Within-person process-outcome Relationships in Residential Cognitive and Interpersonal Psychotherapy for Social Anxiety Disorder: A Reanalysis Using Disaggregated Data

Abstract

Process-outcome research in psychotherapy has mainly focused on between-person data (e.g., how differences in psychological process among patients are related to differences in outcome among the patients). However, this level of analysis is in danger of missing its target because psychotherapy models and therapists focus primarily on within-person relationships (e.g., whether change in a patient's cognitive process during the course of therapy may lead to a reduction of symptoms in that client). The study of within-person processes requires collection of repeated data and a disaggregation of the between- and within-person components of time-varying process predictors. The purpose of this study was to examine whether the results of a previously published longitudinal process-outcome study of cognitive and interpersonal therapy for social anxiety disorder (SAD) (Hoffart, Borge, Sexton, & Clark, 2009) were maintained when the process predictors were disaggregated. Eighty social phobic patients were randomized to 10-week residential cognitive or interpersonal psychotherapy. In the present reanalysis, time-varying predictors were disaggregated by use of person-mean centering. For the cognitive process predictors (self-focus, estimated probability and estimated cost of negative social events, safety behaviors), the within-person relationships between predictors and subsequent social anxiety remained significant when disaggregating the predictors. On the other hand, the previously significant within-person relationship between the interpersonal variable of perceived acceptance by others and subsequent social anxiety disappeared with disaggregation. Disaggregated social anxiety also predicted fluctuations in self-focus, estimated probability and estimated cost of negative social events, but not in safety behaviors and perceived acceptance.