focused on post-event processing, which is a post-mortem analysis following a social event that is described as ruminative in nature and serves to maintain social anxiety. Participants (N=112; 64 women, 48 men) were presented with vignettes that involved making mistakes in public and were instructed to record their thoughts to allow for the examination of the content of post-event processing. Ruminative coping and distraction were assessed via self-report. Results indicated that participants high in social anxiety (n=55) were more likely to ruminate and less likely to distract when faced with socially anxious stressors compared to those low in social anxiety (n=57). Further, as hypothesized, participants high in social anxiety recorded more negative thoughts and more upward counterfactual thoughts ('if only' type thoughts on how things could have been better; associated with negative affect) compared to those low in social anxiety. These results are discussed in terms of cognitive models of social anxiety.

Personality disorders at the crossroads.

Personality disorders are now at a crossroads with respect to theory, research, and conceptualization. In this article, we review relevant and current issues within the personality disorder field. After reviewing changes in the conception of personality disorders across the past half century (1952 to 2002), we focus on the issue of continuity versus discontinuity methodologies for assessing personality, interactionism, treatments, resolved and unresolved issues, and future directions. The issue of continuity versus discontinuity is a theme in this article. We conclude that the evidence is in favor of a reapprochment between a categorical classification system and a dimensional system and we also outline the difficulties in achieving this change.