Journal of Abnormal Child Psychology

, Volume 47, Issue 12, pp 1945–1956 | Cite as

Effects of Group-Based CBT on Post-Event Processing in Children with Social Anxiety Disorder Following an Experimental Social Stressor

  • Julia AsbrandEmail author
  • Julian Schmitz
  • Martina Krämer
  • Kai Nitschke
  • Nina Heinrichs
  • Brunna Tuschen-Caffier


Theoretical models and previous research suggest that post-event processing (PEP) after social situations maintains social anxiety disorder (SAD). To date, little is known about PEP in childhood, a critical period for disorder development, or about possible positive effects of cognitive behavioral therapy (CBT) on PEP in children. Children with SAD (n = 71; aged 9–13 years) and healthy controls (n = 55) participated in a social stress task (Trier Social Stress Test for Children, TSST-C), which was repeated in children with SAD after either 12 sessions of CBT or a waiting period. PEP was assessed daily with regard to both valence and frequency, as well as in more detail regarding specific negative and positive ruminative thoughts 1 week after each TSST-C. Daily PEP after the TSST-C was more frequent and more negative in children with SAD compared to healthy controls, in particular during the first 2 days after the TSST-C. After CBT treatment, children with SAD reported more positive PEP but not less negative PEP compared to children in the waitlist control group. The current study suggests that negative PEP in children with SAD is most pronounced in the first days following social stress. Group-based CBT seems to be effective in building up positive cognitions after social stress in children, but developing specific interventions targeting negative PEP immediately after a social stressor may be necessary to further increase treatment efficacy.


Rumination Social phobia Child Treatment 



cognitive behavioral therapy


Child Depression Inventory


Daily Thoughts Questionnaire for Children


healthy control


post-event processing


social anxiety disorder


Social Phobia and Anxiety Inventory for Children


Thoughts Questionnaire for Children


waitlist control


Trier Social Stress Test for Children



This research was supported by a grant from the DFG given to the last authors (HE 3342/4–2, TU 78/5–2).

Compliance with Ethical Standards

Conflict of Interest

The authors declare no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. An independent ethics committee (ethic committee of the German Society for Psychology [DGPs]) granted ethical approval for this study (registration code: Tuschen-Heinrichs 11_2010, approval issued 28/11/2010).

Informed Consent

Informed consent was obtained from all individual participants (both parents and children) included in the study in written form.

Supplementary material

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ESM 1 (DOC 63 kb)
10802_2019_558_MOESM2_ESM.doc (39 kb)
ESM 2 (DOC 39 kb)
10802_2019_558_MOESM3_ESM.docx (26 kb)
ESM 3 (DOCX 25 kb)


