Abstract
Background
Social anxiety (SA) is highly comorbid with alcohol use disorder (AUD). Alcohol may be negatively reinforcing for SA individuals by dampening post-event rumination (i.e., negative rumination following social interactions). Prior research has supported this hypothesis with negative rumination. Depression, commonly comorbid with SA and AUD, also features rumination.
Method
Through secondary analyses, we examined the effects of alcohol consumption before an in-lab social interaction and depressive symptoms on both negative and positive post-event rumination about the interaction. Ninety-four high SA undergraduates were randomized to consume alcohol or no alcohol before the interaction; depressive symptoms were measured. Post-event rumination was measured three days later.
Results
Those higher (vs lower) in depressive symptoms reported more negative rumination. Those randomized to the alcohol (vs no alcohol) condition reported more positive rumination after the interaction.
Conclusions
Individuals with SA may find alcohol positively reinforcing by increasing positive post-event rumination, independent of negative reinforcement effects. Clinical implications are discussed.
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References
Abrams, K., Kushner, M., Medina, K. L., & Voight, A. (2001). The pharmacologic and expectancy effects of alcohol on social anxiety in individuals with social phobia. Drug and Alcohol Dependence,64, 219–231. https://doi.org/10.1016/S0376-8716(01)00125-9.
Bandelow, B., & Michaelis, S. (2015). Epidemiology of anxiety disorders in the 21st century. Clinical Research,17(3), 327–335.
Battista, S. R., MacDonald, D., & Stewart, S. H. (2012). The effects of alcohol on safety behaviors in socially anxious individuals. Journal of Social and Clinical Psychology,31(10), 1074–1094. https://doi.org/10.1521/jscp.2012.31.10.1074.
Battista, S. R., Pencer, A. H., & Stewart, S. H. (2014). Drinking and thinking: Alcohol effects on post-event processing in socially anxious individuals. Cognitive Therapy and Research,38(1), 33–42. https://doi.org/10.1007/s10608-013-9574-8.
Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Beck depression inventory-II. The Psychological Corporation (Vol. 78).
Bravo, A. J., Pilatti, A., Pearson, M. R., Mezquita, L., Ibáñez, M. I., & Ortet, G. (2018). Depressive symptoms, ruminative thinking, drinking motives, and alcohol outcomes: A multiple mediation model among college students in three countries. Addictive Behaviors,76(2017), 319–327. https://doi.org/10.1016/j.addbeh.2017.08.028.
Brozovich, F., & Heimberg, R. G. (2008). An analysis of post-event processing in social anxiety disorder. Clinical Psychology Review,28(6), 891–903. https://doi.org/10.1016/j.cpr.2008.01.002.
Carrigan, M. H., & Randall, C. L. (2003). Self-medication in social phobia. Addictive Behaviors,28(2), 269–284. https://doi.org/10.1016/s0306-4603(01)00235-0.
Chutuape, M. A. D., & de Wit, H. (1995). Preferences for ethanol and diazepam in anxious individuals: An evaluation of the self-medication hypothesis. Psychopharmacology (Berl),121(1), 91–103. https://doi.org/10.1007/BF02245595.
Clark, D. M., & Wells, A. (1995). A cognitive model of social phobia. In R. G. Heimberg, M. R. Liebowitz, D. A. Hope, & F. R. Schneier (Eds.), Social phobia: Diagnosis, assessment, and treatment (pp. 69–93). New York: The Guilford Press.
Collins, R. L., Parks, G. A., & Marlatt, A. G. (1985). Self-determinants of alcohol consumption: The effects of social interaction and model status of the self-administration of alcohol. Journal of Consulting and Clinical Psychology,53(2), 189–200. https://doi.org/10.1037/0022-006X.53.2.189.
Crum, R. M., & Pratt, L. A. (2001). Risk of heavy drinking and alcohol use disorders in social phobia: A prospective analysis. American Journal of Psychiatry,158(10), 1693–1700. https://doi.org/10.1176/appi.ajp.158.10.1693.
Diener, E., & Emmons, R. A. (1984). The independence of positive and negative affect. Journal of Personality and Social Psychology,47(5), 1105–1117. https://doi.org/10.1016/0301-4622(94)00049-2.
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. https://doi.org/10.1023/A:1026395526858.
Fisher, H., Simpson, R., & Kapur, B. (1987). Calculation of blood alcohol concentration (BAC) by sex, weight, number of drinks, and time. Cananadian Journal of Public Health, 78(5), 300–304.
Ginzler, J. A., Garrett, S. B., Baer, J. S., & Peterson, P. L. (2007). Measurement of negative consequences of substance use in street youth: An expanded use of the Rutgers Alcohol Problem Index. Addictive Behaviors,32, 1519–1525. https://doi.org/10.1016/j.addbeh.2006.11.004.
