RESEARCH PAPERSPredictors of Response to Cognitive-Behavioral Group Therapy for Social Phobia
Section snippets
Social Impairment
Socially phobic people share the common fear of being negatively evaluated, yet are quite diverse in their degree of social impairment (American Psychiatric Association (1987), American Psychiatric Association (1994)). Clients with social phobia can be classified as belonging to specific (or nongeneralized) or generalized subtypes on the basis of the pervasiveness of their social fear, with the latter being associated with more severe symptoms (e.g., Tran and Chambless, 1995).
Several studies
Depression
The notable prevalence of a comorbid diagnosis of depression in clients with a primary diagnosis of social phobia (e.g., van Ameringen et al., 1991) prompts examination of the effect of mood state on clients' response to treatment. In such research, it is important to control for initial severity of social phobia, which is typically higher in more depressed clients (e.g., Heimberg et al., 1990b). Mixed findings have been obtained. Feske and colleagues (Feske et al., 1996) found that, compared
Personality Disorders
Research on personality disorders and treatment outcome for social phobia has focused almost exclusively on the effect of avoidant personality disorder (APD), the most common comorbid personality disorder for social phobia. The findings are inconsistent. Feske and associates (1996) found that, among clients with generalized social phobia, those with APD reported less improvement on overall functioning, but not on social anxiety, at termination of eclectic-behavior therapy than those without
Treatment Expectancy
The effect of treatment expectancy on outcome for social phobia has yet to be examined, but findings from subclinical speech phobia research suggest the importance of this variable. In studies conducted to date, clients' perceptions of treatment credibility and their expectations for improvement significantly predicted their responses to short-term therapy for speech anxiety (Kirsch and Henry, 1977Kirsch and Henry, 1979).
Posttreatment Negative Cognitions and Treatment Maintenance
Beck and Emery (1985) propose that socially phobic individuals are hypersensitive to the possibility of external evaluation and believe that they lack the personal resources (e.g., social skills, physical attractiveness, intellectual ability) to prevent social devaluation and rejection. At the core of the disorder are a vigilant cognitive set for rejection, rigid rules for socially appropriate behaviors, and exaggerated expectations about the consequences of failure.
Consistent with cognitive
Research Questions
In the present study, we examine the independent and shared effects of the following potential predictors of improvement after group CBT for social phobia at posttest and 6-month follow-up: degree of social impairment, depression, personality disorder traits, and treatment expectancy. Further, we test the relationship between cognitive change and treatment outcome, in particular the hypothesis that clients who have higher rates of negative thinking at posttest will relapse at a greater rate
Participants
The sample included 27 men and 35 women2 who entered the treatment program for social phobia at the American University Agoraphobia and Anxiety Program. All clients met DSM-III-R (American Psychiatric Association, 1987) criteria for a primary diagnosis of social phobia and were classified as generalized (n = 41) or specific (n = 21) in
Preliminary Analyses
Attrition. Of the 64 social phobic clients accepted for treatment, 2 refused treatment and 2 dropped out after pretest assessment. Of the remaining 60 clients who completed treatment, 59 provided posttest data. Forty-eight treatment completers returned 6 months later for follow-up assessment. We did not attempt to collect follow-up data from the first group of participants (n = 5). Because of missing data on some measures, sample sizes vary slightly in the analyses conducted.
Compositing outcome
Client Attributes and Treatment Outcome
Predictor intercorrelations. Two types of predictors were considered to assess their effects on short-term (pre/post) and long-term (pre/follow-up) symptom changes with treatment: predictors of substantive interest (treatment expectancy, depression, social impairment, and personality disorder traits) and predictors as control variables (psychotropic medication and additional therapy during follow-up). With the exception of depression, there was minimal overlap among most predictors.
Data
DISCUSSION
As has been true of previous research on social phobia and of research on other anxiety disorders (e.g., Steketee and Shapiro, 1995), the results of the present study yielded few predictors of treatment outcome for social phobia, and even these were not consistent across outcome measures.
