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. Author manuscript; available in PMC: 2025 May 1.
Published in final edited form as: J Psychiatr Res. 2024 Mar 15;173:87–97. doi: 10.1016/j.jpsychires.2024.03.013

Post-event rumination and social anxiety: A systematic review and meta-analysis

Elizabeth V Edgar 1, Ashlyn Richards 2, Peter J Castagna 3, Michael H Bloch 1, Michael J Crowley 1
PMCID: PMC11018455  NIHMSID: NIHMS1980148  PMID: 38518572

Abstract

Post-event rumination, the extent to which one engages in persistent, detailed, and negative thinking following social situations, serves as a risk process in the pathophysiology of social anxiety. Although a substantial body of research has assessed post-event rumination and social anxiety, this literature has produced inconsistent results. We conducted a systematic review and meta-analysis to examine whether the magnitude of the association between post-event rumination and social anxiety varied as a function of questionnaire and/or task utilized. We included all studies reporting correlation between post-event rumination and social anxiety symptomatology. Fisher’s z correlation coefficients were calculated through random-effect meta-analyses. Results indicated moderate association between post-event rumination and social anxiety symptomatology (r=.45, p<.001, 95%CI [.40–.50]). Subgroup meta-analyses indicated that the type of questionnaire used to assess post-event rumination (Q=44.36, df=3, p<.001) and social anxiety (Q=26.44, df=8, p<.001), as well as the task conducted prior to assessing post-event rumination (Q=14.31, df=2, p<.001), influenced the effect size. This study demonstrates a moderate relation between post-event rumination and social anxiety across the anxiety spectrum, illustrating the importance of treatments specifically targeting post-event rumination. Moreover, we highlight the importance of taking care when designing studies to explore relations between post-event rumination and social anxiety.

Keywords: post-event rumination, post-event processing, social anxiety, meta-analysis

1. Introduction

Social anxiety is a prevalent psychiatric disorder characterized by fear of negative evaluation in social situations in which an individual is exposed to possible scrutiny from others (American Psychiatric Association, 2013). Fear of negative evaluation can occur during interactions with others (e.g., a conversation with an unfamiliar individual), performances (e.g., a speech), and while being observed by others (e.g., eating in public). Elevated social anxiety is associated with impairments in multiple domains of daily functioning, including poorer occupation functioning, greater health-related issues, lower likelihood of forming platonic and romantic relationships, and lower overall life satisfaction (Aderka et al., 2012; Fehm et al., 2008). Efforts have thus focused on identifying and understanding factors that explain the development and persistence of social anxiety disorder.

Prominent models posit that post-event rumination serves as a key maintenance factor of social anxiety disorder (Clark & Wells, 1995; Rapee & Heimberg, 1997). Post-event rumination, also known as post-event processing, involves engaging in repetitive and detailed self-focused thoughts of one’s own performance behavior in previous social interactions (Brozovich & Heimberg, 2008). Although engaging in self-focused thoughts can be constructive for individuals with low levels of social anxiety (Makkar & Grisham, 2012), those with elevated social anxiety tend to recall more negative information about their social performance than those with low social anxiety (Edwards et al., 2003), even if they received positive feedback (Cody & Teachman, 2010). Individuals with high social anxiety also engage in post-ruminative thoughts more frequently (Kocovski et al., 2005) and tend to interpret ambiguous social situations as negative (Badra et al., 2016) relative to those with low social anxiety. Given that post-event rumination contributes to the maintenance of social anxiety (Clark & Wells, 1995; Rapee & Heimberg, 1997), it has been proposed as a target of treatment in cognitive behavioral approaches (Donohue et al., 2024; McEvoy et al., 2009; Modini, Rapee, Costa, et al., 2018) and mindfulness and acceptance-based treatments (Cassin & Rector, 2011; Lewis et al., 2021; Price & Anderson, 2011; Shikatani et al., 2014).

