Therapy For Social Anxiety Disorder Research Articles

D-Cycloserine as an Augmentation Strategy With Cognitive-Behavioral Therapy for Social Anxiety Disorder

The authors examined whether D-cycloserine, a partial agonist at the glutamatergic N-methyl-d-aspartate receptor, augments and accelerates a full course of comprehensive cognitive-behavioral therapy (CBT) in adults with generalized social anxiety disorder. This was a multisite randomized placebo-controlled efficacy study with 169 medication-free adults with generalized social anxiety disorder, of whom 144 completed the 12-week treatment and 131 completed the three follow-up assessments. Patients were randomly assigned to receive 50 mg of D-cycloserine or placebo 1 hour before each of five exposure sessions that were part of a 12-session cognitive-behavioral group treatment. Response and remission status was determined at baseline, throughout treatment, at end of treatment, and at 1-, 3-, and 6-month follow-up assessments by assessors who were blind to treatment condition. D-Cycloserine-augmented and placebo-augmented CBT were associated with similar completion rates (87% and 82%), response rates (79.3% and 73.3%), and remission rates (34.5% and 24.4%) at the posttreatment assessment; response and remission rates were largely maintained at the follow-up assessments. Although D-cycloserine was associated with a 24%-33% faster rate of improvement in symptom severity and remission rates relative to placebo during the treatment phase, the groups did not differ in response and remission rates. D-Cycloserine did not augment a full course of comprehensive CBT for social anxiety disorder.

Changes in implicit and explicit self-esteem following cognitive and psychodynamic therapy in social anxiety disorder

The present investigation is the first to analyse changes in implicit and explicit self-esteem following cognitive therapy (CT) and psychodynamic therapy (PDT) in social anxiety disorder (SAD). We assessed a sub-sample of patients with SAD (n=27 per treatment group, n=12 waitlist condition) in the course of a randomized controlled trial prior to and following individual treatment or wait assessment with an Implicit Association Test and the Rosenberg Self-Esteem Scale. Both CT and PDT consisted of 25 sessions. Treatments were effective in enhancing implicit and explicit self-esteem. In CT and PDT, changes in explicit self-esteem were associated with SAD symptom change. No such relationships were found in implicit self-esteem. The results seem to indicate that both CT and PDT are effective in establishing a positive implicit and explicit self-esteem in SAD. The differential relationships of changes in implicit and explicit self-esteem to treatment effects on social phobic symptoms are discussed.

Acceptance based behavior therapy for social anxiety disorder through videoconferencing

Most individuals with social anxiety disorder (SAD) do not receive any type of treatment. Reasons include logistical barriers (e.g., geographic location, travel time), fear of stigmatization, and fear of the social interactions associated with seeking treatment. Videoconferencing technology holds great promise in the widespread delivery of evidence-based treatments to those who would otherwise not receive treatment. This pilot study assessed the feasibility, acceptability, and initial efficacy of an acceptance-based behavioral intervention using Skype videoconferencing to treat adults with generalized SAD. Twenty-four participants received 12 sessions of weekly therapy and were assessed at pre-treatment, mid-treatment, post-treatment, and 3-month follow-up. Participants and therapists rated the intervention as acceptable and feasible. Analyses revealed significant pre-treatment to follow-up improvements in social anxiety, depression, disability, quality of life, and experiential avoidance, with effect sizes comparable to or larger than previously published results of studies delivering in-person CBT for SAD. Implications and future directions are discussed.

Fear, avoidance and physiological symptoms during cognitive-behavioral therapy for social anxiety disorder

We examined fear, avoidance and physiological symptoms during cognitive-behavioral therapy (CBT) for social anxiety disorder (SAD). Participants were 177 individuals with generalized SAD who underwent a 14-week group CBT as part of a randomized controlled treatment trial. Participants filled out self-report measures of SAD symptoms at pre-treatment, week 4 of treatment, week 8 of treatment, and week 14 of treatment (post-treatment). Cross-lagged Structural Equation Modeling indicated that during the first 8 weeks of treatment avoidance predicted subsequent fear above and beyond previous fear, but fear did not predict subsequent avoidance beyond previous avoidance. However, during the last 6 weeks of treatment both fear and avoidance predicted changes in each other. In addition, changes in physiological symptoms occurred independently of changes in fear and avoidance. Our findings suggest that changes in avoidance spark the cycle of change in treatment of SAD, but the cycle may continue to maintain itself through reciprocal relationships between avoidance and fear. In addition, physiological symptoms may change through distinct processes that are independent from those involved in changes of fear and avoidance.

