This meta-analysis synthesized 226 effect sizes reflecting the relation between self-focused attention and negative affect (depression, anxiety, negative mood). The results demonstrate the multifaceted nature of self-focused attention and elucidate major controversies in the field. Overall, self-focus was associated with negative affect. Several moderators qualified this relationship. Self-focus and negative affect were more strongly related in clinical and female-dominated samples. Rumination yielded stronger effect sizes than nonruminative self-focus. Self-focus on positive self-aspects and following a positive event were related to lower negative affect. Most important, an interaction between foci of self-attention and form of negative affect was found: Private self-focus was more strongly associated with depression and generalized anxiety, whereas public self-focus was more strongly associated with social anxiety. Cognitive biases have been discussed extensively as contributing to emotional disorders. Depressed and anxious individuals show significant memory impairments and biases, judgmental biases, and attentional biases (for a review, see Mineka, RafaeliMor, & Yovel, in press). Such biases may serve as antecedents, concomitants, and consequences of emotional disorders (cf. Barnett & Gotlib, 1988) . For example, anxious and depressed individuals attend selectively to negative information (Mathews & MacLeod, 1994) . In addition, in contrast to nondepressed individuals, depressed individuals recall more negative stimuli than positive stimuli (Burt, Zembar, & Niederehe, 1995; Williams, Mathews, & McLeod, 1996) . Furthermore, mood-disordered individuals demonstrate a variety of judgmental biases; the most notable is their tendency to overestimate the likelihood of negative events (MacLeod & Byrne, 1996) . Self-focused attention (SFA) is one cognitive bias that has been strongly implicated in the experience of chronic negative affect (NA). SFA has been defined as "an awareness of self-referent, internally generated information that stands in contrast to an awareness of externally generated information derived through sensory receptors" (Ingram, 1990b, p. 156). Over the past 2 decades, the relationship between emotional distress, both chronic and acute on the one hand and chronic and temporary states of self-focus on the other, has garnered much discussion, controversy, and empirical research. Yet, unlike other cognitive factors in emotional disorders mentioned earlier, the wealth of research in SFA has not been reviewed systematically. Recently, Fejfar and Hoyle (2000) reviewed the relationship between SFA and NA and attributions of responsibility to the self. However, their review was not comprehensive and examined only private self-focus. Apart from this recent contribution, the most comprehensive review to date was qualitative and was conducted more than 11 years ago (Ingram, 1990b) . Since the time of Ingram's review, the number of studies available on the topic has at least doubled and their focus has changed. In addition, recent studies have examined a wider range of populations and forms of NA that go beyond those reviewed in 1990. The purpose of the present meta-analysis is to organize the wealth of evidence in this area and to provide a systematic and quantitative analysis of the conditions and contexts governing the relationship of SFA and NA. We attempt not only to review and summarize existing knowledge but also to provide a conceptual organization of this knowledge. Specifically, this meta-analysis will speak to two fundamental theoretical issues. Fundamental Issues in the Study of SFA and NA One fundamental issue in this field is whether self-focus is a single psychological construct. If attention to the self is a broad traitlike construct that characterizes people's general attentionallocation tendencies, we would expect great consistency in selffocus across situations and contexts. In addition, if self-focus is a unitary construct, we would expect it to have a consistent relationship with NA. On the other hand, if self-focus is conceptualized as a dynamic information processing operation, we would expect self-focus to vary significantly across situations and contexts, Nilly Mor, Department of Psychology, University of Illinois at Chicago; Jennifer Winquist, Department of Psychology, Valparaiso University. Parts of this research were presented at the June 1999 meeting of the American Psychological Society in Denver, Colorado, and at the November 1999 annual meeting of the Society for Research on Psychopathology in Montreal, Quebec, Canada. We extend special appreciation to Daniel Cervone and Eshkol Rafaeli for their insightful and constructive comments throughout the preparation of this article. We also thank Alice Eagly for her invaluable advice on meta-analytical methodology and Gershon Berkson, Jody Esper, Stanley Hughes, Daniel Moran, and Heather Orom for their helpful comments on an earlier version of this article. Finally, we thank authors who sent us requested data and statistical information. Correspondence concerning this article should be addressed to Nilly Mor, who is now at the Department of Psychology, University of Maryland, College Park, Maryland 20742, or 2002 , Vol. 128, No. 4, 638 -662 0033-2909/02/$5.00 DOI: 10.1037//0033-2909 638 different self-foci to operate differently, and variability in selffocus's relationship to affect. Consistent with views (e.g., Caprara & Cervone, 2000; Kagan, 1998 ) that contemporary personality constructs are often too broad and contain qualitatively distinct phenomena, the construct of SFA seems to have suffered from lack of a clear delineation of its various facets. It is often described as a general tendency to be self-reflective (e.g., Carver & Scheier, 2000) , and conclusions regarding general self-focus tendencies are often drawn from findings pertaining to a specific form or context of self-focus. Although it is possible that this seemingly unitary nature of the construct of SFA is a by-product of its complexity and of the vast number of studies examining it, it is still the case that the general picture being portrayed is murky. Despite this general oversight, several contextual and situation-specific factors have been proposed to distinguish between different forms of SFA (e.g., J. Wood & Dodgson, 1996) . This meta-analysis addresses this fundamental issue through