Abstract
Given the putative importance of maladaptive self-beliefs in cognitive models of social anxiety, there is growing interest in the construct’s influence on social anxiety reduction in treatment. The present study sought to examine whether maladaptive self-beliefs reduce over a 12-week course of cognitive behavioural therapy (CBT) for social anxiety disorder (SAD), and whether change in self-beliefs is an indicator of later change in social anxiety symptom severity within treatment. Participants were 77 individuals with SAD who completed measures of maladaptive self-beliefs every 2 weeks of the treatment protocol and measures of social anxiety each week. Using a dynamic bivariate latent difference score framework, results indicated that maladaptive self-beliefs reduced during CBT for SAD, and that change in maladaptive self-beliefs was a significant predictor of later change in social anxiety symptom severity. Reductions in social anxiety was not a significant predictor of later change in self-beliefs. Findings underscore the importance of maladaptive self-beliefs in the maintenance of social anxiety and in treatment for SAD. Moreover, they permit inferences about the temporal sequence of change processes in therapy and are consistent with CBT therapeutic models suggesting that cognitive change precedes symptom change.
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Notes
These participants were part of an ongoing randomised treatment trial for the treatment of SAD at the CEH, all of whom received 12 weeks group CBT following either three individual preparatory sessions of motivational interviewing or three individual preparatory sessions of supportive counselling. Participants in the present study represent 39% of the participants included in the treatment trial.
For the current study, time was nested within individuals who were also nested within groups throughout treatment. However, intra-class correlation coefficients (ICCs) calculated using the program HLM 7.01 (Raudenbush et al. 2013) demonstrated that there was little effect of group variance on variable scores (i.e., all ICCs < 0.05). Thus, accounting for the three-level hierarchical data structure was not considered a necessary endeavour. The RCT also randomly allocated participants to receive two different types of three weekly and individual preparatory sessions prior to group CBT. Results also indicated that there was no significant random component attributable to this allocation in the models (i.e., all ICCs < 0.05), and therefore the treatment conditions were collapsed and only the nested effect of individuals remained controlled for. For these analyses, please contact the corresponding author.
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This research was supported by a National Health and Medical Research Council Grant (NHMRC Project Grant 102411) awarded to Dr. Lorna Peters.
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Gregory, B., Wong, Q.J.J., Marker, C.D. et al. Maladaptive Self-Beliefs During Cognitive Behavioural Therapy for Social Anxiety Disorder: A Test of Temporal Precedence. Cogn Ther Res 42, 261–272 (2018). https://doi.org/10.1007/s10608-017-9882-5
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DOI: https://doi.org/10.1007/s10608-017-9882-5