Research on post-event rumination in social anxiety began in the late 1990s, influenced by research on rumination in depression (e.g. Morrow & Nolen-Hoeksema, 1990; Nolen-Hoeksema & Morrow, 1993). Depression and anxiety frequently co-occur (for a meta-analysis, see Saha et al., 2021), and rumination has been identified transdiagnostic factor between the two disorders (Konac et al., 2021; McLaughlin & Nolen-Hoeksema, 2011). Although post-event rumination in both anxiety and depression involve repetitive thoughts, the target of these repetitive thoughts differs. In depression, repetitive thoughts often focus on one’s internal (depressive) symptoms (Nolen-Hoeksema, 1991), whereas in social anxiety, repetitive thoughts center around self-appraisals and external evaluations of social partners and other details involving social events (Brozovich & Heimberg, 2008). The present study focuses specifically on post-event rumination in social anxiety through a systematic review and meta-analysis.

A substantial body of work has assessed post-event rumination in social anxiety. Although some studies report a strong and significant association between post-event rumination and social anxiety (e.g., Makkar & Grisham, 2011; Rowa et al., 2016), other studies do not (e.g., (McEvoy & Kingsep, 2006; Ogniewicz et al., 2014). Moreover, the magnitude of the relation between post-event rumination and social anxiety varies widely across studies (correlation r-range: .12–.76). Several factors may account for this wide range of variability across studies. First, across studies, there are differences in the ways in which both post-event rumination and social anxiety are assessed. Many questionnaires that are typically used to assess post-event rumination in those with social anxiety have not been tested psychometrically in clinical populations (Post-Event Processing Inventory: PEPI, Blackie & Kocovski, 2017); Rumination Questionnaire: RQ, Mellings & Alden, 2000; but see, Socially Anxious Rumination Questionnaire: SARQ, previously the Thoughts Questtionaire, TQ1, Donohue et al., 2021) or have not related to measures of trait social anxiety in clinical populations (Post-Event Processing Questionnaire: PEPQ, Rachman et al., 2000). Second, studies differ in the task conducted prior to assessing post-event rumination. For instance, many studies incorporate a social stress task (e.g., a speech) or require participants to recall a socially stressful situation prior to assessing post-event rumination. Other studies assess post-event rumination as part of a larger battery of questionnaires that are being administered all at once. Finally, studies differ in duration of time after which post-event rumination is assessed (e.g., concurrently, a day later, a week later). Those with social anxiety have been found to engage in post-event rumination for a longer period of time after the experience of a social stressor and is related to greater negative self-evaluation of performance (Brozovich & Heimberg, 2011; Rowa et al., 2016; Schmitz et al., 2011). Overall, each of these factors may play a role in the wide range of variability between post-event rumination and social anxiety across studies.

Thus, in the present study, we conducted a systematic review of the existing literature on post-event rumination and social anxiety. Second, we conducted a meta-analysis to assess the magnitude of the association between post-event rumination and social anxiety symptom severity. We also examined whether the magnitude of the relation between post-event rumination and social anxiety differed as a function of the type of post-event rumination assessment, type of social anxiety assessment, task conducted prior to assessment of post-event rumination, or the duration of time prior to assessing post-event rumination.

2. Materials and Methods

The present study is in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA; Page et al., 2021). This study was not pre-registered. All review stages were conducted by two independent reviewers (E.V.E., A.R.). Disagreements were resolved by a third independent reviewer (P.J.C.). A study was considered eligible for inclusion if it reported data on post-event rumination (engaging in repetitive and detailed self-focused thoughts) and social anxiety. Specifically, we included studies that assessed the magnitude of the relation between post-event rumination and symptoms of social anxiety. Eligibility was not restricted based on participant age, race, gender, publication language, or the country in which the study was conducted. All studies published from inception (1995) through June 2023 were included. Studies were excluded based on the following criteria: (1) review papers, (2) conference presentations, editorials, or author response papers, (3) studies with overlapping or duplicate data, (4) if participants were receiving clinical treatment for social anxiety (studies with treatment-seeking participants were included if they had not yet received treatment for social anxiety), (5) if post-event rumination was manipulated (e.g., distraction task versus control task), or (6) if post-event rumination was not assessed as a single construct (e.g., separating positive and negative rumination separately or only one).