the examination of the various facets or manifestations of self-focus as well as the effect of a variety of contextual and population factors on the relationship between self-focus and NA. A second fundamental issue addressed in this analysis is the specificity of the relation between SFA and affective experience. Does self-focus relate to NA in general or only to specific syndromes or disorders? This question was at the center of a pivotal debate in this field in the 1990s. Some have argued that self-focus is a general factor in psychopathology (Ingram, 1990b) , whereas others argued that it relates to depression more so than to other pathological conditions (Pyszczynski, Greenberg, Hamilton, & Nix, 1991) . Although this debate seems to have abated recently, given the proliferation in the past decade of research that examined the relationship between self-focus and various forms of NA, it seems important to examine the specificity question in this meta-analysis. A systematic quantitative analysis of the field is needed to provide answers to these fundamental questions. We return to these questions, and present several other meta-analytic hypotheses, following a historical overview of the theoretical conceptions that have guided research in this area. Theories and Paradigms in the Study of SFA and Affect The concept of self-focus was introduced by Duval and Wicklund (1972) as part of a model relating self-regulation and affect. According to their model, attention focused on the self leads to a self-evaluative process in which an individual's current state in a particular self-relevant domain is compared with his or her standard in that domain. Positive affect is experienced if the current standing surpasses the standard, whereas NA is experienced if the current standing falls short of the standard. According to Duval and Wicklund, the experience of NA leads to attempts either to decrease the discrepancy or to avoid self-focus. Building on Duval and Wicklund's (1972 ) theory, Carver and Scheier (e.g., 1986 , 1990 suggested that self-focus plays a role in a self-regulatory cycle that assists individuals in the pursuit of goals. In this self-regulatory process, individuals assess the discrepancy between their current self and a salient standard and engage in discrepancy-reducing behaviors when a negative discrepancy is detected. If the current self matches the desired standard, the individual terminates the regulatory process. If, on the other hand, the current self falls short of the standard, the individual enters a cycle of behaviors and evaluations that lasts until the self matches the standard or until the individual determines that a match is impossible. NA, according to Carver and Scheier, is experienced as a result of individuals' judgment that the likelihood of attaining the standard is low. In a later revision of their model, Carver and Scheier (1998; Carver, Lawrence, & Scheier, 1996 proposed that individuals assess not only the discrepancy between their current and desired selves but also the rate of their progress toward reducing this discrepancy. Thus, according to this revised model, NA results from too slow progress toward one's goals rather than from the discrepancy itself. Drawing from Duval and Wicklund's (1972) model and on Carver and Scheier's (1981) early model, Pyszczynski and Greenberg (1987) described a profile of individuals with a depressive self-focusing style. They posited that depression occurs when one is unable or unwilling to exit the self-regulatory cycle and is "stuck" in trying to reduce an irreducible discrepancy. Individuals stuck in this cycle often develop a depressive self-focusing style; they focus on their self-aspects following negative events but avoid such focus following positive events. A depressive selffocusing style intensifies NA and leads to increased salience of negative aspects of the self. This increased salience, in turn, leads to an increase in internal attributions, self-criticism, performance deficits, and other components of depression. Although they maintained that self-focus is primarily related to depression, Pyszczynski, Hamilton, Greenberg, and Becker (1991) indicated that selffocus can also be related to the experience of anxiety when one focuses on a potential feared loss as opposed to an already existing loss. Several theorists have addressed the role of rumination in maintaining depression. Early contributions emphasizing cognitive factors in the development and maintenance of depression argued that depressed individuals tend to engage in repetitive and persistent negative automatic thinking, much of which focuses on the self (e.g., Beck, Rush, Shaw, & Emery, 1979; Teasdale, 1983) . Subsequently, and more broadly, rumination was defined as "a class of conscious thoughts that revolve around a common instrumental theme and that recur in the absence of immediate environmental demands requiring the thought" (L. L. Martin & Tesser, 1996, p. 7) and as "a manifestation of people's tendency to persist in goal-directed action until they have either attained their goal or given up the desire for it" (L. L. Martin & Tesser, 1996, p. 11). Nolen-Hoeksema and colleagues (e.g., Lyubomirsky & NolenHoeksema, 1995; Nolen-Hoeksema, 1991; have specifically examined the role of rumination in the increase or maintenance of depressed mood in dysphoric and clinically depressed individuals, and defined ruminative responses as "behaviors or thoughts that focus an individual's attention on his or her depressed mood, and [on] the possible causes and consequences of that mood" (Nolen-Hoeksema, Morrow, & Fredrickson, 1993, p. 20). According to Nolen-Hoeksema and her colleagues, what characterizes rumination and differentiates it from negative automatic thoughts is it being a style of thought rather than its negative content. It is evident from these various 639 SELF-FOCUSED ATTENTION AND NEGATIVE AFFECT conceptualizations of rumination that it is a unique form of selffocus (and see also Hamilton & Ingram, 2001 , for a review of theoretical perspectives relating rumination and distress). Because the majority of studies that relate rumination to NA used NolenHoeksema's definition of rumination, we relied on this definition of rumination in this meta-analysis. Nolen-Hoeksema's response style theory addresses several aspects in the relationship between ruminative self-focus and NA. First, according to the