Abstract
The present study examined the reciprocal relationships between probability estimates, cost estimates, and social anxiety during a 12-week course of cognitive-behaviour therapy (CBT) for social anxiety disorder (SAD). One hundred and sixty-three individuals with a principal diagnosis of SAD completed a weekly tracking measure that included questions about probability and cost estimates for negative consequences and current levels of social anxiety relating to a hypothetical speech task. Paired-samples t tests revealed that these variables changed from pre-to-post treatment. Cross-lagged path analyses revealed that cost estimates predicted subsequent changes in social anxiety levels early in treatment, over and above previous anxiety ratings, while probability estimates predicted subsequent levels of social anxiety at the final stages of treatment, over and above previous anxiety ratings. Overall, the results indicated that (1) cost bias early in treatment predicts subsequent social anxiety levels, and (2) both probability and cost estimates seem to play important, but seemingly independent, roles as mechanisms of change in CBT for SAD.
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Aderka, I. M., McLean, C. P., Huppert, J. D., Davidson, J. R. T., & Foa, E. B. (2013). Fear, avoidance and psychological symptoms during cognitive-behavioral therapy for social anxiety disorder. Behaviour Research and Therapy, 51, 352–358. doi:10.1016/j.brat.2013.03.007.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Andrews, G., Freed, S., & Teesson, M. (1994). Proximity and anticipation of a negative outcome in phobias. Behaviour Research and Therapy, 32, 643–645. doi:10.1016/0005-7967(94)90020-5.
Beck, A. T. (1976). Cognitive therapy and the emotional disorders. New York: International Universities Press.
Bentler, P. M. (1990). Comparative fit indices in structural equation models. Psychological Bulletin, 107, 238–246. doi:10.1037/0033-2909.107.2.238.
Bentler, P. M., & Bonett, D. G. (1980). Significance tests and goodness of fit in the analysis of covariance structure. Psychological Bulletin, 88, 588–606. doi:10.1037/0033-2909.88.3.588.
Bentler, P. M., & Moojaart, A. (1989). Choice of structural equation models via parsimony: A rational based on precision. Psychological Bulletin, 106, 315–317. doi:10.1037/0033-2909.106.2.315.
Carr, A. T. (1974). Compulsive neurosis: A review of the literature. Psychological Bulletin, 81, 311–318. doi:10.1037/h0036473.
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: Guilford Press.
Davidson, J. R. T., Foa, E. B., Huppert, J. D., Keefe, F. J., Franklin, M. E., Compton, J. S., & Gadde, K. M. (2004). Fluoxetine, comprehensive cognitive behavioral therapy, and placeboin generalized social phobia. Archives of General Psychiatry, 61, 1005–1013. doi:10.1001/archpsyc.61.10.1005.
Di Nardo, P. A., Brown, T. A., & Barlow, D. H. (1994). Anxiety disorders interview schedule for DSM-IV-Lifetime version. Allbany, NY: Grey-wind Publications.
Foa, E. B., Franklin, M. E., Perry, K. J., & Herbert, J. D. (1996). Cognitive biases in generalized social phobia. Journal of Abnormal Psychology, 105, 433–439. doi:10.1037/0021-843X.105.3.433.
Gilboa-Schechtman, E., Franklin, M. E., & Foa, E. B. (2000). Anticipated reactions to social events: Differences among individuals with generalised social phobia, obsessive compulsive disorder, and nonanxious controls. Cognitive Therapy and Research, 24, 731–746. doi:10.1023/A:1005595513315.
Goldin, P. R., Lee, I., Zic, M., Jazaieri, H., Heimberg, R. G., & Gross, J. J. (2014). Trajectories of change in emotion regulation and social anxiety disorder during cognitive behavioural therapy for social anxiety disorder. Behaviour Research and Therapy, 56, 7–15. doi:10.1016/j.brat.2014.02.005.
Goldin, P. R., Ziv, M., & Gross, J. J. (2012). Cognitive reappraisal self-efficacy mediates the effects of individual cognitive-behaviour therapy for social anxiety disorder. Journal of Consulting and Clinical Psychology, 80, 1034–1040. doi:10.1037/a0028555.
