Changes in Judgment Biases and Use of Emotion Regulation Strategies During Cognitive-Behavioral Therapy for Social Anxiety Disorder: Distinguishing Treatment Responders from Nonresponders
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Although there is much support for the efficacy of cognitive behavioral therapy (CBT) in treating social anxiety disorder (SAD), many patients fail to respond adequately to treatment. In the present study, self-reported judgment biases (probability and cost estimates of negative social events) and emotion regulation strategies (cognitive reappraisal and expressive suppression) were measured at pre-, mid-, and posttreatment in 25 patients with SAD who completed 12 sessions of group CBT. We compared patterns of change across time in judgment biases and use of emotion regulation strategies during therapy among patients who were ultimately classified as responders (n = 15) and nonresponders (n = 10), and analyzed the extent to which early changes during treatment across these variables accounted for overall symptom improvement in social anxiety symptoms. Results revealed that change trajectories in social probability and cost estimates and use of cognitive reappraisal strategies differed as a function of responder status as patients moved through treatment. The early acquisition of cognitive reappraisal skills was uniquely predictive of overall social anxiety symptom reduction. Implications for clinical practice and research are discussed.
KeywordsSocial anxiety Cognitive behavioral therapy Treatment response Judgment biases Emotion regulation Cognitive reappraisal
This research was supported by an Ontario Mental Health Foundation New Investigator Fellowship and funding from the Canada Research Chairs Program awarded to David A. Moscovitch, and by NSERC and SSHRC Operating Grants awarded to Louis A. Schmidt. We express our gratitude to Sue McKee and to the clinicians, staff, and patients at the Anxiety Treatment and Research Centre, without whom this study would not have been possible.
- Antony, M. M., & Swinson, R. P. (2008). Shyness and social anxiety workbook: Proven, step-by-step techniques for overcoming your fear (2nd ed.). Oakland, CA: New Harbinger Publications.Google Scholar
- Clark, D. M., & Wells, A. (1995). A cognitive model of social phobia. In R. G. Heimberg, M. R. Liebowitz, D. A. Hope, & F. R. Schneier (Eds.), Social phobia: Diagnosis, assessment, and treatment (pp. 69–93). New York, NY: Guilford Press.Google Scholar
- Cohen, J. (1977). Statistical power analysis for the behavioural sciences. New York: Academic Press.Google Scholar
- First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (1996). Structured clinical interview for Axis I and II DSM-IV disorders—Patient edition (SCID-I/P). New York, NY: New York State Psychiatric Institute, Biometrics Research Department.Google Scholar
- Gravetter, F. J., & Wallnau, L. B. (2007). Statistics for the behavioral sciences (7th ed.). Belmont, CA: Thomson Wadsworth.Google Scholar
- Guy, W. (Ed.). (1976). ECDEU assessment for psychopharmacology (revised). Rockville, MD: NIMH Publication.Google Scholar
- Otto, M. W., Pollack, M. H., Gould, R. A., Worthington, J. J., McArdle, E. T., Rosenbaum, J. F., et al. (2000). A comparison of the efficacy of clonazepam and cognitive-behavioral group therapy for the treatment of social phobia. Journal of Anxiety Disorders, 14, 345–358.PubMedCrossRefGoogle Scholar
- Zaider, T. I., Heimberg, R. G., Fresco, D. M., Schneier, F. R., & Liebowitz, M. R. (2003). Evaluation of the clinical global impression scale among individuals with social anxiety disorder. Psychological Medicine: A Journal of Research in Psychiatry and the Allied Sciences, 33, 611–622.CrossRefGoogle Scholar