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01-02-2010 | Brief Report

Cognitive Behavioral Group Therapy for Patients with Co-Existing Social Anxiety Disorder and Substance Use Disorders: A Pilot Study

Auteurs: Christine M. Courbasson, Yasunori Nishikawa

Gepubliceerd in: Cognitive Therapy and Research | Uitgave 1/2010

Abstract

Social anxiety disorder (SAD) frequently co-occurs with substance use disorders (SUDs). Although the efficacy of separate cognitive behavioral treatments for each disorder has been widely documented, there is a dearth of studies investigating treatment outcome for patients with co-existing SAD and SUDs. This paper presents preliminary data from a pilot study that investigated whether cognitive behavioral group therapy—modified to explicitly address the link between social anxiety and substance use—could lead to reductions in social anxiety-related symptoms and improvements in affect and unrealistic alcohol expectancies in a sample of 59 patients diagnosed with co-existing SAD and SUDs. Results indicated significant reductions across treatment in social anxiety-related symptoms and negative affect, whereas no changes in positive affect or unrealistic alcohol expectancies were found. The results warrant a randomized controlled trial to explore the specificity of these effects.

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Axis I status one year prior to referral to treatment as drawn from patient charts.

To partially address this concern, we conducted supplementary exploratory analyses at the lower-order level. We computed total scores for three factors taken from a recently further revised measure of AS, the ASI-3 (Taylor et al. 2007). The scale is composed of three factors, each with six items, labeled: physical concern (PC), cognitive concern (CC), and social concern (SC). We chose to focus on the items retained by the ASI-3 given that Taylor et al.’s study, which utilized a confirmatory factor analytic approach, presented evidence of its superior psychometric properties relative to the original ASI-R. In the current study, computation of cronbach’s coefficient alphas for each of the ASI-3 subscales yielded acceptable to good coefficients (.88, .87, and .78 for PC, CC, and SC, respectively).

Social skills training is not a key component of CBGT. Although in the current study, we did not screen for patients who significantly were in need (or not) of social skills training, given that a high proportion of patients were of the generalized SAD subtype, it might be expected that many would benefit from this component of the treatment.

Cohen’s (1988) d statistic: (M_pre − M_post)/SD_pooled. Per Cohen, .20, .50, and .80 were interpreted as small, medium, and large effect sizes.

Supplementary analyses of treatment effects on the higher-order and lower-order factors of ASI-3 revealed a significant main effect for the ASI-3 total score, F (1, 24) = 6.411, p < .018, ŋ _p ² = .211, ASI-PC total score, F (1, 24) = 4.733, p < .040, ŋ _p ² = .165, and ASI-SC total score, F (1, 24) = 20.486, p < .000, ŋ _p ² = .461, but not for the ASI–CC total score, F (1, 24) = .810, p < .377, ŋ _p ² = .033. Effect size analyses revealed moderate effect sizes for the ASI-3 total score (d = .50), along with the ASI–PC (d = .43), ASI–CC (d = .21), and ASI–SC (d = .65) total scores.

In fact, examination of individual post-treatment SPIN total score revealed that only two patients had scores lower than Conner et al. clinical cut-off score of 19.

It is important to note that, despite the small sample size, a stringent criterion was used to determine significance (α = 0.05/15 tests or 0.00333) rendering an increased likelihood of committing a Type II error. In addition, alcohol expectancies did change in an expected direction. That is, they decreased pre-post treatment.

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Titel: Cognitive Behavioral Group Therapy for Patients with Co-Existing Social Anxiety Disorder and Substance Use Disorders: A Pilot Study
Auteurs: Christine M. Courbasson
Yasunori Nishikawa
Publicatiedatum: 01-02-2010
Uitgeverij: Springer US
Gepubliceerd in: Cognitive Therapy and Research / Uitgave 1/2010
Print ISSN: 0147-5916
Elektronisch ISSN: 1573-2819
DOI: https://doi.org/10.1007/s10608-008-9216-8

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