  1. Abbott, M. J., & Rapee, R. M. (2004). Post-event rumination and negative self-appraisal in social phobia before and after treatment. Journal of Abnormal Child Psychology, 113(1), 136–144. Scholar
  2. Alfano, C. A., Beidel, D. C., & Turner, S. M. (2002). Cognition in childhood anxiety: Conceptual, methodological, and developmental issues. Clinical Psychology Review, 22(8), 1209–1238.CrossRefGoogle Scholar
  3. Alfano, C. A., Beidel, D. C., & Turner, S. M. (2006). Cognitive correlates of social phobia among children and adolescents. Journal of Abnormal Child Psychology, 34(2), 182–194.CrossRefGoogle Scholar
  4. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.CrossRefGoogle Scholar
  5. Bates, D., Mächler, M., Bolker, B., & Walker, S. (2014). Fitting linear mixed-effects models using lme4. arXiv preprint arXiv:1406.5823.Google Scholar
  6. Beesdo, K., Knappe, S., & Pine, D. S. (2009). Anxiety and anxiety disorders in children and adolescents: Developmental issues and implications for DSM-V. Psychiatric Clinics, 32(3), 483–524.PubMedGoogle Scholar
  7. Beidel, D. C. (1991). Social phobia and overanxious disorder in school-age children. Journal of the American Academy of Child & Adolescent Psychiatry, 30(4), 545–552.CrossRefGoogle Scholar
  8. Beidel, D. C., Turner, S. M., Hamlin, K., & Morris, T. L. (2001). The social phobia and anxiety inventory for children (SPAI-C): External and discriminative validity. Behavior Therapy, 31(1), 75–87.CrossRefGoogle Scholar
  9. Bernstein, G. A., & Garfinkel, B. D. (1992). The visual analogue scale for anxiety—Revised: Psychometric properties. Journal of Anxiety Disorders, 6(3), 223–239.CrossRefGoogle Scholar
  10. Blackie, R. A., & Kocovski, N. L. (2016). Letting go of yesterday: Effect of distraction on post-event processing and anticipatory anxiety in a socially anxious sample. Cognitive Behaviour Therapy, 45(1), 60–72.CrossRefGoogle Scholar
  11. Bögels, S. M., & Zigterman, D. (2000). Dysfunctional cognitions in children with social phobia, separation anxiety disorder, and generalized anxiety disorder. Journal of Abnormal Child Psychology, 28(2), 205–211.CrossRefGoogle Scholar
  12. Bringuier, S., Dadure, C., Raux, O., Dubois, A., Picot, M. C., & Capdevila, X. (2009). The perioperative validity of the visual analog anxiety scale in children: A discriminant and useful instrument in routine clinical practice to optimize postoperative pain management. Anesthesia & Analgesia, 109(3), 737–744.CrossRefGoogle Scholar
  13. Brozovich, F., & Heimberg, R. G. (2008). An analysis of post-event processing in social anxiety disorder. Clinical Psychology Review, 28(6), 891–903. Scholar
  14. Burstein, M., He, J. P., Kattan, G., Albano, A. M., Avenevoli, S., & Merikangas, K. R. (2011). Social phobia and subtypes in the National Comorbidity Survey-Adolescent Supplement: Prevalence, correlates, and comorbidity. Journal of the American Academy of Child and Adolescent Psychiatry, 50(9), 870–880. Scholar
  15. Buske-Kirschbaum, A., Jobst, S., Wustmans, A., Kirschbaum, C., Rauh, W., & Hellhammer, D. (1997). Attenuated free cortisol response to psychosocial stress in children with atopic dermatitis. Psychosomatic Medicine, 59(4), 419–426.CrossRefGoogle Scholar
  16. Cartwright-Hatton, S., Tschernitz, N., & Gomersall, H. (2005). Social anxiety in children: Social skills deficit, or cognitive distortion? Behaviour Research and Therapy, 43(1), 131–141.CrossRefGoogle Scholar
  17. Clark, D. M., & McManus, F. (2002). Information processing in social phobia. Biological Psychiatry, 51(1), 92–100.CrossRefGoogle Scholar
  18. Clark, D. M., & Wells, A. (1995). A cognitive model of social phobia). In R. G. Heimberg, M. Liebowitz, D. Hope, & F. Scheier (Eds.), Social phobia: Diagnosis, assessment, and treatment (pp. 69–93). New York: Guilford Press.Google Scholar
  19. Dannahy, L., & Stopa, L. (2007). Post-event processing in social anxiety. Behaviour Research and Therapy, 45(6), 1207–1219. Scholar
