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Articles Section
The Mediational Role of Rumination in Social Anxiety 179
Journal of Evidence-Based Psychotherapies,
Vol. 15, No. 2, September 2015, 179-189.
THE RELATIONSHIPS BETWEEN STRESS,
NEGATIVE AFFECT, RUMINATION AND
SOCIAL ANXIETY
Sergiu Paul VĂLENAȘ* & Aurora SZENTAGOTÁI-TĂTAR Babes-Bolyai University, Cluj-Napoca, Romania
Abstract
Rumination is a vulnerability factor involved in the development of
depression and anxiety. Despite the fact that some studies have proposed a
relationship between rumination and social anxiety, more data is needed to
draw clear conclusions. Moreover, there is a need for research aiming to
find the mechanisms involved in the rumination-social anxiety relation. In
the current study, we examined whether stress, negative affect, and
rumination are predictors of social anxiety symptoms. Also, we tested if
rumination mediates the relationship between stress and social anxiety on
the one hand, and negative affect and social anxiety on the other.
Participants in this study (N = 95) were undergraduate psychology students
(females = 82, males = 13) and the mean age was 21.54 years (SD =2.95,
Range = 18–37). Self-reported stress, negative affect, rumination and social
anxiety were measured. Results showed that stress and negative affect are
predictors of both rumination and social anxiety. Both rumination and stress
significantly predicted social anxiety, but negative affect was no longer a
predictor when rumination was included in the predictive model. This study
provides evidence that rumination is involved in the relationship between
stress and social anxiety and negative affect and social anxiety. Also, this
study provides insights for developing prevention interventions in social
anxiety disorder.
Keywords: rumination, social anxiety disorder, stress, negative affect
Introduction
Rumination is defined as a repetitive cognitive pattern that focuses on the
causes and consequences of emotional states, and also on past problems and
events (Nolen-Hoeksema, 1991). Numerous studies have investigated rumination
* Correspondence concerning this article should be addressed to:
E-mail: valenas.sergiupaul@gmail.com
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Sergiu P. Vălenaș & Aurora Szentágotai-Tătar 180
in relation with depressive symptoms (Nolen-Hoeksema, 1991; Nolen-Hoeksema,
2000; Nolen-Hoeksema, Morrow, & Fredrickson, 1993), but evidence now
suggests that rumination is also associated with anxiety (Abela & Hankin, 2011;
Brozovich & Heimberg, 2008; Fresco, Frankel, Mennin, Turk, & Heimberg,
2002; Susan Nolen-Hoeksema, 2000; Vălenaș & Szentagotai, 2014). Social
anxiety is one of the anxiety disorders most often studied in relation with
rumination; however, some ambiguous aspects still need to be clarified.
Indeed, studies have confirmed the relationship between rumination and
social anxiety (Abbott & Rapee, 2004; Edwards, Rapee, & Franklin, 2003;
Mellings & Alden, 2000). In the social anxiety context, rumination is frequently
conceptualized in terms of repetitive thoughts about a self-related experience
during/after a social interaction, which can include both self or other-related
evaluations and details about the event (Kashdan, Zvolensky, & McLeish, 2008).
In these situations rumination is seen as an effect of social anxiety. Studies have
shown that social anxiety is associated with negative rumination a day after the
interaction, even after statistically controlling for depressive symptoms (Edwards
et al., 2003; Mellings & Alden, 2000). In a social anxiety disorder sample,
Kocovski and Rector (2008) found that individuals with higher levels of social
anxiety report higher levels of rumination after the first group cognitive-
behavioral therapy (gCBT) exposure task.
However, Clark and Wells (1995) suggest that rumination plays an
important role not only following the event, but also in before it taking place.
They suggest that prior to a social interaction, socially anxious individuals engage
in negative thoughts which contribute to their anxiety (Dodge, Hope, Heimberg,
& Becker, 1988). Vassilopoulos (2004) showed that anticipatory processing
before social interactions was specific to individuals with high levels of social
anxiety, even when controlling for general negative affect (i.e., trait anxiety and
depression). In the same line, Brown and Stopa (2006) found that socially
anxious undergraduate students reported higher levels of anxiety and negative
self-images than non-anxious participants after engaging in pre-event rumination.
They suggested that individuals may hold positive meta-beliefs about the function
of anticipation and rumination before a social performance situation that maintain
social anxiety.
Despite the fact that rumination is an important risk factor for depression
and anxiety (Aldao, Nolen-Hoeksema, & Schweizer, 2010), we know relatively
few things about the predictors of ruminative response style. Investigating such
factors would contribute to: 1) a better understanding of rumination, and
2) designing effective prevention strategies.