theory (Nolen-Hoeksema, 1987 , ruminative responses prolong depressive states. This is because they enhance the effects of the negative mood on cognitive processes and prevent the individual from taking action and coping with the mood or with its causes in a problem-solving manner. Second, the theory explains gender differences in the prevalence of depression by women's higher tendency to ruminate (Nolen-Hoeksema, 1987) . Finally, the theory suggests that SFA does not necessarily promote depression in nondysphoric individuals, because they do not focus their attention on NA and on their negative personal attributes. In his review on self-focus and psychopathology, Ingram (1990b) concluded that SFA contributes to many psychopathological conditions including depression, anxiety, substance abuse, schizophrenia, and psychopathy. In explaining the existence of this broad relation to psychopathology in general, Ingram coined the term self-absorption, which he described as the "dysfunctional quality of maladaptive self-focused attention" (p. 169). Selfabsorption is an excessive, sustained, and inflexible attention to internal states. Ingram stated that a chronic SFA style is not necessarily dysfunctional. What renders some self-focus dysfunctional is inflexibility, or an inability to shift to an external focus of attention when the situation warrants. The three features of selfabsorption mentioned above (i.e., being excessive, sustained, and inflexible) are common to many disorders. However, according to Ingram, specific kinds of self-relevant information are disorder specific and reflect the particular psychopathological schemata of the various disorders. For instance, the SFA of an individual with an eating disorder will make salient information related to body image and physical appearance. Ingram's (1990b) conclusions regarding the role of self-focus in psychopathology were criticized by , who maintained that Ingram overestimated the extent of the relationship between selffocus and various pathological conditions, other than depression (see Ingram, 1991, for a response). Earlier, we presented two fundamental issues that are addressed in this meta-analysis; one is whether self-focus is a single psychological construct and the other is whether the relationship between SFA and NA is general or specific. Ingram (1990b) suggested that the relation between increased SFA and a variety of psychopathology conditions poses a "conceptual dilemma." The essence of this dilemma, according to Ingram, is that if SFA characterizes a multitude of psychological disorders, its value as an explanatory mechanism in pathology is greatly reduced. However, this conceptual dilemma would cease to exist if self-focus were not construed as a single construct but instead as an umbrella term for a number of constructs or variants of the same construct, such that different self-foci explain different disorders. Ingram's (1990b) meta-construct model of self-absorption provides a variant of a multifaceted approach to self-focus. According to this model, whereas the process of self-absorption is common to many disorders, specific self-focused schemata or content characterize the different disorders. In other words, Ingram presented both unique and shared aspects in particular kinds of self-focused cognitions. Although the self-absorption model describes general parameters for self-focus, it does not specify various manifestations of self-focus and contextual impact on SFA. Pyszczynski, Greenberg, et al.'s (1991) conceptualization of SFA is consistent with the notion of a multifaceted, contextually based process. Their model of the depressive self-focusing style assumes that self-focus of depressed and nondepressed people differs in context and valence and that depression is uniquely related to self-focus. Carver and Scheier (1998) described a divergence of effects of self-focus, such that only under some circumstances will self-focus be associated with NA and impaired functioning. They argued that "these outcomes occur when self-focus joins with doubt, leading to an impulse to disengage which is not given full expression" (p. 188). Though their model does not directly address the specificity question, their conceptualization of self-focus as a contextually determined process seems to imply a complex set of relations between self-focus and various NA manifestations rather than a specific relationship with just depression or anxiety. The relationship between SFA and emotional disorders has been examined using a variety of methodologies and measurement strategies. Researchers have typically used two broad paradigms. In the first paradigm, SFA is examined in its chronic and traitlike form (usually referred to as self-consciousness), and either chronic negative affectivity or a mood disorder is examined (e.g., Smith & Greenberg, 1981) . This paradigm often involves a correlational design, in which selected or unselected groups are examined to determine the association between SFA and NA, or a quasiexperimental design, in which groups with a priori differences in their level of NA (e.g., depressed and nondepressed) are compared on chronic self-focus tendencies. In the second paradigm, the relationship between temporary self-focus and NA is examined, typically manipulating either affect or SFA and examining their effect on each other (e.g., Carr, Teasdale, & Broadbent, 1991; Salovey, 1992) . This paradigm involves an experimental design and thus allows for causal examination of the relationship between SFA and NA. Understanding the relationship between self-focus and NA requires considering several variables that may moderate this relationship. As we noted earlier, identifying these moderators and mapping their effects is one of the primary aims of this metaanalysis. As an initial step, we classified the various moderators into theoretically meaningful groups and identified moderator variables that fall in the following groups: population characteristics, self-focus characteristics, NA characteristics, contextual factors, and measurement-related factors. In this section, we discuss each of these categories and how it was coded in this meta-analysis. Does self-focus exert the same effect on affect in all people? There are reasons to believe that the relationship between SFA and 640 MOR AND WINQUIST NA is stronger for women than it is for men. This is because women tend to engage in