We searched nine electronic databases (Pubmed, Embase, Cochrane, Scopus, GHL, Web of Science, Ovid Medline, APA PsychInfo, ClinicalTrials.gov) for relevant references from May 2023 to June 2023 using the search: ((anxiety) AND (“post-event processing”) OR (“post-event rumination”)). Reference sections from reviews were used to identify additional eligible studies. Titles and abstracts of the studies obtained through the search were initially screened for inclusion. Then, the full texts of potentially eligible studies were reviewed for inclusion. Data were extracted into an electronic table, coded by study (country, year of publication) participant characteristics (age, gender), and assessment type (social anxiety, post-event rumination). For outcome data, we extracted study sample sizes and correlations between post-event rumination and social anxiety.

All statistical analyses were completed in R version 4.3.1. We first conducted an overall meta-analysis. Then, to examine potential study-level characteristics that may have driven differences in estimates across studies, we conducted subgroup analyses considering differences as a function of the type of post-event rumination assessment, type of social anxiety assessment, and the task conducted prior to the assessment of post-event rumination. For all meta-analyses, the primary model was the random-effects model, and the outcome of interest was the magnitude of the correlation between post-event rumination and social anxiety. Correlations were pooled using Fisher’s z transformation, and interpreted according to Cohen’s (1988) effect size conventions, such that .10–.29 reflects a small effect size, .30–.49 reflects a moderate effect size, and .50 and greater reflects large effect size. Heterogeneity between studies was examined using the Q statistic, where a significant p-value indicates significant heterogeneity. The I2 statistic was then used to assess the percentage of variance in results across studies attributable to real differences in true effects. This statistic ranges from 0–100%, whereby 0%, 25%, 50%, and 75% represent no, low, moderate, and high heterogeneity, respectively. Publication bias was assessed via visual inspection of funnel plots and using Egger regression tests. Finally, we conducted meta-regressions to assess effects of the duration of time before post-event rumination was assessed, age, sample size, and publication year.

3. Results

Figure 1 depicts the procedure for the selection of studies. Our search yielded 193 studies that were potentially eligible for inclusion. Full text examination identified 35 studies that were eligible for inclusion involving 10,082 participants. Table 1 depicts the characteristics of the 35 studies assessing the relation between post-event rumination and symptoms of social anxiety.

Figure 1.

Figure 1.

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PRISMA flow diagram to detail study selection (from Page et al., 2020).

Table 1.

Characteristics of studies included in meta-analysis.

