Metacognitive Therapy Applications in Social Anxiety Disorder: An Exploratory Study of the Individual and Combined Effects of the Attention Training Technique and Situational Attentional Refocusing

Abstract

Individuals with Social Anxiety Disorder have difficulty disengaging from self-processing in social situations. Metacognitive therapy interventions for enhancing attentional control were administered to a convenience sample of 24 with a Social Anxiety Disorder diagnosis. Using a cross-over design, 11 participants were given four weekly sessions of Attention Training Technique (ATT), followed by four weekly sessions of Situational Attentional Refocusing (SAR). For the other 13 participants the two treatment components were given in the reverse order. All participants made significant reductions on interview rated and self-reported measures of social and general levels of anxiety by the end of the first intervention (either ATT or SAR). Following completion of the second treatment components, further reductions were observed and 46% (n = 11) of the total sample no longer met DSM-IV criteria for Social Anxiety Disorder diagnosis. Two large order effects were found favoring patients receiving SAR interventions first. Overall these brief techniques aimed at increasing attentional flexibility were associated with large and clinically significant changes in Social Anxiety Disorder symptoms.