  20. Edwards, S. L., Rapee, R. M., & Franklin, J. (2003). Postevent rumination and recall bias for a social performance event in high and low socially anxious individuals. Cognitive Therapy and Research, 27(6), 603–617.CrossRefGoogle Scholar
  21. Goldin, P. R., Jazaieri, H., Ziv, M., Kraemer, H., Heimberg, R. G., & Gross, J. J. (2013). Changes in positive self-views mediate the effect of cognitive-behavioral therapy for social anxiety disorder. Clinical Psychological Science, 1(3), 301–310.CrossRefGoogle Scholar
  22. Halldorsson, B., & Creswell, C. (2017). Social anxiety in pre-adolescent children: What do we know about maintenance? Behaviour Research and Therapy, 99, 19–36.CrossRefGoogle Scholar
  23. Hearn, C. S., Donovan, C. L., Spence, S. H., & March, S. (2018). Do worry and its associated cognitive variables alter following CBT treatment in a youth population with social anxiety disorder? Results from a randomized controlled trial. Journal of Anxiety Disorders, 53, 46–57.CrossRefGoogle Scholar
  24. Hedman, E., Mörtberg, E., Hesser, H., Clark, D. M., Lekander, M., Andersson, E., & Ljótsson, B. (2013). Mediators in psychological treatment of social anxiety disorder: Individual cognitive therapy compared to cognitive behavioral group therapy. Behaviour Research and Therapy, 51(10), 696–705.CrossRefGoogle Scholar
  25. Hodson, K. J., McManus, F. V., Clark, D. M., & Doll, H. (2008). Can Clark and Wells’ (1995) cognitive model of social phobia be applied to young people? Behavioural and Cognitive Psychotherapy, 36(4), 449–461. Scholar
  26. Hope, D. A., Burns, J. A., Hayes, S. A., Herbert, J. D., & Warner, M. D. (2010). Automatic thoughts and cognitive restructuring in cognitive behavioral group therapy for social anxiety disorder. Cognitive Therapy and Research, 34(1), 1–12. Scholar
  27. Huppert, J. D., Roth, D. A., & Foa, E. B. (2003). Cognitive-behavioral treatment of social phobia: New advances. Current Psychiatry Reports, 5(4), 289–296.CrossRefGoogle Scholar
  28. In-Albon, T., Dubi, K., Rapee, R. M., & Schneider, S. (2009). Forced choice reaction time paradigm in children with separation anxiety disorder, social phobia, and nonanxious controls. Behaviour Research and Therapy, 47(12), 1058–1065.CrossRefGoogle Scholar
  29. Kiko, S., Stevens, S., Mall, A. K., Steil, R., Bohus, M., & Hermann, C. (2012). Predicting post-event processing in social anxiety disorder following two prototypical social situations: State variables and dispositional determinants. Behaviour Research and Therapy, 50(10), 617–626. Scholar
  30. Kocovski, N. L., & Rector, N. A. (2007). Predictors of post-event rumination related to social anxiety. Cognitive Behaviour Therapy, 36(2), 112–122.CrossRefGoogle Scholar
  31. Kovacs, M. (1985). The Children’s depression inventory. Psychopharmacology Bulletin, 21, 995–998.PubMedGoogle Scholar
  32. Kudielka, B. M., Hellhammer, D. H., Kirschbaum, C., Harmon-Jones, E., & Winkielman, P. (2007). Ten years of research with the Trier social stress test—Revisited. In E. Harmon-Jones & P. Winkielman (Eds.), Social neuroscience: Integrating biological and psychological explanations of social behavior (pp. 56–83). New York: The Guilford Press.Google Scholar
  33. Kuznetsova, A., Brockhoff, P. B., & Christensen, R. H. B. (2017). lmerTest package: Tests in linear mixed effects models. Journal of Statistical Software, 82(13).
  34. Lewin, A. B., Peris, T. S., Bergman, R. L., McCracken, J. T., & Piacentini, J. (2011). The role of treatment expectancy in youth receiving exposure-based CBT for obsessive compulsive disorder. Behaviour Research and Therapy, 49(9), 536–543.CrossRefGoogle Scholar
  35. Makkar, S. R., & Grisham, J. R. (2011). The predictors and contents of post-event processing in social anxiety. Cognitive Therapy and Research, 35(2), 118–133. Scholar
  36. McEvoy, P. M., Mahoney, A., Perini, S. J., & Kingsep, P. (2009). Changes in post-event processing and metacognitions during cognitive behavioral group therapy for social phobia. Journal of Anxiety Disorders, 23(5), 617–623. Scholar