more maladaptive self-focus, such as rumination (Nolen-Hoeksema, 1987 . In addition, the higher prevalence of depression among women (American Psychiatric Association, 1994) and the tendency of depressed people to focus on negative information (Beck, 1967) make it likely that there will be a stronger relationship between NA and (negative) self-focus among women than among men. Because relatively few studies examine women only or men only in a way that would allow a direct comparison of the magnitude of the effect sizes associated with the sex of participants, we chose to use the percentage of females in the samples for assessing the differential strength of the relationship between self-focus and NA for men and women. Thus, in this meta-analysis we coded the percentage of female participants in each study and predicted larger effect sizes as the percentage of female participants in the sample increased. Another population-related question is whether SFA is more strongly associated with NA among people who are predisposed to experience chronic NA or those who already experience NA than among people who do not possess these tendencies. Pyszczynski and Greenberg (1987) suggested that experiencing loss predisposes one to develop a depressive self-focusing style in which one focuses on the self after negative events and avoids self-focus after positive events. Thus, according to Pyszczynski and Greenberg, the uniquely depressive self-focusing style strengthens the relationship between self-focus and depression for people who are already depressed or have experienced a loss of a source of esteem. Nolen-Hoeksema (1987 reached similar conclusions, namely that people who experience a dysphoric state and engage in ruminative self-focus become depressed. In contrast, she found that among people who were not experiencing dysphoria, rumination did not lead to negative thoughts and affect (Nolen-Hoeksema, 1991) . Making these predictions, we coded whether studies examined clinical, subclinical (depressed or anxious individuals), or nonclinical populations. We expected to find a stronger relationship between self-focus and NA in clinical populations compared to nonclinical populations. Finally, the relation between SFA and NA may vary with age. Through the course of development, individuals' self-schemata become more elaborate and complex (for reviews, see Damon & Hart, 1988; Harter, 1999) . In addition, children's self-evaluations are known to be positively inflated (Ruble, Eisenberg, & Higgins, 1994). On the basis of these findings, one can assume it is likely that when children engage in self-focus they attend mostly to positive self-aspects and do not experience as much NA as adults do. Therefore, we predicted larger effect sizes for studies that examined the relationship between SFA and NA among adults and adolescents as compared with those that examined the relationship among children. Current research on the nature of attention indicates that it is carried out by a network of interrelated anatomical areas in the brain, jointly characterized by the dimensions of duration, intensity, selection, and automaticity (e.g., Styles, 1997). It may be important to distinguish between states of self-focus that are of different duration, as well as to differentiate between states of self-focus that represent selection of differing content focus (e.g., involve different valence or involve dwelling on the self as an agent as opposed to an object evaluated by the social world). Variations in self-focus may represent divergent attentional processes (e.g., sustained vs. short-term) as well as various contents or self-aspects and may relate differently to NA. In this meta-analysis we compared several variants of SFA that may represent different attentional processes and content areas. Although we refer to these variants as different "types" of self-focus, it is important to note that in discussing self-focus types, we do not imply different attentional systems with different biological or anatomical underpinnings but rather different aspects of the self that one can attend to. One example of a subtype of self-focus is rumination. Ruminative self-focus differs from other types of self-focus in both process and content. It is repetitive and unproductive and is thought to interfere with active problem-focused coping. In addition, ruminative thoughts focus on one's mood and most often on one's negative mood. Thus, both content and process characteristics of ruminative self-focus lead us to predict that rumination would be more strongly associated with NA than would other types of self-focus. To explore this prediction, we coded whether studies examined ruminative self-focus. Another distinction frequently made among types of self-focus is between private and public self-focus (Fenigstein, Scheier, & Buss, 1975) . Private self-focus "reflects private, autonomous, egocentric goals. These are goals that did not necessarily require one to consider others' reactions to what one is doing" (Carver & Scheier, 1987, p. 527). Public self-focus pertains to aspects of behavior in which the needs, desires, or reactions of others are acknowledged and taken into account. These goals are colored by a desire for social consensus or by a desire to consider the impact that an action may have on others' impressions of oneself. (Carver & Scheier, 1987, p. 527) Although this distinction has been used primarily in reference to the trait form of self-focus-self-consciousness-it can distinguish among temporary states of self-focus as well. In fact, the most widely used measure of self-consciousness is composed of private and public self-consciousness subscales (Self-Consciousness Scale [SCS]; Fenigstein et al., 1975) . However, the usefulness of this distinction has been debated. Some (e.g., Wicklund & Gollwitzer, 1987) have maintained that the distinction between these two subtypes is spurious and atheoretical. Others (e.g., Carver & Scheier, 1987) have maintained that the distinction is valid, claiming that the two subtypes represent different self-regulatory processes-one in which individuals evaluate their actions without reference to others and another in which individuals evaluate their actions while taking into account the social context. Findings of different behavioral sequalae for private and public self-focus (cf. Fenigstein, 1979; Froming & Carver, 1981; Froming, Walker, & Lopyan, 