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Cognitive Therapy and Research

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31-03-2023 | Original Article

Safety Behaviors Predict Long-Term Treatment Outcome Following Internet-Based Treatment of Adults with Social Anxiety Disorder

Auteurs: James M. Zech, Tapan A. Patel, Jesse R. Cougle

Gepubliceerd in: Cognitive Therapy and Research | Uitgave 3/2023

Abstract

Background

Social anxiety is thought to be maintained by habitual safety behaviors, actions undertaken to avoid some feared outcome. Safety behaviors may act as a risk factor for the persistence of social anxiety symptoms after treatment completion, though this has not been investigated. We examined the impact of posttreatment safety behavior frequency on subsequent social anxiety symptoms at 3-month follow-up after two non-behavioral digital treatments for social anxiety.

Methods

Participants (N = 64) with social anxiety disorder were randomized to eight sessions of interpretation bias modification or progressive muscle relaxation. A series of hierarchical multiple regressions were run to examine the association between posttreatment safety behavior frequency and social anxiety symptoms at follow-up, controlling for symptoms at posttreatment.

Results

Safety behavior frequency at posttreatment significantly predicted future social anxiety symptoms and fear of negative evaluation at follow-up when covarying for posttreatment symptoms as well as negative social interpretation bias.

Conclusions

This study highlights the potential importance of considering safety behaviors as a social anxiety maintenance factor following treatment.

vorige artikel Reduced Attention Towards Accomplishments Mediates the Effect of Self-Critical Rumination on Regret

volgende artikel Multimodal Remote Research on Social Anxiety Using a New Teleconferencing Paradigm

Amir, N., & Taylor, C. T. (2012). Interpretation training in individuals with generalized social anxiety disorder: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 80(3), 497–511. https://doi.org/10.1037/a0026928CrossRefPubMedPubMedCentral

Antony, M. M., Coons, M. J., McCabe, R. E., Ashbaugh, A., & Swinson, R. P. (2006). Psychometric properties of the social phobia inventory: Further evaluation. Behaviour Research and Therapy, 44(8), 1177–1185. https://doi.org/10.1016/j.brat.2005.08.013CrossRefPubMed

Arditte, K. A., Morabito, D. M., Shaw, A. M., & Timpano, K. R. (2016). Interpersonal risk for suicide in social anxiety: The roles of shame and depression. Psychiatry Research, 239, 139–144. https://doi.org/10.1016/j.psychres.2016.03.017CrossRefPubMed

Beard, C., & Amir, N. (2008). A multi-session interpretation modification program: Changes in interpretation and social anxiety symptoms. Behaviour Research and Therapy, 46(10), 1135–1141. https://doi.org/10.1016/j.brat.2008.05.012CrossRefPubMedPubMedCentral

Boswell, J. F., Kraus, D. R., Miller, S. D., & Lambert, M. J. (2015). Implementing routine outcome monitoring in clinical practice: Benefits, challenges, and solutions. Psychotherapy Research, 25(1), 6–19. https://doi.org/10.1080/10503307.2013.817696CrossRefPubMed

Brozovich, F., & Heimberg, R. G. (2008). An analysis of post-event processing in social anxiety disorder. Clinical Psychology Review, 28(6), 891–903. https://doi.org/10.1016/j.cpr.2008.01.002CrossRefPubMed

Buckner, J. D., Lemke, A. W., Jeffries, E. R., & Shah, S. M. (2017). Social anxiety and suicidal ideation: Test of the utility of the interpersonal-psychological theory of suicide. Journal of Anxiety Disorders, 45, 60–63. https://doi.org/10.1016/j.janxdis.2016.11.010CrossRefPubMed

Buhlmann, U., Wilhelm, S., McNally, R. J., Tuschen-Caffier, B., Baer, L., & Jenike, M. A. (2002). Interpretive biases for ambiguous information in body dysmorphic disorder. CNS Spectrums, 7(6), 435–436, 441–443. https://doi.org/10.1017/s1092852900017946

Canton, J., Scott, K. M., & Glue, P. (2012). Optimal treatment of social phobia: Systematic review and meta-analysis. Neuropsychiatric Disease and Treatment, 8, 203–215. https://doi.org/10.2147/NDT.S23317CrossRefPubMedPubMedCentral

Clark, D. M., & Wells, A. (1995). A cognitive model of social phobia. In Social phobia: Diagnosis, assessment, and treatment (pp. 69–93). The Guilford Press.

