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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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Abstract

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.

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Notes

  1. Because we were particularly interested in understanding potential differences between responder and nonresponder groups when members of each group were exposed to the identical treatment regimen, patients who dropped out of therapy were excluded from the primary analyses. Participants who drop out of treatment early may do so for reasons unrelated to the effects of treatment itself (i.e., low motivation or readiness to change), and we wished to focus specifically on treatment-related mechanisms that may underlie differential response to CBT in responders versus nonresponders. Participants who dropped out of treatment (n = 8) did not differ significantly from either responders or nonresponders on pretreatment measures of social probability and cost estimates, expressive suppression, or emotion suppression (all p’s > .38).

  2. In each of the treatment groups, some patients consented to participate in the present study, while others did not. Although we were, therefore, unable to audiotape group treatment sessions to obtain a more objective measure of adherence, establishing objectively that the therapists adhered strictly to the CBT manual would have been particularly important in the context of a study that was designed to compare the effects of two or more treatment conditions.

  3. To rule out the influence of comorbidity on our results, the primary MANOVA was repeated as a multivariate analysis of covariance (MANCOVA) with number of comorbid diagnoses entered as a covariate. The inclusion of comorbidity as a covariate did not impact the results. The multivariate tests revealed a non-significant main effect of comorbidity, F(4, 18) = .80, P = .54, partial η2 = .15, as well as a non-significant time X comorbidity interaction, F(8, 14) = 1.58, P = .22, partial η2 = .47. The main effect of time and the time X group interaction effect from the original MANOVA remained significant, even with comorbidity entered as a covariate in the model, F’s (8, 14) > 5.85, P’s < .002, partial η2’s > .77. The pattern of results in the follow-up tests was also unaffected when comorbidity was entered as a covariate in the model.

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Acknowledgments

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.

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Authors and Affiliations

  1. Department of Psychology, University of Waterloo, 200 University Ave. West, Waterloo, ON, N2L 3G1, Canada

    David A. Moscovitch & Dubravka L. Gavric

  2. Department of Psychology, Concordia University, Montreal, Canada

    Jessica M. Senn

  3. Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, Canada

    Diane L. Santesso & Louis A. Schmidt

  4. McMaster Integrative Neuroscience Discovery and Study, McMaster University, Hamilton, Canada

    Vladimir Miskovic & Louis A. Schmidt

  5. Anxiety Treatment and Research Centre, St. Joseph’s Healthcare Hamilton, and Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada

    Randi E. McCabe

  6. Department of Psychology, Ryerson University, Toronto, Canada

    Martin M. Antony

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  1. David A. Moscovitch
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Correspondence to David A. Moscovitch.

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Moscovitch, D.A., Gavric, D.L., Senn, J.M. et al. Changes in Judgment Biases and Use of Emotion Regulation Strategies During Cognitive-Behavioral Therapy for Social Anxiety Disorder: Distinguishing Treatment Responders from Nonresponders. Cogn Ther Res 36, 261–271 (2012). https://doi.org/10.1007/s10608-011-9371-1

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