1982) provide partial support for the distinction among these subtypes. To further examine the separability of these two putative subtypes of SFA, we coded the studies for private and public SFA. Finally, focus on positive versus negative aspects of the self may represent two separate types of self-focus, each of which may relate differently to affective experience. Focusing on one's neg-641 SELF-FOCUSED ATTENTION AND NEGATIVE AFFECT ative self-aspects can be assumed to relate to NA, whereas focusing on positive aspects of the self can be assumed to have an opposite effect. This idea is in line with the process of compensation delineated by Wood and Dodgson (1996) . Compensation is a process whereby individuals focus on positive aspects of their lives after experiencing a negative event (e.g., a failure). It has been associated with higher self-esteem and better coping (Baumeister, 1982) . When possible, we coded studies for the valence of self-focus assessed. The theories presented earlier suggest that SFA is often a maladaptive response that is associated with negative mental health consequences. However, each of these theories suggests specific contexts and conditions under which SFA may not be maladaptive. Scheier (1981, 1990; see also Carver, 1996a Carver, , 1996b and Duval and Wicklund (1972) suggested that SFA is essential for a self-regulatory process to take place. According to these models, SFA is maladaptive only when one detects a negative discrepancy between the current self and a relevant standard and is unable to minimize this discrepancy. One context in which this discrepancy is particularly salient is the experience of negative life events such as failures and losses. It is likely that self-focus relates positively to NA when it follows negative events but not when it follows positive events. In a similar vein, Pyszczynski and Greenberg (1987) contended that over time, depressed individuals engage in self-focus after negative events but not after positive events, whereas nondepressed individuals engage in self-focus after positive events but not after negative events. Stated differently, their theory suggests a positive relationship between self-focus and NA after negative events but not after positive ones. Thus, in this meta-analysis we coded studies for contextual factors such as positive and negative events. One of the major debates in this field involves the specificity of the relationship between SFA and psychopathology. As mentioned earlier, Ingram (1990b) proposed that SFA is a general factor in psychopathology. , on the other hand, questioned the ubiquity of self-focus in psychological disorders. In this analysis, we chose to focus on NA and disorders to which NA is central. Thus, our analysis can only afford a partial test of this question. Generally speaking, there seems to be a consensus regarding the existence of a strong relationship between self-focus and depression (e.g., Ingram, 1990b; Nolen-Hoeksema, 1991; . As for anxiety, it has been suggested that threatening situations lead to self-focus and that individuals' perceptions that they cannot cope with such situations lead to avoidance behavior and to further anxiety (e.g., Carver & Blaney, 1977; Carver, Blaney, & Scheier, 1979; Filipp, Klauer, & Ferring, 1993; Wells, 1985; Wells, 1991) . However, research evidence for the relationship between self-focus and anxiety has not been very promising: Relatively few studies examined this relationship, and the existing findings have been mixed (see Ingram, 1990b . In examining NA, we addressed the specificity question by distinguishing among the experiences of temporary negative mood, depressive symptoms, and anxiety symptoms. Several anxiety conditions may be associated with SFA. These include social anxiety (Woody, 1996) , panic disorder (Borden, Lowenbraun, Wolff, & Jones, 1993), generalized anxiety disorder (Wells, 1985) , and test anxiety (Deffenbacher, 1978) . In addition to comparing overall anxiety with depression and temporary mood states, we also examined differences between these various anxiety conditions. As mentioned earlier, in this meta-analytic review we examine the specificity question and attempt to provide insight into the debate regarding the generality of the relationship between SFA and various negative affective states. Specifically, we explore whether attention to public and private aspects of the self is differentially related to anxiety and depression. Differential association patterns of private and public self-focus with anxiety and depression are in line with Higgins's self-discrepancy theory (e.g., Higgins, 1987 Higgins, , 1999 , which relates discrepancies among various self-perceptions and NA. According to this theory, a salient discrepancy between the ideal self (i.e., what one would ideally want to be) and the actual self is associated with depression, whereas a salient discrepancy between the ought self (i.e., what one feels he or she should or ought to be) and the actual self is associated with anxiety. Although private self-focus and the ideal-self guide do not refer to identical psychological constructs, they both refer to selfaspects that do not involve other people. Similarly, public selffocus and the ought-self guide both refer to self-aspects in which others are taken into account. In this meta-analysis we examine the interactive effect of type of self-focus (private and public) and type of NA. Specifically, we examine whether attending to one's goals, thoughts, and feelings (i.e., private SFA) is associated with depression and whether attending to public aspects of the self or to the impression one makes on others (i.e., public SFA) is associated with anxiety. A central question in the study of attentional processes and affect is whether self-focus contributes to the experience of NA, NA predisposes people to engage in self-focus, or both. The present meta-analysis allows us to examine the direction of the causal relationship between SFA and NA. Some researchers have demonstrated that NA leads to an increase in self-focus (e.g., Salovey, 1992; Wood, Saltzberg, & Goldsamt, 1990). Others have indicated that a self-focusing tendency primes individuals to experience NA (Ingram, Cruet, Johnson, & Wisnicki, 1988) . The relationship between self-focus and NA has also been described as a cyclic process in which dysphoric individuals engage in negative self-focus, which