Heimberg, R. G., & Becker, R. E. (2002). Cognitive-behavioral group therapy for social phobia: Basic mechanisms and clinical strategies. New York: Guilford.
Heimberg, R. G., Brozovich, F. A., & Rapee, R. M. (2010). A cognitive-behavioral model of social anxiety disorder: Update and extension. In S. G. Hofmann & P. M. DiBartolo (Eds.), Social anxiety: Clinical, developmental, and social perspectives (pp. 395–422). New York: Academic Press.
Hoffart, A., Borge, F. M., Sexton, H., & Clark, D. M. (2009). Change processes in residential cognitive and interpersonal psychotherapy for social phobia: A process-outcome study. Behavior Therapy, 40, 10–22. doi:10.1016/j.beth.2007.12.003.
Hofmann, S. G. (2004). Cognitive mediation of treatment change in social phobia. Journal of Consulting and Clinical Psychology, 72, 392–399. doi:10.1037/0022-006X.72.3.392.
Hofmann, S. G. (2007). Cognitive factors that maintain social anxiety disorder: A comprehensive model and its treatment implications. Cognitive Behaviour Therapy, 36, 193–209. doi:10.1080/16506070701421313.
Hu, L., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6, 1–55. doi:10.1080/10705519909540118.
Kazdin, A. E. (2007). Mediators and mechanisms of change in psychotherapy research. Annual Review of Clinical Psychology, 3, 1–27. doi:10.1146/annurev.clinpsy.3.022806.091432.
Kline, R. B. (1998). Principles and practice of structural equation modeling. New York, NY: Guilford Press.
Little, R. J. A., & Rubin, D. B. (1989). The analysis of social science data with missing values. Sociological Methods & Research, 18, 292–326. doi:10.1177/0049124189018002004.
Loranger, A. W., Janca, A., & Sartorius, N. (1997). Assessment and diagnosis of personality disorders. Cambridge: Cambridge University Press.
Lucock, M. P., & Salkovskis, P. M. (1988). Cognitive factors in social anxiety and its treatment. Behaviour Research and Therapy, 26, 297–302. doi:10.1016/0005-7967(88)90081-2.
McManus, F., Glark, D. M., & Hackmann, A. (2000). Specificity of cognitive biases in social phobia and their role in recovery. Behavioural and Cognitive Psychotherapy, 28, 201–209. doi:10.1891/0889-8391.24.3.213.
Morrison, A. S., & Heimberg, R. G. (2013). Social anxiety and social anxiety disorder. Annual Review of Clinical Psychology, 9, 249–274. doi:10.1146/annurev-clinpsy-050212-185631.
Moscovitch, D. A. (2009). What is the core fear in social phobia? A new model to facilitate individualized case conceptualisation and treatment. Cognitive and Behavioural Practice, 16, 123–134. doi:10.1016/j.cbpra.2008.04.002.
Nelson, E. A., Deacon, B. J., Lickel, J. J., & Sy, J. T. (2010a). Targeting the probability versus cost of fears outcomes in public speaking anxiety. Behaviour Research and Therapy, 48, 282–289. doi:10.1016/j.brat.2009.11.007.
Nelson, E. A., Lickel, J. J., Sy, J. T., Dixon, L. J., & Deacon, B. J. (2010b). Probability and cost biases in social phobia: Nature, specificity, and relationship to treatment outcome. Journal of Cognitive Psychotherapy: An International Quarterly, 24, 213–228. doi:10.1891/0889-8391.24.3.213.
Norton, P. J., & Price, E. C. (2007). A meta-analytic review of adult cognitive-behavioral treatment outcome across the anxiety disorders. Journal of Nervous and Mental Disease, 195, 521–531. doi:10.1097/01.nmd.0000253843.70149.9a.
O’Toole, M. S., Mennin, D. S., Hougaard, E., Zachariae, R., & Rosenberg, N. K. (2014). Cognitive and emotion regulation change processes in cognitive behavioural therapy for social anxiety disorder. Clinical Psychology & Psychotherapy,. doi:10.1002/cpp.1926.