Grant, B. F., Hasin, D. S., Stinson, F. S., Dawson, D. A., Chou, S. P., Ruan, W. J., et al. (2005). Co-occurrence of 12-month mood and anxiety disorders and personality disorders in the US: Results from the national epidemiologic survey on alcohol and related conditions. Journal of Psychiatric Research,39(1), 1–9. https://doi.org/10.1016/j.jpsychires.2004.05.004.
Harwell, B. D., Cellucci, T., & Iwata, A. L. (2011). Rumination, anxiety sensitivity, and negative reinforcement drinking. Journal of Substance Use,16(1), 79–85. https://doi.org/10.3109/14659891.2010.487556.
Hasson, D., & Arnetz, B. B. (2005). Validation and findings comparing VAS vs. Likert scales for psychosocial measurements. International Electronic Journal of Health Education,8, 178–192.
Himle, J. A., Abelson, J. L., Haghighthou, H., Hill, E. M., Nesse, R. M., & Curtis, G. C. (1999). Effect of alcohol on social phobic anxiety. American Journal of Psychiatry,156(8), 1237–1243. https://doi.org/10.1176/ajp.156.8.1237.
Hofmann, S. G. (2007). Cognitive factors that maintain social anxiety disorder: A comprehensive model and its treatment implications. Cognitive Behavioural Therapy,36(4), 193–209. https://doi.org/10.1080/16506070701421313.
Jones, J. E., Hermann, B. P., Woodard, J. L., Barry, J. J., Gilliam, F., Kanner, A. M., et al. (2005). Screening for major depression in epilepsy with common self-report depression inventories. Epilepsia,46(5), 731–735. https://doi.org/10.1111/j.1528-1167.2005.49704.x.
Kashdan, T. B., & Roberts, J. E. (2007). Social anxiety, depressive symptoms, and post-event rumination: Affective consequences and social contextual influences. Journal of Anxiety Disorders,21(3), 284–301. https://doi.org/10.1016/j.janxdis.2006.05.009.
Kashdan, T. B., Weeks, J. W., & Savostyanova, A. A. (2011). Whether, how, and when social anxiety shapes positive experiences and events: A self-regulatory framework and treatment implications. Clinical Psychology Review,31(5), 786–799. https://doi.org/10.1016/j.cpr.2011.03.012.
Khantzian, E. J. (1985). The self-medication hypothesis of addictive disorders: Focus on heroin and cocaine dependence. American Journal of Psychiatry,142(11), 1259–1264. https://doi.org/10.1176/ajp.142.11.1259.
Khantzian, E. J. (1997). The self-medication hypothesis of substance use disorders: A reconsideration and recent applications. Harvard Review of Psychiatry,4(5), 231–244. https://doi.org/10.3109/10673229709030550.
Kocovski, N. L., & Rector, N. A. (2007). Predictors of post-event rumination related to social anxiety. Cognitive Behaviour Therapy,36(2), 112–122. https://doi.org/10.1080/16506070701232090.
MacDonald, A. B., Baker, J. M., Stewart, S. H., & Skinner, M. (2000). Effects of alcohol on the response to hyperventilation of participants high and low in anxiety sensitivity. Alcoholism: Clinical and Experimental Research, 24(11), 1656–1665. https://doi.org/10.1111/j.1530-0277.2000.tb01967.x.
MacLeod, A. K., & Moore, R. (2002). Positive thinking revisited: Positive cognitions, well-being and mental health. Clinical Psychology and Psychotherapy,7(1), 1–10. https://doi.org/10.1002/(sici)1099-0879(200002)7:1%3c1:aid-cpp228%3e3.0.co;2-s.
Mattick, R. P., & Clarke, J. C. (1998). Development and validation of measures of social phobia scrutiny fear and social interaction anxiety. Behaviour Research and Therapy,36, 455–470. https://doi.org/10.1016/S0005-7967(97)10031-6.
McClelland, G. H., Lynch, J. G., Irwin, J. R., Spiller, S. A., & Fitzsimons, G. J. (2015). Median splits, type II errors, and false-positive consumer psychology: Don’t fight the power. Journal of Consumer Psychology,25(4), 679–689. https://doi.org/10.1016/j.jcps.2015.05.006.
McLaughlin, K. A., & Nolen-Hoeksema, S. (2011). Rumination as a transdiagnostic factor in depression and anxiety. Behaviour Research and Therapy,49(3), 186–193. https://doi.org/10.1016/j.brat.2010.12.006.
Mellings, T. M. B., & Alden, L. E. (2000). Cognitive processes in social anxiety: The effects of self-focus, rumination, and anticipatory processing. Behaviour Research and Therapy,38(3), 243–257. https://doi.org/10.1016/S0005-7967(99)00040-6.
Nolen-Hoeksema, S., & Harrell, Z. A. (2002). Rumination, depression, and alcohol use: Tests of gender differences. Journal of Cognitive Psychotherapy,16(4), 391–403. https://doi.org/10.1891/jcop.16.4.391.52526.
Ogniewicz, A., Kuntsche, E., & O’Connor, R. M. (2019). Post-event processing and alcohol intoxication: The moderating role of social anxiety. Cognitive Therapy and Research,43(5), 874–883. https://doi.org/10.1007/s10608-019-10011-4.