exacerbates their dysphoria and predisposes them to prolonged depression (J. . We contrasted studies that manipulated mood or affect with those that manipulated SFA to gain further understanding of the causal precedence of one or the 642 MOR AND WINQUIST other. As both data and theory suggest a reciprocal and cyclical relationship between SFA and NA, we expected the mean effect sizes associated with both types of designs would be positive. It is important to note that causal statements regarding the relationship between self-focus and NA would only pertain to negative mood and cannot be applied to depressive and anxious disorders. We address several questions regarding the choice of SFA measurement in this review. The most common measure for chronic SFA is the SCS (Fenigstein et al., 1975) . This measure has been critiqued for the low validity and reliability of its subscales, and its factor structure has been questioned and alternative factors have been proposed (Burnkrant & Page, 1984; Martin & Debus, 1999) . Several alternative measures have been developed to address shortcomings of the SCS (Burnkrant & Page, 1984; Scheier & Carver, 1985) . Thus, in this analysis we compared studies that used the SCS and those that used other measures of SFA. Because of the frequent use of the SCS, we were particularly interested in determining the relative merits of this scale compared with existing alternatives. Several self-focus manipulations have been used over the years. The most common procedure for manipulating self-focus is placing a mirror in front of participants. Despite its common use, most studies in the meta-analysis did not examine the utility of this manipulation in obtaining the desired effect of increased selffocus. Thus, we compared the magnitude of the effect sizes associated with the various self-focus manipulations. In summary, this review addresses several questions. We first examine the overall relationship between SFA and NA. Then we explore various moderator variables related to population characteristics and aspects of self-focus and of NA. First, we examine specific populations (i.e., males vs. females, clinical vs. nonclinical) to determine whether the relationship between SFA and NA is the same across these populations. Second, we compare effect sizes associated with various types of self-focus, such as private versus public and ruminative versus nonruminative self-focus. Third, we attempt to determine whether specific forms of NA are more strongly associated with SFA than are others. Finally, we compare private and public SFA to determine whether private self-focus is more strongly associated with depression, whereas public self-focus is more strongly associated with anxiety. Design of the Meta-Analysis We included three types of NA measures in the study: negative mood, depression, and anxiety. The inclusion of these three types of measures is based on a number of theoretical considerations. In particular, it follows the theories of Carver and Scheier (1981) and of Duval and Wicklund (1972) regarding the relationship between SFA and general NA. It also follows the predictions of selfregulatory perseveration theory regarding the relationship between SFA and depression. Finally, studies that assessed anxiety were included in the present metaanalysis, as several anxiety conditions have been reported to be associated with SFA. Because anxiety is a superordinate term for several disorders, we included all available studies addressing any of the following subordinate types of anxiety: social anxiety (e.g., Woody, 1996) , panic disorder (e.g., Borden et al., 1993) , generalized anxiety disorder (e.g., Wells, 1985) , and test anxiety (e.g., Deffenbacher, 1978) . Although self-evaluative processes have been associated with self-esteem, which in turn has been found to be strongly associated with depression (e.g., Butler, Hokanson, & Flynn, 1994; Metalsky, Joiner, Hardin, & Abramson, 1993) , we view self-esteem as being beyond the scope of this review and thus excluded it from this meta-analysis. Several studies assessed cognitive performance (e.g., Lewis & Linder, 1997) under conditions of high and low SFA. Although task performance is often associated with anxiety, it is not a direct substitute for the affective core of anxiety. Therefore, only studies that measured anxiety directly (either through self-report or observer report) were included in this study. Studies using several types of measurement or manipulation of SFA were included in the meta-analysis. Some studies experimentally manipulated self-focus by placing a mirror in front of participants (e.g., Carver et al., 1979) or by asking the participants to write an essay that included the words I, me, mirror, or alone (e.g., Pyszczynski, Holt, & Greenberg, 1987) . Other studies manipulated SFA by instructing the participants to focus on their current physical and emotional feeling, their personality, or their goals (e.g., Lyubomirsky & Nolen-Hoeksema, 1993). Self-report measures of SFA have been used mostly in correlational designs. The most commonly used self-report measure is the Public and Private Self-Consciousness Scale (Fenigstein et al., 1975) . Other common self-report measures are sentence completion tasks (Exner, 1973; Wegner & Giuliano, 1980) ; the extent to which participants choose to complete sentences with the word I or with other self-related words is assumed to reflect their tendency to self-focus. Consistent with the above discussion, studies were included in the meta-analysis if they reported using appropriate measures of emotional disorders and of SFA and conducted an appropriate test of the relationship between these measures. Three types of studies were considered appropriate: (a) experimental designs that manipulated SFA and measured emotional disorders using self-report measures (e.g., Woody, 1996), (b) experimental designs that manipulated mood and measured SFA using self-report measures (e.g., Salovey, 1992), and (c) correlational designs that measured SFA and emotional disorders simultaneously when both were measured using self-report measures (e.g., Anderson, Bohon, & Berrigan, 1996). Method We conducted a computerized search using key word terms. These terms were grouped into two sets and combined into a single search that included 643 SELF-FOCUSED ATTENTION AND NEGATIVE AFFECT at least one term from each of the two groups. The first group included