Clark, D. M. (2001). A cognitive perspective on social phobia. In International handbook of social anxiety: Concepts, research and interventions relating to the self and shyness (pp. 405–430). Wiley.

Clark, D. M., Ehlers, A., Hackmann, A., McManus, M., Fennell, M., Grey, N., Waddington, L., & Wild, J. (2006). Cognitive therapy versus exposure and applied relaxation in social phobia: A randomized controlled trial. Journal of Consulting and Clinical Psychology. https://doi.org/10.1037/0022-006X.74.3.568

Connor, K. M., Davidson, J. R., Churchill, L. E., Sherwood, A., Foa, E., & Weisler, R. H. (2000). Psychometric properties of the Social Phobia Inventory (SPIN). New self-rating scale. The British Journal of Psychiatry: THe Journal of Mental Science, 176, 379–386. https://doi.org/10.1192/bjp.176.4.379CrossRefPubMed

Cougle, J. R., Mueller, N. E., McDermott, K. A., Wilver, N. L., Carlton, C. N., & Okey, S. A. (2020a). Text message safety behavior reduction for social anxiety: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 88(5), 445–454. https://doi.org/10.1037/ccp0000494CrossRefPubMed

Cougle, J. R., Wilver, N. L., Day, T. N., Summers, B. J., Okey, S. A., & Carlton, C. N. (2020b). Interpretation bias modification versus progressive muscle relaxation for social anxiety disorder: A web-based controlled trial. Behavior Therapy, 51(1), 99–112. https://doi.org/10.1016/j.beth.2019.05.009CrossRefPubMed

Craske, M., & Barlow, D. (2006). Mastery of your anxiety and worry: Workbook Edition. Oxford University Press. https://www.barnesandnoble.com/w/mastery-of-your-anxiety-and-worry-michelle-g-craske/1101080831

Cuming, S., Rapee, R. M., Kemp, N., Abbott, M. J., Peters, L., & Gaston, J. E. (2009). A self-report measure of subtle avoidance and safety behaviors relevant to social anxiety: Development and psychometric properties. Journal of Anxiety Disorders, 23(7), 879–883. https://doi.org/10.1016/j.janxdis.2009.05.002CrossRefPubMed

Davidson, C. L., Wingate, L. R., Grant, D. M., Judah, M. R., & Mills, A. C. (2011). Interpersonal suicide risk and ideation: The influence of depression and social anxiety. Journal of Social and Clinical Psychology, 30(8), 842–855. https://doi.org/10.1521/jscp.2011.30.8.842CrossRef

Duffy, M. E., Mueller, N. E., Cougle, J. R., & Joiner, T. E. (2020). Perceived burdensomeness uniquely accounts for suicidal ideation severity in social anxiety disorder. Journal of Affective Disorders, 266, 43–48. https://doi.org/10.1016/j.jad.2020.01.116CrossRefPubMed

Filho, A. S., Hetem, L. A. B., Ferrari, M. C. F., Trzesniak, C., Martín-Santos, R., Borduqui, T., De Lima Osório, F., Loureiro, S. R., Busatto Filho, G., Zuardi, A. W., & Crippa, J. a. S. (2010). Social anxiety disorder: What are we losing with the current diagnostic criteria? Acta Psychiatrica Scandinavica, 121(3), 216–226. https://doi.org/10.1111/j.1600-0447.2009.01459.x

First, M. B. (2015). Structured clinical interview for the DSM (SCID). In The Encyclopedia of Clinical Psychology (pp. 1–6). Wiley. https://doi.org/10.1002/9781118625392.wbecp351

George, D., & Mallery, P. (2009). SPSS for windows step by step: A simple study guide and reference, 17.0 Update (10th ed.). Allyn & Bacon.