  37. Melfsen, S., Walitza, S., & Warnke, A. (2011). Psychometrische Eigenschaften und Normierung des Sozialphobie und -angstinventars für Kinder (SPAIK) an einer klinischen Stichprobe. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 39(6), 399–406. Scholar
  38. Morgan, J., & Banerjee, R. (2008). Post-event processing and autobiographical memory in social anxiety: The influence of negative feedback and rumination. Journal of Anxiety Disorders, 22(7), 1190–1204.CrossRefGoogle Scholar
  39. Normann, N., & Esbjørn, B. H. (2018). How do anxious children attempt to regulate worry? Results from a qualitative study with an experimental manipulation. Psychology and Psychotherapy: Theory, Research and Practice. Advance online publication.
  40. Norton, A. R., & Abbott, M. J. (2016). Self-focused cognition in social anxiety: A review of the theoretical and empirical literature. Behaviour Change, 33(1), 44–64. Scholar
  41. Papageorgiou, C., & Wells, A. (2003). An empirical test of a clinical metacognitive model of rumination and depression. Cognitive Therapy and Research, 27(3), 261–273.CrossRefGoogle Scholar
  42. R Core Team. (2013). R: A language and environment for statistical computing. Vienna: R Foundation for Statistical Computing.Google Scholar
  43. Rachman, S., Grüter-Andrew, J., & Shafran, R. (2000). Post-event processing in social anxiety. Behaviour Research and Therapy, 38(6), 611–617.CrossRefGoogle Scholar
  44. Rao, P. A., Beidel, D. C., Turner, S. M., Ammerman, R. T., Crosby, L. E., & Sallee, F. R. (2007). Social anxiety disorder in childhood and adolescence: Descriptive psychopathology. Behaviour Research and Therapy, 45(6), 1181–1191. Scholar
  45. Rapee, R. M., & Heimberg, R. (1997). A cognitive-behavioral model of anxiety in social phobia. Behaviour Research and Therapy, 35(8), 741–756.CrossRefGoogle Scholar
  46. Schmitz, J., Krämer, M., Blechert, J., & Tuschen-Caffier, B. (2010). Post-event processing in children with social phobia. Journal of Abnormal Child Psychology, 38(7), 911–919. Scholar
  47. Schmitz, J., Krämer, M., & Tuschen-Caffier, B. (2011). Negative post-event processing and decreased self-appraisals of performance following social stress in childhood social anxiety: An experimental study. Behaviour Research and Therapy, 49(11), 789–795. Scholar
  48. Schneider, S., Unnewehr, S., & Margraf, J. (2009). Kinder-DIPS: Diagnostisches Interview bei psychischen Störungen im Kindes- und Jugendalter (2nd ed.). Heidelberg: Springer.Google Scholar
  49. Spence, S. H., Donovan, C., & Brechman-Toussaint, M. (1999). Social skills, social outcomes, and cognitive features of childhood social phobia. Journal of Abnormal Psychology, 108(2), 211–221.CrossRefGoogle Scholar
  50. Stiensmeier-Pelster, J., Schürmann, M., & Duda, K. (2000). Depressions- Inventar für Kinder und Jugendliche (2nd ed.). Göttingen: Hogrefe.Google Scholar
  51. Wewers, M. E., & Lowe, N. K. (1990). A critical review of visual analogue scales in the measurement of clinical phenomena. Research in Nursing & Health, 13(4), 227–236.CrossRefGoogle Scholar
  52. Wong, Q. J. J. (2016). Anticipatory processing and post-event processing in social anxiety disorder: An update on the literature. Australian Psychologist, 51(2), 105–113. Scholar
  53. Wong, Q. J. J., Gregory, B., McLellan, L. F., Kangas, M., Abbott, M. J., Carpenter, L., McEvoy, P. M., Peters, L., & Rapee, R. M. (2017). Anticipatory processing, maladaptive attentional focus, and postevent processing for interactional and performance situations: Treatment response and relationships with symptom change for individuals with social anxiety disorder. Behavior Therapy, 48(5), 651–663. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Clinical Psychology and Psychotherapy, Institute of PsychologyUniversity of FreiburgFreiburg im BreisgauGermany
  2. 2.Department for Clinical Child and Adolescent PsychologyLeipzig UniversityLeipzigGermany
  3. 3.Leipzig Research Center for Early Child DevelopmentLeipzig UniversityLeipzigGermany
  4. 4.Institute of PsychologyUniversity of BraunschweigBraunschweigGermany

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