Author Year Sample; Mage; %women SA Assessment PER Assessment Task & Duration Prior to PER
Rachman et al. 2000 130; 20 years; 73 SPAI PEPQ 13-item Questionnaire only; Concurrent
McEvoy & Kingsep 2006 117; 35 years; 44 SIAS PEPQ-R NA-item Questionnaire only; Concurrent
Kocovski & Rector 2007 439; 21 years; 76 SPS PEPQ-R 7-item Questionnaire only; Concurrent
Fehm et al. 2008 130; 23 years; 51 FNE PEPQ 15-item Questionnaire only; Concurrent
Battista & Kocovski 2010 208; 19 years; 78 SPS PEPQ 12-item Questionnaire only; Concurrent
Makkar & Grisham 2011 40; 25 years; 35 SIAS, SPS, SPAI-T E-PEPQ 18-item Conversation task; 1 day
Brozovich & Heimberg 2011 64; 20 years; 100 SIAS PEPQ 13-item Questionnaire only; Concurrent
Hosey 2013 154; 21 years; 79 SPAI PEPQ 13-item Questionnaire only; Concurrent
Fisak & Hammond 2013 300; 23 years; 74 SPIN PEPQ-R 14-item Questionnaire only; Concurrent
Ogniewicz et al. 2014 89; 18–30 years; 82 SPS PEPQ-R 14-item EMA social event prior night; 3 weeks
Mitchell & Schmidt 2014 42; 19 years; 76 SIAS PEPQ-R 9-item Speech task; 4 days
Laposa et al. 2014 233; 34 years; 63 SIAS PEPQ-R 7-item Questionnaire only; Concurrent
Brown & Kocovski 2014 104; 19 years; 69 LSAS PEPQ-R 18-item Speech task; 2 days
Cox & Chen 2015 48; 24 years; 71 BNFE-S trait TQ 24-item Speech task; ~3 days
Rowa et al. 2016 65; 32 years; 68 SPIN PEPQ-R 8-item Speech task; 5 days
Helbig-Lang, Poels et al. 2016 65; 23 years; 77 SASKO subscale PEPQ-R NA-item Course presentation or speech; 7 days
Helbig-Lang, Von Auer, et al. 2016 49; 40 years; 64 LSAS-SR NA 3-item Ambulatory after social; concurrent
Buckner & Dean 2017 127; 20 years; 80 SIAS PEPQ 13-item SEQ weekend social event; concurrent
Cândea & Szentágotai-Tătar 2017 104; 20 years; 91 LSAS-SR TQ 16-item Speech task; 1 day, 7 days
Rodriguez et al. 2017 728; 21 years; 70 SPIN E-PEPQ NA-item Questionnaire only; Concurrent
Vassilopoulos et al. 2017 290; 12 years; 52 SASC-R PEPQ-R 9-item Questionnaire only; Concurrent
Pitura & Maranzan 2018 180; 20 years; 81 SIAS, SPS PEPI-T 12-item Questionnaire only; Concurrent
Modini et al. 2018 239; 33 years; 50 SIAS, SPS composite TQ 24-item Speech task; 7 days
Ecker & Buckner 2018 244; 20 years; 76 SIAS PEPQ 13-item Questionnaire only; Concurrent
Sluis et al. 2018 35; 20 years; 74 SIAS PEPQ-R 9-item Questionnaire only; Concurrent
Nielsen et al. 2018 72; 23 years; 67 LSAS PTQ 15-item Concert task; Concurrent
Maeda et al. 2018 1000; 21 years; 61 SPS, SIAS PEPQ-R 8-item Questionnaire only; Concurrent
Blöte et al. 2019 229; 15 years; 49 SAS-A TQ 24-item Speech task; 7 days
Sarfan et al. 2019 88; 20 years; 61 SIAS-S PEPQ-R 9-item Structured conversation task; 2 days
Yu et al. 2020 2755; 14 years; 51 SAS-A PEPI-T 12-item Questionnaire only; Concurrent
Constantin et al. 2021 126; 20 years; 77 SPIN PEPQ-R 8-item Questionnaire only; Concurrent
Maeda et al. 2022 400; 47 years; 48 SIAS PEPI-T 12-item Questionnaire only; Concurrent
Maeda et al. 2022 400; 48 years; 41 SIAS PEPI-T 12-item Questionnaire only; Concurrent
Kim et al. 2022 487; 40 years; 49 SIAPS-12 PEPI-T 10-item Questionnaire only; Concurrent
Gök & Yalçınkaya-Alkar 2023 325; 21 years; 73 LSAS-SR RTQ 31-item Written task of recent social event; Concurrent
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Meta-analysis of the 35 studies investigating the magnitude of the association between post-event rumination and symptoms of social anxiety revealed a significant relation between the two (r = .45, p < .001, 95% CI [.40 – .50]), reflecting a moderate effect size. Figure 2a depicts a forest plot describing the effect size between post-event rumination and social anxiety. There was significant heterogeneity in correlation coefficients between studies (Q = 169, df = 34, p < .001, I2 = 80%). Visual inspection of the funnel plot for publication bias showed asymmetry for the studies with smaller sample sizes, but it did not reach statistical significant on the Egger regression test (p = .28, Figure 2b).

Figure 2.

Figure 2.

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a. Fisher’s z correlations between post-event rumination and symptoms of social anxiety. b. Funnel plots examining publication bias

Subgroup analyses revealed significant effects as a function of the type of post-event rumination assessment (Q = 44, df = 3, p < .001). Figure 3 shows a forest plot demonstrating that the effect was largest for studies using the Post-Event Processing Inventory (PEPI; Blackie & Kocovski, 2017) (k = 5; r = .58, 95% CI [.37 – .80]; heterogeneity Q = 49, p < .01, I2 = 92%), reflecting a large effect size.This was followed by the Post-Event Processing Questionnaire (PEPQ; Rachman et al., 2000) (k = 23; r = .42, 95% CI [.35 – .49]; heterogeneity Q = 68, p < .01, I2 = 68%), and the Thoughts Questionnaire (TQ; Abbott & Rapee, 2004) (k = 6; r = .38, 95% CI [.28 – .47]; heterogeneity Q = 7, p = .24, I2 = 26%), both reflecting moderate effect sizes. Only one study used ambulatory assessment (Helbig-Lang et al., 2016; r = .66, 95% CI [.37 – .95]).