Changes in Positive Self-Views Mediate the Effect of Cognitive-Behavioral Therapy for Social Anxiety Disorder.

Social Anxiety Disorder (SAD) is thought to be characterized by maladaptive self-views. This study investigated whether (1) patients with SAD (n=75) differ at baseline from healthy controls (HC; n=43) in negative and positive self-views, (2) Cognitive-Behavioral Therapy (CBT) for SAD vs. waitlist control (WL) produces statistically and clinically significant changes in negative and positive self-views, (3) changes in self-views mediate the effect of CBT on social anxiety symptoms, and (4) changes in self-views during CBT related to social anxiety symptoms at 1-year post-CBT. As expected, patients endorsed more negative and fewer positive self-views than HC at baseline. Compared to WL, CBT yielded statistically and clinically significant changes, specifically, fewer negative and more positive self-views. Mediational analysis indicated that increased positive (but not reduced negative) self-views mediated the effect of CBT on social anxiety reduction. Correlational analyses determined that increased positive self-views were associated with social anxiety symptom reduction at 1-year-post-CBT.

A preliminary study of individual cognitive behavior therapy for social anxiety disorder in Japanese clinical settings: a single-arm, uncontrolled trial

BackgroundCognitive behavior therapy (CBT) is regarded as an effective treatment for social anxiety disorder (SAD) in Europe and North America. Individual CBT might be acceptable and effective for patients with SAD even in non-Western cultures; therefore, we conducted a feasibility study of individual CBT for SAD in Japanese clinical settings. We also examined the baseline predictors of outcomes associated with receiving CBT.MethodsThis single-arm trial employed a 14-week individual CBT intervention. The primary outcome was the self-rated Liebowitz Social Anxiety Scale, with secondary measurements of other social anxiety and depressive severity. Assessments were conducted at baseline, after a waiting period before CBT, during CBT, and after CBT.ResultsOf the 19 subjects screened, 15 were eligible for the study and completed the outcome measures at all assessment points. Receiving CBT led to significant improvements in primary and secondary SAD severity (ps < .001). The mean total score on the Liebowitz Social Anxiety Scale improved from 91.8 to 51.7 (before CBT to after CBT), and the within-group effect size at the end-point assessment was large (Cohen’s d = 1.71). After CBT, 73% of participants were judged to be treatment responders, and 40% met the criteria for remission. We found no significant baseline predictors of those outcomes.ConclusionDespite several limitations, our treatment—which comprises a 14-week, individual CBT program—seems feasible and may achieve favorable treatment outcomes for SAD in Japanese clinical settings. Further controlled trials are required in order to address the limitations of this study.Trial registrationUMIN-CTR UMIN000005897

Sudden gains in cognitive therapy and interpersonal therapy for social anxiety disorder.

The present study examined the effects of sudden gains on treatment outcome in a randomized controlled trial including individual cognitive therapy (CT) and interpersonal therapy (IPT) for social anxiety disorder (SAD). Participants were 67 individuals with SAD who received 16 treatment sessions. Symptom severity at each session was assessed using the Social Phobia Weekly Summary Scale (Clark et al., 2003). Results indicate that 22.4% of participants experienced a sudden gain during treatment. Individuals with sudden gains had significantly lower social anxiety symptoms at post-treatment and follow-up compared to individuals without sudden gains. Sudden gains in CT and IPT had similar magnitudes, frequencies, and timings. However, sudden gains resulted in lower levels of post-treatment symptoms in CT compared to IPT. Cognitive changes did not precede sudden gains, but sudden gains resulted in cognitive changes. Sudden gains in CT and IPT for SAD are predictive of long-term outcome. In addition, the effect of sudden gains may be greater in CT compared to IPT.

