Changes in post-event processing and metacognitions during cognitive behavioral group therapy for social phobia Peter M. McEvoy a,c, *, Alison Mahoney b , Sarah J. Perini b , Patrick Kingsep c a Clinical Research Unit for Anxiety and Depression, St Vincent’s Hospital, School of Psychiatry, University of New South Wales, 299 Forbes Street, Darlinghurst, Sydney, 2010, Australia b Clinical Research Unit for Anxiety and Depression, St Vincent’s Hospital, 299 Forbes Street, Darlinghurst, Sydney, 2010, Australia c Centre for Clinical Interventions, 223 James Street, Northbridge, Perth, WA, 6003, Australia 1. Introduction Social phobia is characterized by persistent fears of negative evaluation in social interactions and performance situations (American Psychiatric Association, 2000). Contemporary cognitive models argue that post-event processing (PEP) significantly con- tributes to the maintenance of social phobia (Clark & Wells, 1995; Rapee & Heimberg, 1997). PEP occurs when people with social phobia engage in a detailed review or ‘‘post-mortem’’ of their thoughts, feelings, and performance following social situations. This information is often highly negative because attentional biases lead people with social phobia to focus on internal sensations and thoughts that reinforce negative self-appraisals, and distort or neglect external information in a way that further reinforces negative self-perceptions. PEP may also involve recollections of past failures and promote anticipation of future failures, thereby increasing anxiety and further entrenching beliefs about inade- quacy. This paper attempts to further explore the nature of PEP and the potential mechanisms that underlie it. Studies exploring the nature and consequences of PEP support cognitive models (Clark & Wells, 1995; Rapee & Heimberg, 1997). Research demonstrates that PEP is positively correlated with social anxiety and leads to avoidance of similar social interactions (Edwards, Rapee, & Franklin, 2003; Lundh & Sperling, 2002; Mellings & Alden, 2000; Rachman, Gruter-Andrew, & Shafran, 2000). Regarding the content of PEP, Kocovski, Endler, Rector, and Flett (2005) found that socially anxious students engaged in more negative thoughts and more ‘upward counterfactual’ thinking (‘if only’ thoughts about how things could have been) during PEP compared to low-anxiety students. Furthermore, other studies of socially anxious students have found that PEP leads to greater recall of negative self-relevant information (Mellings & Alden), as well as increasing negative memories about past social failures (Field & Morgan, 2004). However, not all studies find recall biases (Edwards et al., 2003), and research regarding PEP in clinical populations is limited. Research has also examined predictors of PEP. In a study comparing people with social phobia to nonanxious controls, Abbott and Rapee (2004) found that engagement in PEP was best predicted by social anxiety symptoms and self-appraisals of performance following an impromptu speech task. Interestingly, Perini, Abbot, and Rapee (2006) found that negative self-appraisals during an impromptu speech mediated the relationship between social anxiety and PEP. In student samples, Fehm, Schneider, and Hoyer (2007) reported that the degree of PEP after an anxiety- provoking situation predicted subsequent PEP in similar social situations. Fehm et al. also reported that fear of negative evaluation Journal of Anxiety Disorders 23 (2009) 617–623 ARTICLE INFO Article history: Received 28 May 2008 Received in revised form 20 January 2009 Accepted 20 January 2009 Keywords: Social phobia Post-event processing Metacognition Anxiety Depression Rumination Cognitive behavior therapy ABSTRACT This study examined changes in post-event processing (PEP), metacognitions, and symptoms of social anxiety and depression following cognitive behavioral group therapy for social phobia (N = 61). Social anxiety, depression symptoms and PEP all significantly reduced following treatment. Reductions in PEP were associated with reductions in symptoms of social anxiety, but not depression. Metacognitions were also less strongly endorsed following treatment, with the exception of positive metacognitions. Interestingly, however, changes in metacognitions were generally associated with reductions in depression and not social anxiety. Theoretical and clinical implications as well as future research directions are discussed. ß 2009 Elsevier Ltd. All rights reserved. * Corresponding author at: Centre for Clinical Interventions, 223 James Street, Northbridge, WA, 6003, Australia. Tel.: +61 8 9227 4399; fax: +61 8 9328 5911. E-mail address: peter.mcevoy@health.wa.gov.au (P.M. McEvoy). Contents lists available at ScienceDirect Journal of Anxiety Disorders 0887-6185/$ – see front matter ß 2009 Elsevier Ltd. All rights reserved. doi:10.1016/j.janxdis.2009.01.011