For young adults fortunate enough to be accepted and enrolled, college offers fantastic opportunities for self-exploration and growth. In addition, though, it also promises terrifying amounts of stress. During this phase of life, many young adults must move away from home for the first time, make entirely new sets of friends, try to avoid the "Freshman 15", and deal with completely different social pressures. Meanwhile, they experience the full brunt of difficult college courses and professors who expect only their very best efforts. These stressors alone can make anyone feel anxious. However, they take on an even more frightening character for individuals with social anxiety disorder.

Psychologists define social anxiety disorder, previously diagnosed as "social phobia", as a "marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny"1. In particular, these individuals worry that others will reject them for their inability to properly handle social situations. Such fear can make an individual scared to go to a social event, on edge while at the event, and anxious for days afterward. Consequently, college and its constant barrage of new social interactions can take a toll on an individual with social anxiety disorder.

Problematic Alcohol Use in College

A major concern for college students with social anxiety disorder is that they will drink to cope with the anxiety brought about by social situations2. According to the National Institute on Alcohol Abuse and Alcoholism3, approximately 4 out of 5 college students drink alcohol, and about 50% of these individuals drink at a rate considered "binge drinking"4 (4 drinks for women and 5 drinks for men in a 2-hour span). Every year 599,000 college students receive unintentional injuries while intoxicated, and 1,825 of these individuals die from these injuries3. Furthermore, 25% of students report academic problems related to alcohol consumption.

Given the above statistics, many universities have attempted to decrease alcohol overconsumption through intervention programs. However, evidence suggests that these programs have less impact on individuals with social anxiety disorder5. Additionally, a number of studies indicate that social anxiety disorder might increase the chances that an individual develops an alcohol-use disorder2,6. Thus, identifying how social anxiety affects an individual's desire and motivation to drink could help researchers to develop alcohol-related interventions that are more effective.

Social Anxiety and Alcohol Abuse: The Role of Post-Event Processing

Social anxiety disorders may relate to problematic drinking through a form of rumination known as post-event processing. Post-event processing occurs when a person repetitively rehashes and overanalyzes their previous social encounters7, which might amplify the anxiety associated with those events. Preliminary evidence suggests that post-event processing is associated with problematic drinking behaviors8,9. However, it remains unclear whether increased post-event processing causes increased problematic drinking or whether increased problematic drinking causes increase post-event processing.

To address this problem, a team of researchers at the Adult Anxiety Clinic of Temple University, led by Carrie Potter, along with Dr. Richard Heimberg and others, directly investigated whether post-event processing can cause an increased desire to drink after a social encounter10. The researchers recruited two groups of participants: one high in social anxiety and one low in social anxiety. Both groups were told that they would participate with another student, who was secretly an experimenter (known as a "confederate" in the parlance of social psychology), in a mock social situation. The participants were asked to imagine that they knew the other student from class but that they had never met or talked with this person. The researchers told participants to approach and sit next to the student as if they were at lunch and strike up a conversation.

After this encounter, participants received a task that either promoted or inhibited post-event processing. In the post-event processing promotion task, participants were specifically prompted to reflect on and write about their experience in the mock social situation. In the post-event processing inhibition task, participants reflected on a completely unrelated event, such as the last movie they saw, to distract them from engaging in post-event processing. Afterwards, the researchers asked participants about their current urge to drink, and one week later, they again contacted participants to evaluate their motives to drink in the week following the experiment.

The Findings

The researchers found that promoting post-event processing after the mock social task increased the urge to drink alcohol – but only for individuals high in social anxiety. In the week following the study, these individuals also reported a greater motivation to cope with depressive symptoms by drinking. In other words, for individuals high in social anxiety, ruminating about a brief social encounter had long-lasting effects on their desire and motivation to drink alcohol. Importantly, high social anxiety individuals who participated in the post-event processing inhibition task did not show this effect. Thus, by simply distracting participants from ruminating about a social encounter, the researchers reduced their desire to cope with alcohol.

What does this mean? Implications for Interventions

This study suggests that post-event processing plays an important role in the connection between social anxiety disorder and problematic drinking among college students. It also highlights that inhibiting post-event processing reduces can serve to decrease an individual's desire and motivation to drink. This latter finding could help guide researchers and officials seeking better alcohol-related interventions for students. It might also help individuals with social anxiety disorder that struggle with alcohol abuse. By targeting this specific form of rumination, therapists may be able to help their clients reduce their desire to drink after stressful encounters. Future studies will have to investigate whether socially anxious individuals can learn to inhibit post-event processing and whether this treatment works over an extended period of time. However, this study provides a promising first step in addressing this major health concern.

Date of original publication:

Sources

1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

2. Schry, A. R., & White, S. W. (2013). Understanding the relationship between social anxiety and alcohol use in college students: A meta-analysis.Addictive Behaviors, 38(11), 2690-2706.

3. National Institue on Alcohol Abuse and Alcoholism. College drinking. Retrieved July 7, 2011 from https://www.niaaa.nih.gov/alcohol-health/special-populations-co-occurring-disorders/college-drinking

4. National Institue on Alcohol Abuse and Alcoholism. Drinking Levels Defined. Retrieved July 7, 2011 from https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/moderate-binge-drinking

5. Terlecki, M. A., Buckner, J. D., Larimer, M. E., & Copeland, A. L. (2011). The role of social anxiety in a brief alcohol intervention for heavy-drinking college students. Journal of Cognitive Psychotherapy, 25(1), 7-21.

6. Morris, E. P., Stewart, S. H., & Ham, L. S. (2005). The relationship between social anxiety disorder and alcohol use disorders: A critical review. Clinical psychology review, 25(6), 734-760.

7. Brozovich, F., & Heimberg, R. G. (2008). An analysis of post-event processing in social anxiety disorder. Clinical psychology review, 28(6), 891-903.

8. Battista, S. R., & Kocovski, N. L. (2010). Exploring the effect of alcohol on post-event processing specific to a social event. Cognitive behaviour therapy, 39(1), 1-10.

9. 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.

10. Potter, C. M., Galbraith, T., Jensen, D., Morrison, A. S., & Heimberg, R. G. (2016). Social anxiety and vulnerability for problematic drinking in college students: the moderating role of post-event processing. Cognitive behaviour therapy, 1-17.

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