the following terms (using wild cards, such as focus* for focus, focusing, focused, etc.): self-focus, self-aware, self-referent, self-conscious, preoccupation, rumination, self-regulate, and self-direct. The second group included the following terms : anxiety, depression, mood, affect, emotional adjustment, well-being, phobia, dysphoria, panic, and emotional disorder. The intersection of the two groups was entered into the following databases from the beginning point of each database through the end of 1998: PsycINFO, Educational Resources Information Center, MEDLINE, and Dissertation Abstracts International. The Social Science Citation Index was also searched for references citing the following seminal articles: Ingram (1990b ), Fenigstein et al. (1975 . In addition, reference lists of the obtained articles as well as numerous review articles (e.g., Ingram, 1990b; Wood & Dodgson, 1996) were reviewed. Relevant books (e.g., Filipp et al., 1993; Schwarzer & Wicklund, 1991) and chapters were also reviewed but did not contain any data that had not already been reported in individual research reports. Finally, we obtained unpublished data from various researchers in the field via social psychology and clinical psychology e-mail networks. Studies were included in the meta-analysis if (a) they included either a manipulation of mood states or at least one affect measure-that is, a measure of mood, depression, or anxiety; (b) they included either a manipulation of attentional focus or a measure of SFA; or (c) they reported correlations between the affect and the attentional focus measure or a measure of group differences (such as t or F) in mood, emotional disorder between groups differing in self-focus, or group differences in self-focus in groups differing in mood or affect. Studies were excluded from this meta-analysis if the measurement of SFA was confounded with the measurement of NA. The most common example of studies excluded for this reason is usage of an overall score on the SCS, which includes a Social Anxiety subscale in addition to the Private and Public Self-Consciousness subscales. Studies were also excluded if they reported only that the results were or were not significant but did not provide the necessary statistical information needed for computation of an effect size. Finally, studies that reported only results of regression analyses were excluded from this meta-analysis, as these analyses cannot be used for computation of effect sizes (Hunter & Schmidt, 1990) . A standard coding sheet was completed for each study. The following general information was coded: (a) date of publication, (b) publication form (journal article, chapter, dissertation, or unpublished report), (c) whether the study originated from a larger study for which more than one subsample was used in the meta-analysis, (d) age group of participants (children, adolescents, or adults), (e) population type (nonclinical, subclinical, clinical), and (f) percentage of female participants. We coded several characteristics of SFA for each study: (a) type (private, public, both), (b) objective (whether it was ruminative), (c) valence (positive, negative, neutral), and (d) whether SFA was manipulated, measured, or both. Self-focus was classified as private when individuals' attention was turned to personal aspects of the self and as public when it was turned to self-aspects that were relevant to others. Self-focus was defined as ruminative when individuals' attention was aimed at their moods and the reasons for and implications of their moods. Several characteristics of NA were coded for each study: (a) type (mood, depression, or anxiety); (b) if mood, whether it was manipulated or measured; (c) if depression or anxiety, whether a self-report measure or a clinical diagnosis from a version of the Diagnostic and Statistical Manual of Mental Disorders (DSM; e.g., 4th ed. [DSM-IV], American Psychiatric Association, 1994) was used; (d) if anxiety, the type of anxiety symptoms under study (generalized, social, specific phobia, panic, test anxiety, or other); and (e) relevant situational context during or just prior to measurement of self-focus and/or NA (i.e., the experience of positive or negative events such as success and failure). Information regarding the reliability of NA and SFA measures was also coded. For each study, we noted whether reliability estimates were reported, could be obtained from norms of the measures, or were not available. In addition, when possible, we coded reliability estimates and the type of reliability estimate (e.g., alpha, kappa, test-retest). Finally, we coded each study for the direction of causal inference it allowed. Studies were coded as relevant to the hypothesis that SFA leads to NA if they included a controlled manipulation of SFA and measured NA postmanipulation. Studies were coded as relevant to the hypothesis that NA leads to SFA if they included a controlled manipulation of NA and measured SFA postmanipulation. Otherwise, studies were coded as not providing sufficient information for causal inference. Both authors coded all studies, and we computed kappas to determine interrater reliability. Kappa coefficients ranged from .80 to .99 with a mean of .92 and a median of .94. All discrepancies were discussed until full agreement was reached. The effect size index we used in this meta-analysis was d, the difference between the means of the two groups (either two groups of self-focus or two groups of NA) divided by the pooled standard deviation (see Hedges & Olkin, 1985) . This effect size was weighted by the reciprocal of its variance to give more weight to studies with more reliable estimates. A positive sign of the effect size indicates that higher levels of SFA were associated with higher levels of NA. Several studies presented data on the relationship between SFA and NA separately for subgroups within the overall sample (e.g., males vs. females). In these studies, each subsample was treated as a separate study. In addition, studies that included more than one situational context (e.g., both failure and success conditions) were treated as separate reports, such that each type of situational context served as a separate study. Although the resulting partition of some of the studies produced some nonindependence between the studies, this partition was necessary for the testing of the hypotheses posed in this meta-analysis. In addition, the