Hirsch, C. R., & Clark, D. M. (2004). Information-processing bias in social phobia. Clinical Psychology Review, 24(7), 799–825. https://doi.org/10.1016/j.cpr.2004.07.005CrossRefPubMed

Hirsch, C. R., Meeten, F., Krahé, C., & Reeder, C. (2016). Resolving ambiguity in emotional disorders: The nature and role of interpretation biases. Annual Review of Clinical Psychology, 12, 281–305. https://doi.org/10.1146/annurev-clinpsy-021815-093436CrossRefPubMed

Hofmann, S. G. (2007). Cognitive factors that maintain social anxiety disorder: A comprehensive model and its treatment implications. Cognitive Behaviour Therapy, 36(4), 193–209. https://doi.org/10.1080/16506070701421313CrossRefPubMedPubMedCentral

Hofmann, S. G., Asnaani, A., Vonk, I. J. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research, 36(5), 427–440. https://doi.org/10.1007/s10608-012-9476-1CrossRefPubMedPubMedCentral

Hofmann, S. G., Heinrichs, N., & Moscovitch, D. A. (2004). The nature and expression of social phobia: Toward a new classification. Clinical Psychology Review, 24, 769–797. https://doi.org/10.1016/j.cpr.2004.07.004CrossRefPubMed

Hofmann, S. G., & Smits, J. A. J. (2008). Cognitive-behavioral therapy for adult anxiety disorders: A meta-analysis of randomized placebo-controlled trials. The Journal of Clinical Psychiatry, 69(4), 621–632. https://doi.org/10.4088/jcp.v69n0415CrossRefPubMedPubMedCentral

Hofmann, S. G., Wu, J. Q., & Boettcher, H. (2014). Effect of cognitive-behavioral therapy for anxiety disorders on quality of life: A meta-analysis. Journal of Consulting and Clinical Psychology, 82(3), 375–391. https://doi.org/10.1037/a0035491CrossRefPubMedPubMedCentral

Huynh, H., & Feldt, L. S. (1976). Estimation of the box correction for degrees of freedom from sample data in randomized block and split-plot designs. Journal of Educational Statistics, 1(1), 69–82. https://doi.org/10.3102/10769986001001069CrossRef

Kessler, R. C., Ruscio, A. M., Shear, K., & Wittchen, H.-U. (2010). Epidemiology of anxiety disorders. Current Topics in Behavioral Neurosciences, 2, 21–35.CrossRefPubMed

Kindred, R., Bates, G. W., & McBride, N. L. (2022). Long-term outcomes of cognitive behavioural therapy for social anxiety disorder: A meta-analysis of randomised controlled trials. Journal of Anxiety Disorders, 92, 102640. https://doi.org/10.1016/j.janxdis.2022.102640

Lampe, L., Slade, T., Issakidis, C., & Andrews, G. (2003). Social phobia in the Australian National Survey of Mental Health and Well-Being (NSMHWB). Psychological Medicine, 33(4), 637–646. https://doi.org/10.1017/s0033291703007621CrossRefPubMed

Leary, M. R. (1983). A brief version of the Fear of Negative Evaluation Scale. Personality and Social Psychology Bulletin, 9, 371–375. https://doi.org/10.1177/0146167283093007CrossRef

Lim, M. H. (2016). Loneliness over time: The crucial role of social anxiety. Journal of Abnormal Psychology, 125(5), 620. https://doi.org/10.1037/abn0000162CrossRefPubMed

Liu, H., Li, X., Han, B., & Liu, X. (2017). Effects of cognitive bias modification on social anxiety: A meta-analysis. PLOS ONE, 12(4), e0175107. https://doi.org/10.1371/journal.pone.0175107

Mendoza, J. L. (1980). A significance test for multisample sphericity. Psychometrika, 45(4), 495–498. https://doi.org/10.1007/BF02293611CrossRef

Okajima, I., Kanai, Y., Chen, J., & Sakano, Y. (2009). Effects of safety behaviour on the maintenance of anxiety and negative belief social anxiety disorder. International Journal of Social Psychiatry, 55(1), 71–81. https://doi.org/10.1177/0020764008092191CrossRefPubMed

R Core Team. (2022). R: A language and environment for statistical computing (Version 4.1.1) [Computer software]. R Foundation for Statistical Computing. https://www.R-project.org/

Rapee, R. M., & Heimberg, R. G. (1997). A cognitive-behavioral model of anxiety in social phobia. Behaviour Research and Therapy, 35(8), 741–756. https://doi.org/10.1016/s0005-7967(97)00022-3CrossRefPubMed