A Kind of D-Amino Acid Oxidase Inhibitor, Sodium Benzoate, Might Relieve Panic Symptoms in a First-Episode, Drug-Naïve Panic-Disorder Patient

A Kind of D-Amino Acid Oxidase Inhibitor, Sodium Benzoate, Might Relieve Panic Symptoms in a First-Episode, Drug-Naïve Panic-Disorder Patient

CBT preferred over drug therapy for social anxiety disorder

CBT preferred over drug therapy for social anxiety disorder

Cognitive reappraisal self-efficacy mediates the effects of individual cognitive-behavioral therapy for social anxiety disorder.

To examine whether changes in cognitive reappraisal self-efficacy (CR-SE) mediate the effects of individually administered cognitive-behavioral therapy (I-CBT) for social anxiety disorder (SAD) on severity of social anxiety symptoms. A randomized controlled trial in which 75 adult patients (21-55 years of age; 53% male; 57% Caucasian) with a principal diagnosis of generalized SAD were randomly assigned to 16 sessions of I-CBT (n = 38) or a wait-list control (WL) group (n = 37). All patients completed self-report inventories measuring CR-SE and social anxiety symptoms at baseline and post-I-CBT/post-WL, and I-CBT completers were also assessed at 1-year posttreatment. Compared with WL, I-CBT resulted in greater increases in CR-SE and greater decreases in social anxiety. Increases in CR-SE during I-CBT mediated the effect of I-CBT on social anxiety. Gains achieved by patients receiving I-CBT were maintained 1-year posttreatment, and I-CBT-related increases in CR-SE were also associated with reduction in social anxiety at the 1-year follow-up. Increasing CR-SE may be an important mechanism by which I-CBT for SAD produces both immediate and long-term reductions in social anxiety.

The Relation Between Mindfulness and Fear of Negative Evaluation Over the Course of Cognitive Behavioral Therapy for Social Anxiety Disorder

This study examined the relation between mindfulness and fear of negative evaluation over the course of nonmindfulness based cognitive-behavioral therapy (CBT) for social anxiety disorder (SAD). We expected that higher levels of mindfulness would be associated with a more positive response to treatment. This study is a secondary report from a randomized controlled trial in which participants (N = 65) diagnosed with SAD were randomly assigned to receive 8 weeks of 1 of 2 manualized treatments (exposure group therapy, n = 33; or virtual reality exposure therapy, n = 32) either immediately or following an 8 week waiting period. Fear of negative evaluation decreased following treatment and was negatively related to mindfulness throughout treatment and follow-up. Mindfulness did not moderate treatment outcome. These findings indicate that while mindfulness is related to fear, it is not a moderator of symptom reduction in nonmindfulness-based treatment. Implications for treatment and future research are discussed.

Treatment specific competence predicts outcome in cognitive therapy for social anxiety disorder

Several studies have demonstrated a positive relationship between competence and outcome in CBT for depression but studies of CBT for anxiety disorders are lacking. The present study explores the relationship between competence and outcome in cognitive therapy (CT) for social anxiety disorder, using hierarchical linear modeling analyses (HLM). Data were drawn from a multicenter randomized controlled trial. Five trained raters evaluated videotapes of two therapy sessions per patient using the Cognitive Therapy Competence Scale for Social Phobia (CTCS-SP). Overall adherence to the treatment manual and patient difficulty were also assessed. Patient outcome was rated by other assessors using the Clinical Global Impression Improvement Scale (CGI-I) and the Liebowitz Social Anxiety Scale (LSAS). Results indicated that competence significantly predicted patient outcome on the CGI-I (β = .79) and LSAS (β = .59). Patient difficulty and adherence did not further improve prediction. The findings support the view that competence influences outcome and should be a focus of training programs. Further research is needed to compare different ways of assessing competence and to understand the complex relationships between competence and other therapy factors that are likely to influence outcome.

