Assessing Client Progress Session by Session in the Treatment of Social Anxiety Disorder: The Social Anxiety Session Change Index

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Abstract

Frequent assessment during therapy can improve treatments and provide accountability. However, clinicians often do not monitor progress because of the time it takes to administer and score assessments. In response, the Social Anxiety Session Change Index (SASCI) was developed. The SASCI is a short, easily administered rating of subjective improvement that asks clients with social anxiety disorder how much they have changed since the beginning of therapy. Change on the SASCI was related to change in fear of negative evaluation, a core aspect of social anxiety, and to clinician-rated improvement, but not to ratings of anxiety sensitivity or depression. Because it is brief and easily interpretable, the SASCI can be used in a variety of clinical settings to monitor change across therapy. The SASCI is presented along with examples of how the information gathered from frequent administration can inform clinical practice.

Section snippets

Participants

Participants were 42 adult clients (52.4% women) with a mean age of 36.95 (SD = 13.97) seeking treatment for social anxiety disorder at either the Anxiety Disorders Clinic of the University of Nebraska–Lincoln (UNL; n =26) or at the Adult Anxiety Disorders Clinic of Temple University (n = 16). The majority of participants (n = 28) were part of a multicenter treatment outcome study. The remaining 14 participants were clients seen as training cases for the larger study, clients who did not meet the

Results

Table 1 presents the means and standard deviations of SASCI and BFNE scores for each session. Table 2 presents the pre-and posttreatment means for each of the outcome variables. Overall, clients improved on all outcome measures. There were no site differences on any of the session or outcome ratings.

A growth model was constructed which simultaneously estimated the change in SASCI and BFNE scores across treatment. Based on this linear growth model, on average, clients began the second therapy

Clinical Utility of the SASCI

If the SASCI is completed by clients prior to each therapy session, it can quickly alert the therapist to changes that have occurred over the week so that the therapist can focus session time on such changes if necessary. This approach allows the therapist to adapt therapy as necessary, which may lead to improved clinical outcome. To illustrate how the SASCI could be used to enhance therapy, four examples are presented in Fig. 2.

Discussion

This study introduces the SASCI, a short, easily administered rating of subjective improvement which can be frequently administered over the course of therapy for social anxiety disorder. Overall, clients rated themselves as improving from session to session across therapy. In this study, the SASCI demonstrated good internal consistency. In addition, change on the SASCI and final session SASCI scores were significantly related to improvement on a number of more commonly utilized, but more

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    This research was supported by an NIMH Fellowship (1F31MH071071-01) awarded to the first author. We would like to thank Justin Weeks for his help with this project.

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