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It hurts but I still need it: a qualitative investigation of post-event processing in social anxiety disorder

  • Naoki Yoshinaga (a1), Kota Takaoka (a2) and Osamu Kobori (a3)

Abstract

Background:

It has been proposed that both positive and negative metacognitive beliefs sustain engagement in post-event processing (PEP). However, it is unknown: (1) whether individuals with social anxiety disorder (SAD) actually derive the benefits from PEP that they expect; (2) if this is not the case, how their positive beliefs are maintained; and (3) if they are aware of the counterproductive effects of PEP, why they still perform PEP.

Aims:

To explore the phenomenology of the processes involved in PEP from the perspective of SADs, in order to address the research questions above.

Method:

Twenty-one participants suffering from SAD received individual semi-structured interviews. Transcripts were analysed using thematic analysis.

Results:

Analysis revealed three main themes: (1) ‘Only, safe and useful way to improve myself’: SADs feel the need to improve their social performance, and they believe that PEP is the only, safe, and private way to do so, which is an underlying motive for them to do PEP; (2) ‘It hurts more than helps me’: however, through PEP, they do not seem to obtain the benefit that they expect, or only find a variety of counterproductive outcomes; (3) ‘Better safe than sorry’: they sometimes find makeshift solutions to improve their social performance during PEP, which may maintain their PEP as a form of intermittent reinforcement. They weigh up such costs and benefits, and choose to perform PEP while feeling conflicted about PEP.

Conclusions:

The results suggest that: (1) SADs rarely obtain the benefits from PEP that they expect; (2) their positive metacognitive beliefs are maintained by solutions they sometimes find during PEP; and (3) SADs choose to perform PEP while feeling conflicted; while PEP ironically maintains and exacerbates negative self-beliefs/images, it is the only safe and useful way to improve their social performance. These findings support and expand on the theories of PEP.

Copyright

Corresponding author

*Corresponding author. Email: naoki-y@med.miyazaki-u.ac.jp

Footnotes

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§

The current affiliation of O. Kobori is Department of Psychology, International University of Health and Welfare, 4-1-26 Akasaka, Minato-ku, Tokyo 107-8402, Japan.

Footnotes

References

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Brozovich, F., & Heimberg, R. G. (2008). An analysis of post-event processing in social anxiety disorder. Clinical Psychology Review, 28, 891903. 10.1016/j.cpr.2008.01.002.
Clark, D. M., & Wells, A. (1995). A cognitive model of social phobia. In Heimberg, R. G. L., Michael, R., Hope, D. A. and Schneier, F. R. (eds), Social Phobia: Diagnosis, Assessment, and Treatment (pp. 6993). New York, USA: Guilford Press.
Halldorsson, B., & Salkovskis, P. M. (2017). Why do people with OCD and health anxiety seek reassurance excessively? An investigation of differences and similarities in function. Cognitive Therapy and Research, 41, 619631. 10.1007/s10608-016-9826-5.
Matthews, G., & Wells, A. (2004). Rumination, depression, and metacognition: the S-REF model. In Rumination: Nature, Theory and Treatment, 125151. Chichester, UK: Wiley.
Wells, A. (2007). Cognition about cognition: metacognitive therapy and change in generalized anxiety disorder and social phobia. Cognitive and Behavioral Practice, 14, 1825. https://doi.org/10.1016/j.cbpra.2006.01.005.
Wong, Q. J. J., & Moulds, M. L. (2010). Do socially anxious individuals hold positive metacognitive beliefs about rumination? Behaviour Change, 27, 6983. 10.1375/bech.27.2.69.

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It hurts but I still need it: a qualitative investigation of post-event processing in social anxiety disorder

  • Naoki Yoshinaga (a1), Kota Takaoka (a2) and Osamu Kobori (a3)

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It hurts but I still need it: a qualitative investigation of post-event processing in social anxiety disorder

  • Naoki Yoshinaga (a1), Kota Takaoka (a2) and Osamu Kobori (a3)
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