Why Did I Say That? Assessing, Understanding and Treating Rumination in Social Anxiety Disorder

Abstract

Cognitive models of Social Anxiety Disorder (SAD) consistently identify pre-event and post-event rumination as key processes that maintain and exacerbate symptoms of SAD. However, these processes are not typically targeted in treatment, and several aspects of these processes are yet to be sufficiently understood by the empirical and theoretical literature. Consequently, this thesis aims to improve the way we assess, understand and treat pre-event and post-event rumination in individuals with SAD. A mixed-methods series of four studies are presented to address these aims. Chapter 1 provides a review of the literature on the measurement, maintenance mechanisms, and treatment of pre-event and post-event rumination. Chapter 2 comprises a systematic review and meta-analysis of psychological treatments for pre-event and post-event rumination. Chapter 3 (Empirical Study 1) investigates the psychometric properties of a self-report tool designed to measure pre-event and post-event rumination. Chapter 4 (Empirical Study 2) examines qualitative aspects of the content, characteristics, perceived function, impact of, and responses to, pre-event and post-event rumination, via thematic analysis of semi-structured interviews. Chapter 5 (Empirical Study 3) evaluates the effectiveness of a brief metacognitive therapy (MCT) intervention that aims to reduce pre-event and post-event rumination in individuals with SAD by targeting specific metacognitive beliefs proposed to maintain engagement in these processes. Chapter 6 synthesises the findings and discusses the theoretical and clinical implications of the thesis, and proposes directions for future research. Overall, this thesis extends upon past research informing the assessment of pre-event and post-event rumination, furthers our understanding of how pre-event and post-event rumination are maintained in individuals with SAD, and contributes new insights into how these processes may be best targeted in evidence-based treatment.