Pini, S., Cassano, G. B., Simonini, E., Savino, M., Russo, A., & Montgomery, S. A. (1997). Prevalence of anxiety disorders comorbidity in bipolar depression, unipolar depression, and dysthymia. Journal of Affective Disorders,42(2–3), 145–153. https://doi.org/10.1016/S0165-0327(96)01405-X.
Pokorny, A. D., Miller, B. A., & Kaplan, H. B. (1972). The brief MAST: A shortened version of the Michigan Alcoholism Screening Test. The American Journal of Psychiatry,129(3), 342–345. https://doi.org/10.1176/ajp.129.3.342.
Post, M. W. (2016). What to do with “moderate” reliability and validity coefficients? Archives of Physical Medicine and Rehabilitation,97, 1051–1052. https://doi.org/10.1016/j.apmr.2016.04.001.
Rachman, S., Grüter-Andrew, J., & Shafran, R. (2000). Post-event processing in social anxiety. Behaviour Research and Therapy,38(6), 611–617. https://doi.org/10.1016/s0005-7967(99)00089-3.
Robinson, J., Sareen, J., Cox, B. J., & Bolton, J. M. (2011). Role of self-medication in the development of comorbid anxiety and substance use disorders: A longitudinal investigation. Archives of General Psychiatry,68(8), 800–807. https://doi.org/10.1001/archgenpsychiatry.2011.75.
Robinson, M. S., & Alloy, L. B. (2003). Negative cognitive styles and stress-reactive rumination interact to predict depression: A prospective study. Cognitive Therapy and Research,27(3), 275–292. https://doi.org/10.1023/A:1023914416469.
Schneier, F. R., Foose, T. E., Hasin, D. S., Heimberg, R. G., Liu, S. M., Grant, B. F., et al. (2010). Social anxiety disorder and alcohol use disorder co-morbidity in the National Epidemiologic Survey on Alcohol and Related Conditions. Psychological Medicine,40(6), 977–988. https://doi.org/10.1017/S0033291709991231.
Sher, K. J., & Grekin, E. R. (2007). Alcohol and affect regulation. In R. F. Baumeister & K. D. Vohs (Eds.), Handbook of emotion regulation (pp. 560–580). New York, NY: Guilford Press.
Spurr, J. M., & Lusia, S. (2002). Self-focused attention and social anxiety. Clinical Psychology Review,22(7), 947–975. https://doi.org/10.1111/j.1742-9536.2011.00027.x.
Testa, M., Fillmore, M. T., Norris, J., Abbey, A., Curtin, J. J., Leonard, K. E., … Jacques, A. J. (2006). Understanding alcohol expectancy effects: Revisiting the placebo condition. Alcoholism: Clinical and Experimental Research, 30(2), 339–348. https://doi.org/10.1111/j.1530-0277.2006.00039.x
White, H. R., & Labouvie, E. W. (1989). Towards the assessment of adolescent and problem drinking. Journal of Studies on Alcohol,50(1), 30–37. https://doi.org/10.15288/jsa.1989.50.30.
Acknowledgements
The dataset generated during and analysed during the current study are not publicly available as participants did not consent to the publication of their individual data (only aggregate data), but the data is available from the corresponding author on reasonable request.
Funding
This work was supported by the Social Sciences and Humanities Research Council of Canada (410–2009-1043); and the Social Sciences and Humanities Research Council of Canada, Canada Graduate Scholarship-Doctoral.
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All authors contributed to the study conception and design. Funding acquisition and conceptualization were conducted by Alissa H. Pencer and Sherry H. Stewart. Additional conceptualization, material preparation, and data collection were performed by Susan R. Battista. Analyses and interpretation were conducted by Amanda E. F. Hagen and Alissa H. Pencer. The first draft of the manuscript was written by Amanda E. F. Hagen and Marie-Eve Couture and all authors commented on previous versions of the manuscript. All authors have read and approved the final manuscript.
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Alissa H. Pencer is the co-founder and Scientific Director of an iCBT company, Tranquility Online. This has no association or bearing on the current research. Amanda E. F. Hagen, Susan R. Battista, Marie-Eve Couture, and Sherry H. Stewart declare that they have no conflict of interest.
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All procedures performed in this human participant study were in accordance with the ethical standards of the institutional research committee (Dalhousie Health Sciences Research Ethic Board) and with the 1964 Helsinki declaration and its later amendments. This article does not contain any studies with animals performed by any of the authors.
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Informed consent was obtained from all individual participants included in the study.
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Hagen, A.E.F., Battista, S.R., Couture, ME. et al. The Effects of Alcohol and Depressive Symptoms on Positive and Negative Post-Event Rumination in Social Anxiety. Cogn Ther Res 44, 801–810 (2020). https://doi.org/10.1007/s10608-020-10100-9
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DOI: https://doi.org/10.1007/s10608-020-10100-9