Testing the Efficacy of Theoretically Derived Improvements in the Treatment of Social Phobia

Centre for Emotional Health, Macquarie University, Sydney, Australia.
Journal of Consulting and Clinical Psychology (Impact Factor: 4.85). 05/2009; 77(2):317-27. DOI: 10.1037/a0014800
Source: PubMed


Recent theoretical models of social phobia suggest that targeting several specific cognitive factors in treatment should enhance treatment efficacy over that of more traditional skills-based treatment programs. In the current study, 195 people with social phobia were randomly allocated to 1 of 3 treatments: standard cognitive restructuring plus in vivo exposure, an "enhanced" treatment that augmented the standard program with several additional treatment techniques (e.g., performance feedback, attention retraining), and a nonspecific (stress management) treatment. The enhanced treatment demonstrated significantly greater effects on diagnoses, diagnostic severity, and anxiety during a speech. The specific treatments failed to differ significantly on self-report measures of social anxiety symptoms and life interference, although they were both significantly better than the nonspecific treatment. The enhanced treatment also showed significantly greater effects than standard treatment on 2 putative process measures: cost of negative evaluation and negative views of one's skills and appearance. Changes on these process variables mediated differences between the treatments on changes in diagnostic severity.

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    • "Therefore, our results strengthen the conclusion that CBT results in improvements in anxiety from pre-to post-speech above and beyond the effects of the passage of time and repetition of the speech task. Considered together with studies that used a single time point or mean indicators of performance anxiety (Heimberg et al., 1990Heimberg et al., , 1998Rapee et al., 2009), there is relatively consistent evidence that CBT results in reduced anxiety during or immediately following the performance phase of feared social situations in SAD. Less consistent support has been found for the effect of treatment on anxiety during the anticipatory period. "
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    ABSTRACT: The subjective experience of anxiety plays a central role in cognitive behavioral models of social anxiety disorder (SAD). However, much remains to be learned about the temporal dynamics of anxiety elicited by feared social situations. The aims of the current study were: (1) to compare anxiety trajectories during a speech task in individuals with SAD (n=135) versus healthy controls (HCs; n=47), and (2) to compare the effects of CBT on anxiety trajectories with a waitlist control condition. SAD was associated with higher levels of anxiety and greater increases in anticipatory anxiety compared to HCs, but not differential change in anxiety from pre- to post-speech. CBT was associated with decreases in anxiety from pre- to post-speech but not with changes in absolute levels of anticipatory anxiety or rates of change in anxiety during anticipation. The findings suggest that anticipatory experiences should be further incorporated into exposures.
    Full-text · Article · Dec 2015 · Journal of anxiety disorders
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    • " , 1999 ) , ( c ) the effect sizes were amongst the largest in the published literature , including trials that have included control groups ( Clark et al . , 2003 , 2006 ) , and ( d ) the historical control treatment used in this study has been demonstrated to be more efficacious than more tradi - tional CBT and stress management control groups ( Rapee et al . , 2009 ) and equally effective across research and community mental health settings ( McEvoy et al . , 2012 ) . Another limitation was that treatment adherence was not independently assessed , but was instead supported by the use of detailed therapist notes , handouts , and worksheets . Effectiveness trials emphasise external validity and the "
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    ABSTRACT: Emerging evidence suggests that imagery-based techniques may enhance the effectiveness of traditional verbal-linguistic cognitive interventions for emotional disorders. This study extends an earlier pilot study by reporting outcomes from a naturalistic trial of an imagery-enhanced cognitive behavioural group therapy (IE-CBGT, n = 53) protocol for social anxiety disorder (SAD), and comparing outcomes to historical controls who completed a predominantly verbally-based group protocol (n = 129). Patients were consecutive referrals from health professionals to a community clinic specialising in anxiety and mood disorders. Both treatments involved 12, two-hour group sessions plus a one-month follow-up. Analyses evaluated treatment adherence, predictors of dropout, treatment effect sizes, reliable and clinically significant change, and whether self-reported tendencies to use imagery in everyday life and imagery ability predicted symptom change. IE-CBGT patients were substantially more likely to complete treatment than controls (91% vs. 65%). Effect sizes were very large for both treatments, but were significantly larger for IE-CBGT. A higher proportion of the IE-CBGT patients achieved reliable change, and better imagery ability was associated with larger symptom change. Outcomes compared very favourably to published group and individual treatments for SAD, suggesting that IE-CBGT may be a particularly effective and efficient mode of treatment delivery.
    Full-text · Article · Dec 2014 · Behaviour Research and Therapy
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    • "Few studies have examined actual changes in impaired social functioning/behavior, which is an important element in SAD's clinical presentation (Beidel, Rao, Scharfstein, Wong, & Alfano, 2010). Even among the few investigations that included behavioral tasks in their assessment battery, most used the tasks only to assess social anxiety, not social behavior (Clark et al., 2006; Herbert et al., 2005; Rapee et al., 2009). Given the plethora of available treatment trials for SAD, why the lack of attention to assessing objective social skill? "
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    ABSTRACT: Objective: Social anxiety disorder (SAD) impacts social, occupational and academic functioning. Although many interventions report change in social distress, improvement in social behavior remains under-addressed. This investigation examined the additive impact of social skills training (SST) for the treatment of SAD. Method: Using a sample of 106 adults who endorsed SAD across numerous social settings, participants were randomized to exposure therapy (imaginal and in vivo) alone, a combination of SST and exposure therapy known as Social Effectiveness Therapy (SET), or a wait list control. The assessment strategy included self-report measures, blinded clinical ratings and blinded assessment of social behavior. Results: Both interventions significantly reduced distress in comparison to the wait list control and at post-treatment, 67% of patients treated with SET and 54% of patients treated with exposure therapy alone no longer met diagnostic criteria for SAD, a difference that was not statistically significant. When compared to exposure therapy alone, SET produced superior outcomes (p<.05) on measures of social skill and general clinical status. In addition to statistical significance, participants treated with SET or exposure reported clinically significant decreases on two measures of self-reported social anxiety and several measures of observed social behavior (all ps<.05). Conclusions: Both interventions produced efficacious treatment outcome, although SET may provide additional benefit on measures of social distress and social behavior.
    Full-text · Article · Dec 2014 · Journal of Anxiety Disorders
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