Cognitive predictors of treatment outcome for exposure therapy: do changes in self-efficacy, self-focused attention, and estimated social costs predict symptom improvement in social anxiety disorder?

Isabel L Kampmann,Paul M G Emmelkamp,Nexhmedin Morina

doi:10.1186/s12888-019-2054-2

Isabel L Kampmann, Paul M G Emmelkamp + Show 1 more

Open Access

https://doi.org/10.1186/s12888-019-2054-2

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Abstract

BackgroundCognitions play an important role in the development and maintenance of social anxiety disorder (SAD).MethodsTo investigate whether changes in cognitions during the first six sessions of exposure therapy are associated with treatment outcome, we assessed reported self-focused attention, self-efficacy in social situations, and estimated social costs in 60 participants (Mage = 36.9 years) diagnosed with SAD who received in vivo or virtual reality exposure therapy.ResultsPatients demonstrating a greater decrease in estimated social costs during treatment reported greater improvement of their social anxiety symptoms following both forms of exposure therapy. While changes in self-focused attention and social self-efficacy during treatment were significantly associated with treatment outcome when examined individually, these changes did not significantly predict symptom improvement beyond social costs.ConclusionsChanges in estimated social costs during treatment are associated with improvement of social anxiety symptoms after exposure therapy. Future research needs to further investigate estimated social costs as a predictor in relation to other cognitive variables.Trial registrationNCT01746667; www.clinicaltrials.gov, November 2012, retrospectively registered.

Highlights

Cognitions play an important role in the development and maintenance of social anxiety disorder (SAD)
Individual predictor analyses revealed that a decrease in estimated social costs and self-focused attention in the first six sessions was associated with a better treatment outcome, as indicated by lower social fear and avoidance on the Liebowitz Social Anxiety Scale-Self Report (LSAS-SR)
This indicates that the associations of social costs, self-focused attention, and self-efficacy with treatment outcome did not vary across treatment condition

Summary

Introduction

Cognitions play an important role in the development and maintenance of social anxiety disorder (SAD). Cognitive models of SAD assume that an individual’s negative beliefs related to social situations as well as the fear of behaving inappropriately and the subsequent consequences play an important role in the development and maintenance of the disorder [2]. Hofmann [10] showed that exposure therapy, it does not explicitly target cognitions, can lead to reduced self-focused attention in patients with SAD after treatment. It remains unclear whether changes in self-focused attention are associated with treatment outcome in pure exposure therapy

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