Robins, L. N., Wing, J., Wittchen, H. U., Helzer, J. E., Babor, T. F., Burke, J., Farmer, A., Jablenski, A., Pickens, R., & Regier, D. A. (1988). The Composite International Diagnostic Interview. An epidemiologic Instrument suitable for use in conjunction with different diagnostic systems and in different cultures. Archives of General Psychiatry, 45(12), 1069–1077. https://doi.org/10.1001/archpsyc.1988.01800360017003

Rodebaugh, T. L., Woods, C. M., Thissen, D. M., Heimberg, R. G., Chambless, D. L., & Rapee, R. M. (2004). More information from fewer questions: The factor structure and item properties of the original and brief fear of negative evaluation scale. Psychological Assessment, 16(2), 169–181. https://doi.org/10.1037/1040-3590.16.2.169CrossRefPubMed

Rose, G. M., & Tadi, P. (2022). Social anxiety disorder. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK555890/

Salemink, E., Kindt, M., Rienties, H., & van den Hout, M. (2014). Internet-based Cognitive Bias Modification of Interpretations in patients with anxiety disorders: A randomised controlled trial. Journal of Behavior Therapy and Experimental Psychiatry, 45(1), 186–195. https://doi.org/10.1016/j.jbtep.2013.10.005CrossRefPubMed

Salkovskis, P. M. (1991). The importance of behaviour in the maintenance of anxiety and panic: A cognitive account. Behavioural Psychotherapy, 19, 6–19. https://doi.org/10.1017/S0141347300011472CrossRef

Sheehan, D. V., Lecrubier, Y., Sheehan, K. H., Amorim, P., Janavs, J., Weiller, E., Hergueta, T., Baker, R., & Dunbar, G. C. (1998). The Mini-International Neuropsychiatric Interview (M.I.N.I.): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. The Journal of Clinical Psychiatry, 59 Suppl 20, 22–33;quiz 34–57.

Spokas, M. E., & Cardaciotto, L. (2014). Heterogeneity within social anxiety disorder. In The Wiley Blackwell handbook of social anxiety disorder (pp. 247–267). Wiley. https://doi.org/10.1002/9781118653920.ch12

Springer, K. S., Levy, H. C., & Tolin, D. F. (2018). Remission in CBT for adult anxiety disorders: A meta-analysis. Clinical Psychology Review, 61, 1–8. https://doi.org/10.1016/j.cpr.2018.03.002CrossRefPubMed

Stangier, U., Heidenreich, T., & Schermelleh-Engel, K. (2006). Safety behaviors and social performance in patients with generalized social phobia. Journal of Cognitive Psychotherapy, 20(1), 17–31. https://doi.org/10.1891/jcop.20.1.17CrossRef

Stentz, L. A., & Cougle, J. R. (2022). Effects of safety behavior fading on social anxiety and emotional disclosure. Behaviour Research and Therapy, 157, 104165. https://doi.org/10.1016/j.brat.2022.104165

Teachman, B. A., Joormann, J., Steinman, S. A., & Gotlib, I. H. (2012). Automaticity in anxiety disorders and major depressive disorder. Clinical Psychology Review, 32(6), 575–603. https://doi.org/10.1016/j.cpr.2012.06.004CrossRefPubMedPubMedCentral

Weeks, J. W., Heimberg, R. G., Fresco, D. M., Hart, T. A., Turk, C. L., Schneier, F. R., & Liebowitz, M. R. (2005). Empirical validation and psychometric evaluation of the Brief Fear of Negative Evaluation Scale in patients with social anxiety disorder. Psychological Assessment, 17(2), 179–190. https://doi.org/10.1037/1040-3590.17.2.179CrossRefPubMed

Titel: Safety Behaviors Predict Long-Term Treatment Outcome Following Internet-Based Treatment of Adults with Social Anxiety Disorder
Auteurs: James M. Zech
Tapan A. Patel
Jesse R. Cougle
Publicatiedatum: 31-03-2023
Uitgeverij: Springer US
Gepubliceerd in: Cognitive Therapy and Research / Uitgave 3/2023
Print ISSN: 0147-5916
Elektronisch ISSN: 1573-2819
DOI: https://doi.org/10.1007/s10608-023-10368-7

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Abstract

Background

Methods

Results

Conclusions

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