The most salient predictor was depression. Clients with higher pretreatment scores on the Beck Depression Inventory were less likely to improve or remain improved on anxious apprehension and on self-rated
Acknowledgements
The authors wish to thank the many graduate students at American University who made this research possible by participating as raters, role play partners, and research assistants. We also thank Richard Heimberg for his generosity in sharing his treatment manual and Kristin Staroba and Melina Walker for their assistance in data analysis and reliability ratings.
References (60)
- et al.
Assessment of social phobia: Reliability of an impromptu speech task
Journal of Anxiety Disorders
(1989) - et al.
Credibility of analogue therapy rationales
Journal of Behavior Therapy and Experimental Psychiatry
(1972) - et al.
Social phobia subtype and avoidant personality disorder: Effect on severity of social phobia, impairment, and outcome of cognitive-behavioral treatment
Behavior Therapy
(1995) Predicting outcome after treatment for generalised anxiety disorder
Behaviour Research and Therapy
(1993)- et al.
MCMI-diagnosed personality disorders among agoraphobic outpatients: Prevalence and relationship to severity and treatment outcome
Journal of Anxiety Disorders
(1992) - et al.
Adherence during sessions and homework in cognitive-behavioral group treatment of social phobia
Behaviour Research and Therapy
(1995) - et al.
Effects of historically portrayed modeling and group treatment on self-observation: A comparison with agoraphobics
Behaviour Research and Therapy
(1975) - et al.
Cognitive behavioral versus exposure only treatment for social phobia: A meta-analysis
Behavior Therapy
(1995) - et al.
The impact of variations in treatment rationales on expectancies for therapeutic change
Behavior Therapy
(1983) - et al.
The revised Stroop color-naming task in social phobics
Behaviour Research and Therapy
(1993)
Methodological issues in prediction of treatment outcome
Clinical Psychology Review
Predicting behavioral treatment outcome for agoraphobia and obsessive-compulsive disorder
Clinical Psychology Review
Cognitive processes in social phobia
Behaviour Research and Therapy
Psychopathology of social phobia: Effects of subtype and of avoidant personality disorder
Journal of Anxiety Disorders
Relationship of social phobia with other psychiatric illness
Journal of Affective Disorders
Physiological habituation to continuous phobic stimulation
Behaviour Research and Therapy
Self-focused attention in the treatment of social phobia
Behaviour Research and Therapy
The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations
Journal of Personality and Social Psychology
States of mind model and cognitive change in treated social phobics
Cognitive Therapy and Research
A comparison of cognitive therapy, applied relaxation, and imipramine in the treatment of panic disorder
British Journal of Psychiatry
Avoidant personality disorder as a predictor for severity and treatment outcome among generalized social phobics
Journal of Personality Disorders
Cited by (187)
Do depressive symptoms affect the outcome of treatments for SAD? A meta analysis of randomized controlled trials
2020, Clinical Psychology ReviewMotivational interviewing prior to cognitive behavioural treatment for social anxiety disorder: A randomised controlled trial
2019, Journal of Affective DisordersPositivity-approach training for depressive symptoms: A randomized controlled trial
2019, Journal of Affective DisordersCitation Excerpt :Depressive symptoms are, for instance, associated with a higher chronic disease burden (Poole and Steptoe, 2018) and a higher mortality risk (Everson-Rose et al., 2004). They also predict worse treatment outcome in other psychological disorders, such as social phobia (Chambless et al., 1997), obsessive-compulsive disorder (Keijsers et al., 1994), or drug dependence (Compton et al., 2003). Thus, reducing depressive symptom severity in clinical settings is an important treatment target.
Modification of Hostile Interpretation Bias in Depression: A Randomized Controlled Trial
2018, Behavior Therapy
- 1
Dianne Chambless is now at the University of North Carolina-Chapel Hill.