Modelling the relationship between changes in social anxiety and rumination before and after treatment

Pre- and post-event rumination have been proposed to be key processes involved in the maintenance of social anxiety disorder. While the importance of addressing rumination in treatment is becoming increasingly clear, factors that mediate the relationship between changes in social anxiety and changes in rumination have yet to be investigated. Individuals with social anxiety disorder (N = 82) completed measures that assessed key cognitive and attentional processes of social anxiety, including pre- and post-event rumination, before and after cognitive behavioural treatment. Following treatment there were significant reductions in pre- and post-event rumination in addition to other cognitive and attentional aspects of social anxiety. Mediation analyses revealed that changes in state anxiety and performance and threat appraisals mediated the relationship between changes in social anxiety and pre-event rumination, while only changes in threat appraisals mediated the relationship between changes in social anxiety and post-event rumination. It appears that key cognitive and attentional processes have differing importance when anticipating feared social situations and when reflecting on it afterwards. This suggests that treatment that aims to reduce the role of pre-event rumination needs to consider multiple factors, while threat appraisals particularly need to be addressed when addressing post-event rumination.