Figure 3.

Figure 3.

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Fisher’s z correlations between post-event rumination and symptoms of social anxiety by type of post-event rumination assessment.

Subgroup analyses also revealed significant effects as a function of the type of social anxiety assessment (Q = 26, df = 8, p < .001). Figure 4 depicts a forest plot showing that the effect size was largest for studies using more than one questionnaire (three studies used the SPS and SIAS and one study used the SPS, SIAS, and SPAI-T; see Table 1) (k = 3; r = .57, 95% CI [.27 – .88]; heterogeneity Q = 5, p < .01, I2 = 83%) and lowest for studies using the Social Phobia Scale (SPS; Mattick & Clarke, 1998)(k = 5; r = .33, 95% CI [−.08 – .75]; heterogeneity Q = 9, p = .01, I2 = 77%).

Figure 4.

Figure 4.

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Fisher’s z correlations between post-event rumination and symptoms of social anxiety by type of social anxiety assessment.

Stratified subgroup analyses also revealed significant effects as a function of the task conducted prior to assessing post-event rumination (Q = 14, df = 2, p < .001). Figure 5 depicts a forest plot showing that the effect size was moderate for all subgroups, but largest for studies administering the questionnaire only (k = 20; r = .46, 95% CI [.38 – .55]; heterogeneity Q = 18, p < .01, I2 = 85%), closely followed by those administering a speech task (k = 8; r = .43, 95% CI [.36 – .51]; heterogeneity Q = 5, p = .60, I2 = 0%), and then studies using other types of assessments (k = 7; r = .41, 95% CI [.20 – .62]; heterogeneity Q = 21, p < .01, I2 = 71%).

Figure 5.

Figure 5.

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Fisher’s z correlations between post-event rumination and symptoms of social anxiety by the task conducted prior to assessing post-event rumination.

Meta-regression analyses revealed that the the magnitude of association between post-event rumination and social anxiety symptoms was not significantly predicted by the duration of time before post-event rumination was assessed (b = −.004, SE = .01, 95% CI [−.03 – .02], p = .76), age (b = .003, SE = .003, 95% CI [−.003 – .009], p = .28), sample size (b = .00, SE = .0001, 95% CI [−.0001 – .0001], p = .55), and publication year (b = .004, SE = .01, 95% CI [−.01 – .02], p = .48).

4. Discussion

We conducted a systematic review and meta-analysis to assess the magnitude of the association between post-event rumination and social anxiety symptomatology. Several findings emerged. We observed a moderately strong effect size between post-event rumination and symptoms of social anxiety across the various assessment methods, such that greater post-event rumination was associated with greater social anxiety symptom severity. However, the effect size between post-event rumination and symptoms of social anxiety varied as a function of the method used to assess post-event rumination, the questionnaire used to assess social anxiety symptomatology, and the type of task conducted prior to assessing post-event rumination.

Our meta-analytic findings support the notion that post-event rumination is a key characteristic of social anxiety disorder (Clark & Wells, 1995; Rapee & Heimberg, 1997), with a moderate effect size. The effect size was generated from studies examining symptoms of social anxiety across the clinical-subclinical spectrum, indicating that post-event rumination predicts social anxiety symptomatology across the anxiety spectrum. Thus, findings are relevant for individuals with both subthreshold and clinical levels of social anxiety.