One predictor of increased ruminative thoughts is the experiences of
stress. Stress is conceptualized as a general state defined by difficulty relaxing,
nervous arousal, feeling of being easily upset/agitated, irritable/over-reactive or
impatient. Monroe (2008) defines experiences of stress as psychological and
physiological adaptations of the organism to social and environmental
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The Mediational Role of Rumination in Social Anxiety 181
circumstances. One conceptualization of the etiology of rumination maintains that
stressful life events can lead to rumination not only about those events, but also
about many areas of one’s life (Nolen-Hoeksema, Larson, & Grayson, 1999).
Stressful life events have also been found to predict major depression and anxiety
disorders (Kendler, Hettema, Butera, Gardner, & Prescott, 2003). Therefore, it is
possible that rumination may act as a mechanism between social anxiety
symptoms and stress. Past research found that stress caused by a natural disaster
(Nolen-Hoeksema & Morrow, 1991) or bereavement ( Nolen-Hoeksema, Parker,
& Larson, 1994) leads to high levels of rumination and a prolonged negative
mood. Moreover, according to the perseverative cognition theory rumination may
include prolonged physiological consequences (Brosschot, Gerin, & Thayer,
2006). Recent work found that rumination is related with increases in cortisol
stress responses in many different stressors (Johnson, Lavoie, Bacon, Carlson, &
Campbell, 2012; Zoccola & Dickerson, 2012).
Another line of research shows that high levels of ruminative thoughts are
predicted by negative affect. We define negative affect as a general dimension of
subjective distress that includes many aversive mood states such as anger, disgust,
guilt, fear, nervousness (Watson, Clark, & Tellegen, 1988). Research suggests
that high levels of negative mood and negative cognitions intensify rumination
(Watkins, 2008). One study found that beliefs about negative emotions, such as
sadness, fear, and anger, are difficult to control. Consequently, difficulties in
controlling negative emotions were related to a greater tendency to ruminate
(Nolen-Hoeksema & Jackson, 2001).
Given the large body of research regarding associations between stress
and negative affect on the one hand, and rumination on the other hand, and
between rumination and social anxiety symptoms, we believe it is important to
investigate how these variables interact in predicting social anxiety levels. The
aims of this study were: a) to examine the role of stress and negative affect as
predictors of rumination, b) to examine the role of stress, negative affect and
rumination as predictors of social anxiety symptoms, and c) to determine whether
rumination is a mechanism linking stress and negative affect with social anxiety
symptoms. We expected that stress, negative affect and rumination would be
associated with social anxiety symptoms, such that individuals with high levels of
negative affect, stress and rumination would show higher levels of social anxiety.
We additionally predicted that rumination would mediate the relationship between
stress and social anxiety symptoms and negative affect and social anxiety
symptoms.
Method
Participants
Participants in this study (N = 95) were undergraduate psychology
students (82 females; 13 males). The mean age of the sample was 21.54 years
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Sergiu P. Vălenaș & Aurora Szentágotai-Tătar 182
(SD =2.95, Range = 18–37). Participants who completed all tasks received course
credit.
Measures
Liebowitz Social Anxiety Scale (LSAS)
The LSAS (Liebowitz, 1987) consists of 11 items related to social
interaction and 13 items related to public performance. This scale measures fear
and avoidance of social situations in general, on 4-point Likert-type scales. The
first rating is a measure of fear/ anxiety and ranges from 0 (none) to 3 (severe).
The second rating is a measure of avoidance and ranges from 0 (never) to 3
(usually; 68–100%). A total score is calculated by summing all of the fear and
avoidance ratings. In the current study, Cronbach's alpha for the total score was
.96.
Depression and Anxiety, Stress Scale (DASS)
The DASS (Lovibond & Lovibond, 1995) comprises three self-report
scales designed to measure the negative emotional states of depression, anxiety
and stress. The Stress scale (the only one included in the analysis) is sensitive to
levels of chronic non-specific arousal. Participants are asked to use 4-point
severity/frequency scales to rate the extent to which they have experienced each
state over the past week.
Positive and Negative Affect Schedule (PANAS)
We used the Basic Negative Emotion Scales (i.e., fear, hostility, guilt and
sadness) of the PANAS (Watson et al., 1988). These consist of two 10-item
mood scales and were developed to provide brief measures of positive affect (PA)
and negative affect (NA). Respondents are asked to rate the extent to which they
have experienced each particular emotion within a specified time period, with
reference to a 5-point scale. The scale points are: 1 (‘very slightly or not at all’),
2 (‘a little’), 3 (‘moderately’), 4 (‘quite a bit’), and 5 (‘very much’).