Otto, M. W., Pollack, M. H., Gould, R. A., Worthington, J. J, I. I. I., McArdle, E. T., Rosenbaum, J. F., & Heimberg, R. G. (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. doi:10.1016/S0887-6185(00)00027-X.
Rapee, R. M., Gaston, J. E., & Abbott, M. J. (2009). Testing the efficacy of theoretically derived improvements in the treatment of social phobia. Journal of Consulting and Clinical Psychology, 77, 317–327. doi:10.1037/a0014800.
Rapee, R. M., & Heimberg, R. G. (1997). A cognitive-behavioral model of anxiety in social phobia. Behaviour Research and Therapy, 35, 741–756. doi:10.1016/S0005-7967(97)00022-3.
Rapee, R. M., MacLeod, C., Carpenter, L., Gaston, J. E., Frei, J., Peters, L., & Baillie, A. J. (2013). Integrating cognitive bias modification into a standard cognitive behavioural treatment package for social phobia: A randomized controlled trial. Behaviour Research and Therapy, 51, 207–215. doi:10.1016/j.brat.2013.01.005.
Rapee, R. M., & Sanderson, W. C. (1998). Social phobia: Clinical application of evidence-based psychotherapy. Northvale, NJ: Aronson.
Satorra, A., & Bentler, P. M. (1998). Scaling corrections for Chi square statistics in covariance structure analysis. Proceedings of the American Statistical Association (pp. 308–313).
Satorra, A., & Bentler, P. M. (2001). A scaled difference Chi square test statistic for moment structure analysis. Psychometrika, 66, 507–514. doi:10.1007/BF02296192.
Smits, J. A., Rosenfield, D., McDonald, R., & Telch, M. J. (2006). Cognitive mechanisms of social anxiety reduction: An examination of specificity and temporality. Journal of Consulting and Clinical Psychology, 74, 1203–1212. doi:10.1037/0022-006X.74.6.1203.
Steiger, J. H. (1980). Test for comparing elements of a correlation matrix. Psychological Bulletin, 87, 245–251. doi:10.1037/0033-2909.87.2.245.
Tabachnick, B. G., & Fidell, L. S. (2004). Using multivariate statistics (5th ed.). Boston: Pearson Publications.
Uren, T. H., Szabó, M., & Lovibond, P. F. (2004). Probability and cost estimates for social and physical outcomes in social phobia and panic disorder. Journal of Anxiety Disorders, 18, 481–498. doi:10.1016/S0887-6185(03)00028-8.
Voncken, M. J., Bo¨gels, S. M., & de Vries, K. (2003). Interpretation and judgmental biases in social phobia. Behaviour Research and Therapy, 41, 1481–1488. doi:10.1016/S0005-7967(03)00143-8.
Voncken, M. H., & Bögels, S. M. (2006). Changing interpretation and judgmental bias in social phobia: A pilot study of a short, highly structured cognitive treatment. Journal of Cognitive Psychotherapy, 20, 59–73. doi:10.1891/0889-8391.24.3.213.
Wilson, J. K., & Rapee, R. M. (2005). The interpretation of negative social events in social phobia: Changes during treatment and relationship to outcome. Behaviour Research and Therapy, 43, 373–389. doi:10.1016/j.brat.2004.02.006.
Acknowledgments
The research was supported in part by the National Health and Medical Research Council (NHMRC Project Grant 192107; NHMRC Project Grant 434213). We thank Idan Aderka for statistical advice.
Conflict of Interest
Bree Gregory, Lorna Peters, Maree J. Abbott, Jonathan E. Gaston, and Ronald M. Rapee declare that they have no conflict of interest.
Informed Consent
All procedures were in accordance with the ethical standards of the responsible committee on human experimentation (national and institutional). Informed consent was obtained from all individual participants in the study.
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No animal studies were carried out by the authors for this article.
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Gregory, B., Peters, L., Abbott, M.J. et al. Relationships Between Probability Estimates, Cost Estimates, and Social Anxiety During CBT for Social Anxiety Disorder. Cogn Ther Res 39, 636–645 (2015). https://doi.org/10.1007/s10608-015-9692-6
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DOI: https://doi.org/10.1007/s10608-015-9692-6