We found that the effect size between post-event rumination and social anxiety was impacted by the types of questionnaires administered to assess both post-event rumination and social anxiety symptomatology. For post-event rumination, heterogeneity in the effect size remained unexplained, indicating variation between studies. Some of this variation may be due to the number of different questionnaires and versions of each questionnaire administered across the 35 studies. For example, four different questionnaires were administered to assess post-event rumination across the 35 studies included. However, for each of these four questionnaires, different questionnaire versions – with differing numbers of items across versions – were administered. Leftover heterogeneity was highest for the Post-Event Processing Inventory (PEPI) subgroup (92%; of which the most versions were used across studies) and lowest for the Thoughts Questionnaire (TQ) subgroup (26%; least versions used across studies). Leftover heterogeneity may also be partially explained by the way in which post-event rumination was operationalized differed across questionnaire types. For example, the PEPI, which had the highest amount of leftover heterogeneity, reflects the frequency, intensity, and extent of self-judgment of ruminative thoughts. In the present meta-analysis, studies administered the trait form, which asks about the tendency to engage in post-event rumination generally, and did so without administering a social stress task prior to the questionnaire. Future research may consider comparing the relations between state and trait post-event rumination with social anxiety. Second, the PEPQ and associated versions require participants to answer questions in relation to an unspecified anxiety-inducing social situation that they experienced recently over the past few months. Previous research has found that the PEPQ-R reflects depressive rumination and general anxiety (i.e., worry) rumination. Both of the two previously cited studies that did not find a relation between post-event rumination and social anxiety used the PEPQ-R (McEvoy & Kingsep, 2006; Ogniewicz et al., 2014). Finally, the TQ (now the SARQ), is a state-based questionnaire that assesses ruminative responses as they are occurring in relation to a social threat task, and includes items that capture thoughts that are likely to be negative and salient during a bout of post-event rumination. In the present meta-analyses, studies administered the TQ after a speech task, which may have been advantageous because it allowed social situation (e.g., speech task) and temporal distance from the task to be controlled. Indeed, the TQ had the least amount of leftover heterogeneity. An important topic of future research may involve refining the assessment of post-event rumination, possibly through the use of multiple indices and latent constructs.

Similarly, eight different types of questionnaires were used to assess social anxiety, although similar versions of each questionnaire were administered. Studies that used more than one questionnaire to assess symptoms of social anxiety found the largest effect size, closely followed by studies that used the Social Interaction Anxiety Scale (SIAS; Mattick & Clarke, 1998), the Social Anxiety Scale for Adolescents (SAS-A; La Greca & Lopez, 1998), and the Social Phobia Inventory (SPIN; Connor et al., 2000). Work that used the Liebowitz Social Anxiety Scale (LSAS; Liebowitz, 1987), the Social Phobia and Anxiety Inventory (SPAI; Turner et al., 1989), and the Fear of Negative Evaluation Scale (FNE; Watson & Friend, 1969) showed slightly smaller effect sizes than the previous group, although similar to one another. All six of these questionnaires assess one or more dimension of social anxiety – cognitive, behavioral, and/or somatic. Studies using the Social Phobia Scale (SPS; Mattick & Clarke, 1998) showed the smallest effect size. Across all seven questionnaires, leftover heterogeneity was 50% or greater. It may be that different aspects of social anxiety differentially relate to post-event rumination. Indeed, two of the questionnaires with the highest effect sizes (SIAS, SAS-A) pertain to situations that involve interacting with others. In contrast, questionnaires with lower effect sizes (LSAS, SPAI) pertain to a larger variety of life situations, and the questionnaire with the lowest effect size (SPS) pertains to anticipatory fears of being scrutinized during routine situations, including eating, drinking, writing, and more. Thus, an important topic of future research may involve identifying what aspects of social anxiety relate more strongly to post-event rumination.

We also found that the type of task conducted prior to assessing post-event rumination influenced the effect size. Studies that administered only a questionnaire [with no task prior] to assess post-event rumination found the largest effect size between post-event rumination and social anxiety. However, the heterogeneity for this subgroup was very large (85%), potentially due to the use of different questionnaires for assessing post-event rumination and idiosyncrasies in the self-report of trait post-event ruminiaiton tendencies. Studies that used speech tasks prior to assessing post-event rumination closely followed in magnitude, followed last by studies that used other types of tasks, including structured conversation or concert tasks. This category also showed a large amount of leftover heterogeneity (71%), likely due to the use of different tasks to induce post-event rumination. In contrast to the other two categories, studies that used speech tasks had little to no leftover heterogeneity, indicating no variation between studies. Post-event rumination involves dwelling on previous social performances or encounters (Edwards et al., 2003). The administration of the speech task prior to the assessment of post-event rumination partially explains the effect size in the present study, and may be useful to incorporate in future studies assessing these constructs. We speculate the weaker association between post-event rumination and self-reported social anxiety in studies using speech tasks may reflect post-event rumination state effects which may be less strongly tied to general post-event rumination tendencies. As well, social threat tasks may be “strong situations” that elicit adaptive fear responses among socially anxious individual and less socially anxious individuals alike, reducing variability for all participants (Lissek et al., 2006).

