Exploring the temporal associations between avoidance behavior and cognitions during the course of cognitive behavioral therapy for clients with symptoms of social anxiety disorder

Lervik, Linn Vathne; Hoffart, Asle; Knapstad, Marit; Smith, Otto Robert Frans

doi:10.1080/10503307.2021.1930243

Cited by 8 publications

(4 citation statements)

References 51 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our second post hoc analysis indicated that this was not due to the omission of the variable depression in the model. It is therefore likely that other mechanisms were involved, for example, operating through mediators like anxiety cognitions and avoidance behavior [38].…”

Section: Discussionmentioning

confidence: 99%

The Importance of Symptom Reduction for Functional Improvement after Cognitive Behavioral Therapy for Anxiety and Depression: A Causal Mediation Analysis

Smith¹,

Aarø²,

Knapstad³

2023

Psychother Psychosom

View full text Add to dashboard Cite

Introduction: The temporal relationship between symptoms and functioning in the context of cognitive behavioral therapy (CBT) for anxiety and depression is not fully understood, and there are few high-quality studies that have examined to what extent late intervention effects of CBT on functioning are mediated by initial intervention effects on symptoms while accounting for the initial effects on functioning and vice versa. Objective: The aim of the study was to investigate whether intervention effects on symptoms and functioning at 12-month follow-up were mediated by intervention effects on these outcomes at 6-month follow-up. Methods: Participants with anxiety and/or mild-to-moderate depression were randomly assigned to a primary mental health care service (n = 463) or treatment-as-usual (n = 215). Main outcomes were depressive symptoms (Patient Health Questionnaire [PHQ-9]), anxiety (General Anxiety Disorder-7 [GAD-7]), and functioning (Work and Social Adjustment Scale [WSAS]). Direct/indirect effects were derived using the potential outcomes and counterfactual framework. Results: The intervention effect on functioning at 12 months was largely explained by intervention effects at 6 months on depressive symptoms (51%) and functioning (39%). The intervention effect on depressive symptoms at 12 months was largely explained by the intervention effect at 6 months on depressive symptoms (70%) but not by functioning at 6 months. The intervention effect on anxiety at 12 months was only partly accounted for by intervention effects at 6 months on anxiety (29%) and functioning (10%). Conclusions: The findings suggest that late intervention effects of CBT on functioning were to a substantial degree explained by initial intervention effects on depressive symptoms even after accounting for initial effects on functioning. Our results support the importance of symptoms as an outcome in the context of CBT delivered in primary health care.

show abstract

Section: Discussionmentioning

confidence: 99%

The Importance of Symptom Reduction for Functional Improvement after Cognitive Behavioral Therapy for Anxiety and Depression: A Causal Mediation Analysis

Smith¹,

Aarø²,

Knapstad³

2023

Psychother Psychosom

View full text Add to dashboard Cite

show abstract

“…Another interesting study evaluating mechanisms of change asked an age-old question among CBT clinical researchers: “Does changing cognitions change behavior, or does changing behavior change cognitions?” Using a sample of patients with SAD who received CBT, the study found that avoidance behavior predicted cognitions at subsequent timepoints but not vice versa 68 . This is a fascinating finding showing the direct pathway from behavior to cognition but not the opposite, which is the more traditional way that the cognitive model is presented to patients.…”

Section: Recent Advances In Improving the Treatment Of Sadmentioning

confidence: 96%

Recent advances in the understanding and psychological treatment of social anxiety disorder

Wolitzky-Taylor¹,

LeBeau²

2023

Fac Rev

View full text Add to dashboard Cite

Social anxiety disorder (SAD) is characterized by persistent anxiety or avoidance of social situations because of a fear of negative evaluation. Cognitive behavioral therapy (CBT) (typically with an exposure component) is a first-line treatment for social anxiety, but there remains room for improvement with regard to treatment efficacy. Therefore, the field continues to better understand the mechanisms underlying SAD and its common and complex comorbidities in order to develop targeted interventions to improve symptom outcomes. Additionally, efforts are under way to improve the efficacy and accessibility of CBT. This review outlines major advances in understanding and treating SAD in adults over the past roughly 3 years (2019 to early May 2022). Themes are identified and discussed, as are recommendations for future research.

show abstract

“…Another process scale is the 28-item Social Behavior Questionnaire (SBQ) which measures the presence of avoidance and safety behaviours common in social anxiety disorder, including strategies for impression management (Gray et al ., 2019). These behaviours are at the core of most cognitive behavioural conceptualizations of the maintenance of social anxiety disorder, and are believed to maintain or perhaps even exacerbate dysfunctional patterns in cognition and emotion (Lervik et al ., 2022; Wong and Rapee, 2016). In line with this view, avoidance behaviours including as measured using the SBQ have been found to mediate the effect of CBT on social anxiety disorder (Santoft et al ., 2019b; Thew et al ., 2022).…”

Section: Introductionmentioning

confidence: 99%

Brief scales for the measurement of target variables and processes of change in cognitive behaviour therapy for major depression, panic disorder and social anxiety disorder

Axelsson,

Santoft,

Särnholm

et al. 2023

Behav. Cogn. Psychother.

View full text Add to dashboard Cite

Background: The measurement of process variables derived from cognitive behavioural theory can aid treatment development and support the clinician in following treatment progress. Self-report process measures are ideally brief, which reduces the burden on patients and facilitates the implementation of repeated measurements. Aims: To develop 13 brief versions (3–6 items) of existing cognitive behavioural process scales for three common mental disorders: major depression, panic disorder, and social anxiety disorder. Method: Using data from a real-world teaching clinic offering internet-delivered cognitive behavior therapy (n=370), we drafted brief process scales and then validated these scales in later cohorts (n=293). Results: In the validation data, change in the brief process scales significantly mediated change in the corresponding domain outcomes, with standardized coefficient point estimates in the range of –0.53 to –0.21. Correlations with the original process scales were substantial (r=.83–.96), internal consistency was mostly adequate (α=0.65–0.86), and change scores were moderate to large (|d|=0.51–1.18). For depression, the brief Behavioral Activation for Depression Scale-Activation subscale was especially promising. For panic disorder, the brief Agoraphobic Cognitions Questionnaire-Physical Consequences subscale was especially promising. For social anxiety disorder, the Social Cognitions Questionnaire, the Social Probability and Cost Questionnaire, and the Social Behavior Questionnaire-Avoidance and Impression Management subscales were all promising. Conclusions: Several brief process scales showed promise as measures of treatment processes in cognitive behaviour therapy. There is a need for replication and further evaluation using experimental designs, in other clinical settings, and preferably in larger samples.

show abstract

Exploring the temporal associations between avoidance behavior and cognitions during the course of cognitive behavioral therapy for clients with symptoms of social anxiety disorder

Abstract: Exploring the temporal associations between avoidance behavior and cognitions during the course of cognitive behavioral therapy for clients with symptoms of social anxiety disorder, Psychotherapy Research,

Cited by 8 publications

References 51 publications

The Importance of Symptom Reduction for Functional Improvement after Cognitive Behavioral Therapy for Anxiety and Depression: A Causal Mediation Analysis

The Importance of Symptom Reduction for Functional Improvement after Cognitive Behavioral Therapy for Anxiety and Depression: A Causal Mediation Analysis

Recent advances in the understanding and psychological treatment of social anxiety disorder

Brief scales for the measurement of target variables and processes of change in cognitive behaviour therapy for major depression, panic disorder and social anxiety disorder

Contact Info

Product

Resources

About