Fear of Negative Evaluation and Rapid Response to Treatment During Cognitive Behaviour Therapy for Social Anxiety Disorder

  • Karen AuyeungEmail author
  • Lance L. Hawley
  • Kevin Grimm
  • Randi McCabe
  • Karen Rowa
Original Article


Cognitive behavioural therapy (CBT) for Social Anxiety Disorder (SAD) is an effective intervention for SAD, however, many individuals with SAD remain symptomatic at the end of CBT. Therefore, it is important to understand variables that influence patients’ responses to treatment. The present study investigated temporal changes in SAD symptoms as related to fear of negative evaluation (FNE) in a clinical sample of individuals with SAD who completed CBT. Participants with SAD (N = 175) completed self-report measures of SAD symptoms and FNE weekly across 12 weeks of group CBT. We used latent difference score dynamic modelling to explore the relationship between SAD symptom scores and FNE during CBT. Reductions in FNE were associated with subsequent reductions in SAD symptoms for individuals who showed a rapid response to treatment. The coupling of FNE and subsequent reductions in SAD symptoms was not seen in individuals not showing a rapid response. This study provides further support for the phenomenon of rapid response in CBT for SAD and suggests that mechanisms of change may be different for rapid responders as compared to non-rapid responders. The results of the current study may have implications for understanding the mechanisms underlying treatment response during CBT for SAD and for whom particular mechanisms are relevant.


Social anxiety Cognitive behavior therapy Fear of negative evaluation Rapid response 



There are no sources of funding to declare.

Compliance with Ethical Standards

Conflict of Interest

Karen Auyeung, Lance L. Hawley, Kevin Grimm, Randi McCabe, and Karen Rowa declares that there are no potential conflicts of interest

Ethical Approval

All procedures performed in current study were in accordance with the Ethical Standards of the Ethical Committee of Ghent University and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Animal Rights

This article does not contain any studies with animals performed by any of the authors.

Supplementary material

10608_2020_10077_MOESM1_ESM.docx (24 kb)
Supplementary file1 (DOCX 24 kb)


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Authors and Affiliations

  1. 1.Anxiety Treatment and Research ClinicSt. Joseph’s HealthcareHamiltonCanada
  2. 2.Sunnybrook Health Sciences CentreTorontoCanada
  3. 3.Department of PsychiatryUniversity of TorontoTorontoCanada
  4. 4.Department of PsychologyArizona State UniversityArizonaUSA
  5. 5.Department of Psychiatry and Behavioural NeurosciencesMcMaster UniversityHamiltonCanada
  6. 6.North Shore Stress and Anxiety ClinicNorth VancouverCanada

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