Surprisingly, meta-regression analyses indicated that the duration of time prior to assessing post-event rumination did not significantly predict the effect size. Given that cognitive models posit that post-event rumination increases anticipatory rumination and anxiety for future social events, thus maintaining social anxiety (e.g., Clark & Wells, 1995), it may be expected that post-event rumination after a duration of time (e.g., 1 day, 7 days) would predict symptoms of social anxiety. However, this variable is likely to be confounded with the task administered prior to assessing post-event rumination. For instance, all studies that administered only a questionnaire did so concurrently, whereas studies that administered a speech task prior to assessing post-event rumination were more varied in duration. Additionally, the strong moderating effects of other study related variables (e.g. manner of assessment of social anxiety and post-event rumination) limited our power to examine the effects of time by creating a large amount of heterogeneity between studies. Finally, the duration of time prior to assessing post-event rumination did not vary substantially across the 35 studies (i.e., concurrent, 1 day, 7 days). Future research may consider comparing durations that are more variable (i.e., 1 day, 7 days, 1 month following an anxiety provoking situation). Overall, more research is warranted to determine the influence of elapsed duration prior to assessing post-event rumination.

Our systematic review and meta-analysis were limited by the quality of studies included due to methodological limitations. Combinations across several of the variables examined may account for heterogeneity in the effect size. For instance, some studies used trait questionnaires to assess post-event rumination after speech tasks, whereas other studies used questionnaires designed to assess state post-event rumination. Moreover, we assessed continuous relations between post-event rumination and social anxiety symptomatology, which led to the inclusion of studies with participants with low/no, subthreshold, or clinical levels of social anxiety. Future research may consider examining effects in clinical samples or in those receiving treatment for social anxiety. However, findings from the present study have implications for clinical practice. Findings highlight the need for treatments specifically targeting post-event rumination in socially anxious individuals. Given that specific aspects of social anxiety seem to relate more strongly to post-event rumination than others, treatments targeting aspects of social anxiety that relate most strongly to post-event rumination may be of importance. A recent review and meta-analysis on the treatment of pre- and post-event rumination in social anxiety supports the need for targeted treatment of post-event rumination, specifically. Donohue et al. (2024) found that cognitive behavioral therapy (CBT) reduced both pre- and post-event rumination in adults with social anxiety. However, the authors highlighted findings demonstrating that those with high levels of pre- and post-event rumination display slower response rates to CBT (Price & Anderson, 2011). Thus, Donohue et al. (2024) also examined and demonstrated that interventions specifically targeting pre- and post-event rumination produced larger effect sizes than non-targeted treatments. The effect size for post-event rumination was not statistically significant, but there were only six targeted treatments across four studies. Overall, more research is needed on how to best target post-event rumination for those with social anxiety.

In conclusion, the present meta-analysis revealed a moderate relation between post-event rumination and social anxiety symptomatology in the general population. The present meta-analysis demonstrated that the types of questionnaires used to assess both post-event rumination and social anxiety, as well as the type of task administered prior to assessing post-event rumination, influenced the relation between these two constructs. These findings illustrate 1) the importance of mechanistic studies targeted specifically at post-event rumination, including treatment studies, and 2) the importance of study design in research exploring relations between post-event rumination and social anxiety.

Highlights:

  • Greater post-event rumination is associated with greater social anxiety

  • Across 35 studies, the meta-analytic effect size of this relation is moderate

  • The magnitude of this effect size depends on the questionnaires and tasks used

Acknowledgments

This research was supported by the T32 MH18268 (EVE), the Sewanee at Yale Summer Internship (AR), and the Mind & Life Institute (MJC).

Footnotes

Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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.

Informed consent: Informed consent was obtained from all individual participants included in the study.

Declaration of interest: On behalf of all authors, the corresponding author states that there is no conflict of interest.

1

The Thoughts Questionnaire (TQ; Abbott & Rapee, 2004) was orginally named to conceal its purpose from participants, but was renamed the Socially Anxious Rumination Questionnaire (SARQ; Donohue et al., 2021) in order to properly reflect the construct it was designed to measure. Given that most studies assessed in the present study used the TQ, we refer to it as such throughout the manuscript.

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