Social Mishap Exposures for Social Anxiety Disorder: An Important Treatment Ingredient

Conventional cognitive-behavioral therapy for social anxiety disorder, which is closely based on the treatment for depression, has been shown to be effective in numerous randomized placebo-controlled trials. Although this intervention is more effective than waitlist control group and placebo conditions, a considerable number of clients do not respond to this approach. Newer approaches include techniques specifically tailored to this particular population. One of these techniques, social mishap exposure practice, is associated with significant improvement in treatment gains. We will describe here the theoretical framework for social mishap exposures that addresses the client's exaggerated estimation of social cost. We will then present clinical observations and outcome data of a client who underwent treatment that included such social mishap exposures. Findings are discussed in the context of treatment implications and directions for future research.

Prepared for the best: Readiness to modify attentional processing and reduction in anxiety vulnerability in response to therapy.

Individuals differ in the extent to which their vulnerability to anxiety is reduced by psychological therapy. However, the cognitive basis for such individual differences is still poorly understood. To test a cognitive account of differences in anxiety reduction in response to treatment, the present study examined individuals undergoing group therapy for social anxiety disorder. We assessed whether differences in their readiness to adopt selective attentional processing in response to an experimental contingency predicted positive changes in a range of anxiety measures in response to treatment. Findings were consistent with the position that readiness to alter attentional processing bias may underpin individual differences in the tendency to respond to positive experiential conditions, such as group therapy, by reducing anxiety vulnerability.

Psychotherapy for Social Anxiety Disorder: Long‐Term Effectiveness of Resource‐Oriented Cognitive‐Behavioral Therapy and Cognitive Therapy in Social Anxiety Disorder

Resource-oriented cognitive-behavioral therapy (ROCBT) and cognitive therapy (CT) have been shown to be effective treatments for social anxiety disorder. However, so far few studies have examined the long-term effectiveness of these treatments. Thus, there is little information available about the durability of change in treated patients with social anxiety disorder. This study examined the effectiveness of both treatments at 2-year and 10-year follow-up assessments. Patients who received ROCBT or CT were re-contacted after 2 (n = 51), and 10 years (n = 27), respectively, and completed a battery of self-report questionnaires. Treatment gains were maintained over the 2-year follow-up on all measures. Furthermore, there was a significant improvement on 2 social anxiety measures between posttreatment and the 10-year follow-up. ROCBT and CT did not differ in overall effectiveness. The results suggest that both treatments are effective and durable approaches in the treatment of social anxiety disorder.

Therapist adherence to interpersonal vs. supportive therapy for social anxiety disorder

We assessed therapist adherence to interpersonal therapy (IPT) and supportive therapy (ST) in a controlled trial for social anxiety disorder. Raters blindly scored n = 133 videotapes from 53 participants using the Collaborative Study Psychotherapy Rating Scale (CSPRS). Results reveal statistical differences across groups, but higher than expected overlap. Greater use of IPT in beginning sessions predicted better outcome in both therapies. Suboptimal adherence may be due to the crossed design in which the same therapists delivered both IPT and ST. Since switching between different approaches is a clinical reality for integrative psychotherapists, these findings may have important clinical implications.

Clinical and genetic outcome determinants of Internet‐ and group‐based cognitive behavior therapy for social anxiety disorder

No study has investigated clinical or genetic predictors and moderators of Internet-based cognitive behavior therapy (ICBT) compared with cognitive behavioral group therapy for (CBGT) for SAD. Identification of predictors and moderators is essential to the clinician in deciding which treatment to recommend for whom. We aimed to identify clinical and genetic (5-HTTLPR, COMTval158met, and BDNFval66met) predictors and moderators of ICBT and CBGT. We performed three types of analyses on data from a sample comprising participants (N = 126) who had undergone ICBT or CBGT in a randomized controlled trial. Outcomes were i) end state symptom severity, ii) SAD diagnosis, and iii) clinically significant improvement. The most stable predictors of better treatment response were working full time, having children, less depressive symptoms, higher expectancy of treatment effectiveness, and adhering to treatment. None of the tested gene polymorphisms were associated with treatment outcome. Comorbid general anxiety and depression were moderators meaning that lower levels were associated with a better treatment response in ICBT but not in CBGT. We conclude that demographic factors, symptom burden, adherence, and expectations may play an important role as predictors of treatment outcome. The investigated gene polymorphisms do not appear to make a difference.

