Identifying mediators of cognitive behaviour therapy and exposure therapy for social anxiety disorder (SAD) using repeated measures

Abstract

• Process research aiming to identify mediators of therapy can aid in making therapy more efficient and optimal. • Repeated measurement, at the start of each session of potential mediators of CBT and Exposure Therapy for social anxiety was carried out. • Both CBT and Exposure Therapy were found to have common mediational pathways and were equally effective in the treatment of SAD. • Perceived social self-efficacy and estimated social cost was found to be mediators of CBT and Exposure Therapy. Process research aims to identify mediators of therapy which can help increase the efficacy and optimization of therapy. The present study examined the role of estimated social cost, perceived social self-efficacy and perceived emotional control as potential mediators in Cognitive Behaviour Therapy (CBT) and Exposure Therapy (EXP) in individuals with social anxiety disorder. Fifty adults with a primary diagnosis of social anxiety disorder (SAD) were recruited from a tertiary treatment center and randomly assigned to receive either CBT (N=25) or EXP (N=25).Levels of social anxiety, estimated social cost, perceived social self-efficacy, and perceived emotional control were assessed at the beginning of each session. Multilevel modeling was used to estimate the effects of the above variables on social anxiety and examine differences between the two groups. Changes in perceived social self-efficacy and estimated social cost predicted changes in social anxiety. Perceived emotional control was not a significant predictor of changes in social anxiety. There were no significant differences between the two groups. The study has a small sample size, and there is a lack of adequate follow-up data. A single therapist delivered both interventions, which could limit external validity. Perceived social self-efficacy and estimated social cost emerged as mediators of both CBT and EXP. The two interventions had common meditational pathways, and there was an interactive bi-directional relationship between social anxiety and the studied mediators.