The Rumination-Reflection Questionnaire (RRQ)
The RRQ (Trapnell & Campbell, 1999) was developed to discriminate
between neurotic and intellective forms of private self-consciousness. The 12-
item Rumination subscale assesses repetitive thoughts about threats to the self
(e.g., “I tend to ‘ruminate’ or dwell over things that happen to me for a really long
time afterward”), whereas the 12-item Reflection subscale assesses reflections on
the self-motivated by intellectual curiosity (e.g., “I love exploring my ‘inner’
self”). In the current study, only RRQ rumination subscale was used. The scale
showed good psychometric properties (Cronbach's alpha coefficient was .89).
Results
Data analysis
In order to examine the suitability of the current data for regression
analysis, a series of analyses were performed. Each model showed a normal
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The Mediational Role of Rumination in Social Anxiety 183
distribution of residuals. Tests conducted to see if the data met the assumption of
collinearity indicated that multicollinearity was not a concern (Rumination
Scores, Tolerance = .75, VIF = 1.33; Stress, Tolerance = .66, VIF = 1.51,
Negative affect, Tolerance = .66, VIF = 1.50). The data met the assumption of
independent errors (Durbin–Watson values = 2.28). Overall, the results indicate
that these data are adequate for regression analysis. Table (1) presents Pearson
correlations between social anxiety scores and stress, negative affect and
rumination scores.
Table 1. Correlations of social anxiety scores, stress, negative affect, and rumination
(N = 95).
Social anxiety Stress Negative affect
Social anxiety
Stress
Negative affect
Rumination
.52*
.49*
.69
.53*
.43*
.44*
Note: p < 0.01
A multiple regression analysis (enter method) was conducted to see if
stress and negative affect predict rumination levels. We found that stress level and
negative affect level explain a significant amount of the variance of rumination
(F(2, 92) = 15.31, p < .01, R2 =.25, R2Adjusted = .23)Both stress (β = .27, t(94) =
2.59, p < .05) and negative affect (β = .29, t(94) = 2.27, p < .01) significantly
predicted rumination.
A second multiple regression analysis (enter method) was conducted to
assess whether stress and negative affect predict social anxiety in students. We
found that stress level and negative affect level explain a significant amount of the
variance in social anxiety symptoms (F(2, 92) = 23.47, p < .01, R2 =.34, R2Adjusted
= .32).Both stress (β = .36, t(94) = 3.63, p < .01) and negative affect (β = .29,
t(94) = 2.29, p < .01) were significant predictors of social anxiety symptoms.
A third multiple regression analysis was conducted to see if adding
rumination would increase the prediction of social anxiety symptoms. We found
that rumination, stress and negative affect explain a significant proportion of the
variance in social anxiety symptoms (F(3, 91) = 37.05, p < .05, R2 =.55, R2Adjusted
= .54).Results show that negative affect does not significantly predict social
anxiety symptoms (β = .14, t(94) = 1.64, p > .05); however rumination (β = .53,
t(94) = 6.5, p < .01) and stress (β = .21, t(94) = 2.51, p < .05) significantly predict
social anxiety symptoms.
Bootstrapping analyses (bias-corrected, with 1000 iterations) were used to
test whether rumination had a mediator role in the relation between negative
affect and social anxiety symptoms. In the first model, rumination was a
significant mediator. As shown in Figure (a), negative affect was a significant
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Sergiu P. Vălenaș & Aurora Szentágotai-Tătar 184
positive predictor of both rumination and social anxiety and bootstrapping 95%
CI [.48, 1.24] supported the indirect effect of negative affect on social anxiety,
carried by rumination.
Figure (a) Unstandardized regression coefficients from the models
in which rumination has a significant mediator role in the relationship between
the level of stress and social anxiety. * p < .01
In the second model, rumination was also a significant mediator. As
shown in Figure (b), stress was a significant positive predictor of both rumination
and social anxiety and the bootstrapping 95% CI [0.75, 1.92] supported the
indirect effect (effect size k2 = 0.1) of stress on social anxiety, carried by
rumination.
Figure (b) Unstandardized regression coefficients from the models
in which rumination has a significant mediator role in the relationship between
the level of stress and social anxiety. * p < .01
Discussion
This study shows that individuals with a ruminative response style tend to
have high levels of negative affect and stress, a result which is consistent with a
generous line of research ( Nolen-Hoeksema & Morrow, 1991; Watkins, 2008).
