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

ABSTRACT: 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.

SUBMITTER: Goldin PR

PROVIDER: S-EPMC4274797 | biostudies-literature | 2013 Jul

REPOSITORIES: biostudies-literature

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

Goldin Philippe R PR Jazaieri Hooria H Ziv Michal M Kraemer Helena H Heimberg Richard R Gross James J JJ

Clinical psychological science : a journal of the Association for Psychological Science 20130701 3

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) change ...[more]

PMID: 25541599

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Project description:ImportanceCognitive behavioral therapy (CBT) for social anxiety disorder (SAD) is thought to enhance cognitive reappraisal in patients with SAD. Such improvements should be evident in cognitive reappraisal-related prefrontal cortex responses.ObjectiveTo determine whether CBT for SAD modifies cognitive reappraisal-related prefrontal cortex neural signal magnitude and timing when implementing cognitive reappraisal with negative self-beliefs. DESIGN Randomized clinical trial of CBT for SAD vs wait-list control group during a study that enrolled patients from 2007 to 2010.SettingUniversity psychology department.ParticipantsSeventy-five patients with generalized SAD randomly assigned to CBT or wait list.InterventionSixteen sessions of individual CBT for SAD.Main outcome measuresNegative emotion ratings and functional magnetic resonance imaging blood oxygen-level dependent signal when reacting to and cognitively reappraising negative self-beliefs embedded in autobiographical social anxiety situations. RESULTS During reactivity trials, compared with wait list, CBT produced (1) greater reduction in negative emotion ratings and (2) greater blood oxygen-level dependent signal magnitude in the medial prefrontal cortex. During cognitive reappraisal trials, compared with wait list, CBT produced (3) greater reduction in negative emotion ratings, (4) greater blood oxygen level-dependent signal magnitude in the dorsolateral and dorsomedial prefrontal cortex, (5) earlier temporal onset of dorsomedial prefrontal cortex activity, and (6) greater dorsomedial prefrontal cortex-amygdala inverse functional connectivity.Conclusions and relevanceModulation of cognitive reappraisal-related brain responses, timing, and functional connectivity may be important brain changes that contribute to the effectiveness of CBT for social anxiety. This study demonstrates that clinically applied neuroscience investigations can elucidate neurobiological mechanisms of change in psychiatric conditions.Trial registrationclinicaltrials.gov Identifier: NCT00380731.

Project description:Background and aimsInternet-based cognitive-behavioral therapy (iCBT) for social anxiety disorder has been found effective, as attested by independently conducted randomized controlled trials in four languages. The study aim is to test the efficacy of an iCBT program in a culture where it was not tested before (i.e. Romania).MethodsParticipants (n = 76) were recruited, screened and randomized to either a nine-week guided iCBT or a wait-list control group in April and May 2012. Self-report measures were collected before (April 2012) and after the intervention (July 2012), as well as six months later (January 2013). Although social anxiety was assessed with multiple measures, the Liebowitz Social Anxiety Scale - Self Report version (LSAS-SR) and Social Phobia Inventory (SPIN) were used as the primary outcome measures.ResultsA significant difference with a large between-group effect size in favor of iCBT was found (Cohen's d = 1.19 for LSAS-SR and d = 1.27 for SPIN). Recovery rates show that 36.8% (n = 14) in the treatment group score below the SPIN clinical cut-off compared to only 2.6% (n = 1) in the wait-list control group. Post-intervention clinical interviews also revealed that 34.2% (n = 13) of the treatment group was completely recovered (full remission) while additionally 36.8% (n = 14) retained some social anxiety symptoms (partial remission). However, an important study limitation is that post-intervention interviewers were not blinded to the study conditions. The program also effectively reduced depression and dysfunctional thinking (between-group Cohen's d = 0.84 for depression and d = 0.63 for dysfunctional thinking). Moreover, the iCBT intervention appears to have a long-term impact for participants' functioning, as the treatment gains were maintained six months later.ConclusionsInternet-delivered interventions display a high potential to quickly and widely disseminate effective evidence-based programs around the world. This study provides support for guided iCBT as a promising treatment approach in Romania.Trial registrationClinicalTrials.gov NCT01557894.

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

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

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