nonindependence was never due to overlap in participants. We computed effect sizes with the aid of a computer program (DSTAT Version 1.10, B. T. . These computations were based on reports of means and standard deviations, r values, t tests, and F ratios. Results Because we examined several independent variables (i.e., different types of self-focus) and several dependent variables (i.e., different types of NA), many studies yielded more than one relevant effect size. Overall, 408 effect sizes were computed from all available studies. However, as noted by H. Cooper and Hedges (1994) , using more than one effect size per sample violates the independence assumptions of meta-analysis. Thus, we created a data set that included only one effect size per sample. When more than one effect size was available, effect sizes were combined using one of the following two procedures. If intercorrelations among the various independent or dependent variables to be aggregated were available, we computed a combined effect size 644 MOR AND WINQUIST using statistical procedures outlined by Gleser and Olkin (1994) . If these intercorrelations were not available, we computed the mean effect size for the sample. As correlational studies examined predictors of the variance in self-focus and NA measures, whereas experimental studies examined the strength of a manipulation, we conducted separate analyses for the two types of design. Thus, the overall data set included a total of 226 independent effect sizes (N ϭ 30,763) . The correlational studies data set included a total of a 149 effect sizes (N ϭ 28,095). The majority of the effect sizes that were obtained from experimental designs examined self-focus manipulations, whereas only five studies examined mood manipulations (N ϭ 224). We explored studies that manipulated mood separately. Thus, the experimental studies data set included 72 effect sizes in which self-focus was manipulated (N ϭ 2,444) . In outlining the characteristics of the sample, we describe the characteristics of the overall sample and then describe the characteristics of each of the subsamples. The characteristics of the included studies are presented in Table 1 . The majority of the studies included in this review were relatively recent and consisted of published data. Most often, the sample was of a nonclinical population. Samples typically included more female participants than male participants. Most of the studies used a correlational design in which SFA and NA were measured with self-report scales. The most common self-focus measure used was the SCS. Temporary negative mood was usually assessed using a variety of mood adjective Likert scales. The Beck Depression Inventory (BDI; Beck, 1967) was the modal depression measure, and the Social Anxiety subscale of the SCS was the modal anxiety measure. The most common self-focus manipulation procedures included instructing participants to focus on themselves and placing a mirror in front of the participants. The summary of the study-level effect sizes presented in Table  2 allows one to examine whether, on the whole, heightened SFA is associated with higher levels of NA. The weighted mean effect size averaged across the 149 correlational studies yielding studylevel effect sizes was 0.51, and the weighted mean effect size averaged across the 72 experimental studies yielding study-level effect sizes was 0.44. The weighted mean effect size for studies that manipulated NA was 0.55. All three mean effect sizes differed significantly from zero. Thus, higher self-focus is associated with higher levels of NA. These effect sizes represent a medium magnitude effect size according to Cohen's (1988) effect size classification. A mean effect size of this magnitude is considered by Cohen to be large enough to be visible to the naked eye. The mean effect size for the correlational studies is equivalent to a correlation of .25, and that of the experimental studies is equivalent to a correlation of .20. The mean effect size for studies that manipulated NA is equivalent to a correlation of .26. These findings suggest that overall SFA accounts for about 4 -6% of the variance in NA. The proportion of study-level comparisons supporting a positive relationship between self-focus and NA (140 of 149 for the correlational studies and 56 of the 72 experimental studies, or .93 and .77 of the studies, respectively) was significantly different from the 0.50 expected under the null hypothesis ( p Ͻ .001, by sign test). To address concerns of publication bias, whereby the results of the meta-analysis may be biased because of the tendency to primarily report and publish statistically significant results, we calculated a fail-safe N (Orwin, 1983) . This procedure involves estimation of the number of unreported unpublished studies required to negate the significant effect found. The results of the fail-safe N analysis indicate that to reduce the obtained mean effect size of 0.51 across the 149 correlational studies to a mean effect size of 0.3, there would have had to be 268 effect sizes of zero. To reduce the obtained mean effect size of 0.41 across the 72 experimental studies to a mean effect size of 0.3, there would have had to be 107 effect sizes of zero. Thus, in both study designs, the number of studies that would have had to report null results to reduce the mean effect size from the obtained effect size to a 0.3 mean effect size exceeds the number of studies included in this meta-analysis. For the purposes of this meta-analysis we had to exclude 28 studies for which we could not compute an effect size. Of those studies, 17 reported significant results, whereas 11 reported nonsignificant results. Although the study-level effect sizes were not skewed, neither were they homogeneous (see Table 2 ). Homogeneity was not attained until 52 (correlational) and 17 (experimental) effect sizes (34.9% and 23.6% of the effects, respectively) were removed. Removing these outliers did not significantly change the overall mean effect sizes, which were 0.49 for the correlational studies and 0.53 for the experimental studies-still significantly different from zero. On the basis of these results and of our theoretical
Mor et al. REF 's metaanalysis showed that self-focus is associated with depression, anxiety, and negative mood.
Self-focused attention and negative affect: A meta-analysis
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