Cost-effectiveness of Internet-based cognitive behavior therapy vs. cognitive behavioral group therapy for social anxiety disorder: Results from a randomized controlled trial

Social anxiety disorder (SAD) is highly prevalent and associated with a substantial societal economic burden, primarily due to high costs of productivity loss. Cognitive behavior group therapy (CBGT) is an effective treatment for SAD and the most established in clinical practice. Internet-based cognitive behavior therapy (ICBT) has demonstrated efficacy in several trials in recent years. No study has however investigated the cost-effectiveness of ICBT compared to CBGT from a societal perspective, i.e. an analysis where both direct and indirect costs are included. The aim of the present study was to investigate the cost-effectiveness of ICBT compared to CBGT from a societal perspective using a prospective design. We conducted a randomized controlled trial where participants with SAD were randomized to ICBT ( n = 64) or CBGT ( n = 62). Economic data were assessed at pre-treatment, immediately following treatment and six months after treatment. Results showed that the gross total costs were significantly reduced at six-month follow-up, compared to pre-treatment in both treatment conditions. As both treatments were equivalent in reducing social anxiety and gross total costs, ICBT was more cost-effective due to lower intervention costs. We conclude that ICBT can be more cost-effective than CBGT in the treatment of SAD and that both treatments reduce societal costs for SAD.

A 5-Year Follow-up of Internet-Based Cognitive Behavior Therapy for Social Anxiety Disorder

BackgroundInternet-based cognitive behavior therapy (CBT) has been shown to be a promising method to disseminate cognitive behavior therapy for social anxiety disorder (SAD). Several trials have demonstrated that Internet-based CBT can be effective for SAD in the shorter term. However, the long-term effects of Internet-based CBT for SAD are less well known.ObjectiveOur objective was to investigate the effect of Internet-based CBT for SAD 5 years after completed treatment.MethodWe conducted a 5-year follow-up study of 80 persons with SAD who had undergone Internet-based CBT. The assessment comprised a diagnostic interview and self-report questionnaires. The main outcome measure was the Liebowitz Social Anxiety Scale-Self-Report (LSAS-SR). Additional measures of social anxiety were the Social Interaction Anxiety Scale (SIAS) and the Social Phobia Scale (SPS). Attrition rates were low: 89% (71/80) of the participants completed the diagnostic interview and 80% (64/80) responded to the questionnaires.ResultsMixed-effect models analysis showed a significant effect of time on the three social anxiety measures, LSAS-SR, SIAS, and SPS (F 3,98 -102 = 16.05 - 29.20, P < .001) indicating improvement. From baseline to 5-year follow-up, participants’ mean scores on the LSAS-SR were reduced from 71.3 (95% confidence interval [CI] 66.1-76.5) to 40.3 (95% CI 35.2 - 45.3). The effect sizes of the LSAS-SR were large (Cohen’s d range 1.30 - 1.40, 95% CI 0.77 - 1.90). Improvements gained at the 1-year follow-up were sustained 5 years after completed treatment.ConclusionsInternet-based CBT for SAD is a treatment that can result in large and enduring effects.Trial registration Clinicaltrials.gov NCT01145690; http://clinicaltrials.gov/ct2/show/NCT01145690 (Archived by WebCite at http://www.webcitation.org/5ygRxDLfK)

Comparison of Group and Individual Cognitive-Behavioral Therapy in Reducing Fear of Negative Evaluation

Previous studies have established the efficacy of group and individual formats of cognitive-behavioral therapy in reducing fear of negative evaluation in social anxiety disorder, but the effectiveness of the group and individual therapies has not been widely assessed. This study was conducted to compare the effectiveness of cognitive-behavior group therapy to individual cognitive-behavioral therapy in social anxiety disorder. 28 patients were randomly allocated to two groups of 14. Each group participated in 12 weekly sessions. The final sample was 22 participants after drop-out. Pretest and posttest data were collected using the Brief Fear of Negative Evaluation Scale and the Beck Depression Inventory-II. Controlling for pretest fear of negative evaluation and depression, cognitive-behavioral group therapy was more effective than individual cognitive-behavioral therapy in reducing fear of negative evaluation, but the clinical significance and improvement rates of the two treatment formats were equivalent.