Negative affect and stress showed a medium positive association with rumination,
based on Cohen’s (1988) classification of effect sizes. Also, negative affect
showed a medium positive association with social anxiety symptoms, while stress
and rumination showed a high positive association. Stress and negative affect
were significant predictors of rumination. When entered into the regression
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The Mediational Role of Rumination in Social Anxiety 185
model, negative affect and stress explained 34% of the variance in social anxiety.
When rumination was added, in the second model, all variables explained 55% of
the variance in social anxiety. These findings suggest that rumination might play a
role in social anxiety disorder.
The current study shows that rumination explains the association between
both stress and negative affect and social anxiety symptoms. These results are in
line with other studies showing that attempting to reduce the discrepancy between
goals and current state is an important factor involved in the process of
rumination (Martin & Tesser, 1996; Watkins, 2008). In a broad definition,
rumination includes “past-centered negative, unwanted and persistent thoughts”,
has components of emotional sadness, anger, depression/anxiety (Nolen-
Hoeksema, Wisco, & Lyubomirsky, 2008; Segerstrom, Tsao, Alden, & Craske,
2000) and is seen as a maladaptive response to stress prolonging physiological
consequences (Brosschot et al., 2006). A recent review showed that rumination
enhanced cortisol responses to a large variety of stressors (Zoccola & Dickerson,
2012). In this context, the persistence of rumination following negative emotions
or stress responses is understandable if the person focuses on the feelings and
physiological reactions. Additionally, daily life stress interferes with emotion
regulation processes required for individuals to cope with negative emotions
(Wenzlaff, Wegner, & Roper, 1988) and may affect executive functions (i.e.,
increase attention to negative thoughts and feelings), and lead to negative future
expectations (Segal & Ingram, 1994).
Interestingly, when we entered rumination, stress and negative affect in
the regression model trying to predict social anxiety, negative affect was not a
significant predictor. This suggests that, in a social situation, from a wide range of
negative affective reactions, a person will experience anxiety symptoms if he/she
is stressed and ruminates on perceived social failure. One possible explanation
may be that items measuring negative affect tend to be predominantly associated
with symptoms of depression (i.e., “upset”, “guilty”, “hostile”) than social anxiety
(i.e., “stressed”, “nervous”).
The causal direction between rumination and anxiety symptoms cannot be
clearly inferred due to the cross-sectional design of the current study. However,
the results of the present study allow us to speculate that if we aim to reduce
social anxiety symptoms linked to experiences of stress and negative emotions,
we may also have to reduce cognitive rumination. Frequently, when individuals
are confronted with anxiety-provoking situations, a range of unpleasant thoughts
and emotions arise. Trying to control or avoid these psychological experiences
will exacerbate the initial distress.
An important finding of this study is that rumination partially mediates
the relation between stress and social anxiety and negative affect and social
anxiety. These results add to previous findings on factors maintaining social
anxiety symptoms (Clark & Wells, 1995; Hofmann, 2007; Rapee & Heimberg,
1997).
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Sergiu P. Vălenaș & Aurora Szentágotai-Tătar 186
Limitations of the current study must also be acknowledged. First, our
investigation relied on self-report measures and all of the limitations pertaining to
this strategy are relevant, although the validity of the self-report measures used in
this study is well-established (Liebowitz, 1987; Lovibond & Lovibond, 1995;
Trapnell & Campbell, 1999; Watson et al., 1988). Second, due to the cross
sectional nature of the research design, it is not possible to make causal
inferences. An important next step would be to use prospective methodologies or
to experimentally test these variables for causal conclusions. Third, the current
findings were based on a relatively homogenous community sample. It is
important to examine whether the current models still hold in clinical samples and
ethnically diverse samples. Finally, our analysis focused on self-reported
symptoms of social anxiety; we believe that future studies should also include a
clinical assessment, in order to establish a clear association between rumination
and anxiety disorders.
Even though the consequences of engaging in rumination have been
frequently studied, few studies have examined vulnerability factors for rumination
itself. Our study shows that stress and negative affect are associated with
rumination. Moreover, results indicate that stress, negative affect and rumination
are positively associated with social anxiety symptoms. Our results also show that
rumination is involved in the association between stress and negative affect and
social anxiety symptoms. Such results can guide the development of prevention
programs aimed at reducing social anxiety symptoms and risk factors associated
with it.
Acknowledgments
This paper is a result of a doctoral research made possible by the financial support
of the Sectoral Operational Programme for Human Resources Development 2007-
2013, co-financed by the European Social Fund, under the project
POSDRU/159/1.5/S/132400 - “Young successful researchers – professional development
in an international and interdisciplinary environment”.
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