A Comparison of Cognitive and Behavioral Approaches for Reducing Cost Bias in Social Anxiety

Abstract

Cognitive-behavioral theories suggest that anxiety is maintained in part by estimates of the probability and cost of feared negative outcomes. Social phobia may be unique among the anxiety disorders in that it is characterized by overestimates of the cost of events that are objectively noncatastrophic (e.g., committing social mishaps). As such, treatment approaches that target cost bias may be particularly effective in reducing social phobia symptoms. This study examined the efficacy of 2 cost-specific techniques in a single-session intervention for social anxiety. Individuals (n = 61) with elevated social interaction anxiety were randomly assigned to an expressive writing control condition, a cognitive restructuring condition, or a behavioral experiment condition. Results demonstrated that the cognitive restructuring condition produced significantly greater improvement in indices of social anxiety than the other conditions. Reduction in cost bias fully mediated the significantly greater improvement in social interaction anxiety in the cognitive restructuring condition relative to the behavioral experiment condition. The present findings highlight the value of techniques designed to reduce cost biases in social anxiety. Clinical implications are discussed.

Out of the shadows and into the spotlight: Social blunders fuel fear of self-exposure in social anxiety disorder

“…During such exposures, perceived social costs are targeted by having patients repeatedly commit blunders for the purpose of observing and learning that feared consequences (e.g., being ridiculed by others) do not typically occur (Hofmann & Scepkowski, 2006;Fang, Sawyer, Asnaani, & Hofmann, 2013). Despite the potential utility of this intervention, a recent experimental study showed that social mishap exposures may be less effective than cognitive restructuring for facilitating reductions in social cost biases and reducing symptoms of social anxiety (Possis et al, 2013). In fact, Possis et al (2013) reported that postintervention measures of social anxiety and social cost did not differ between the social mishap condition and a psychoeducation control condition.…”

“…Despite the potential utility of this intervention, a recent experimental study showed that social mishap exposures may be less effective than cognitive restructuring for facilitating reductions in social cost biases and reducing symptoms of social anxiety (Possis et al, 2013). In fact, Possis et al (2013) reported that postintervention measures of social anxiety and social cost did not differ between the social mishap condition and a psychoeducation control condition.…”

A scoping review investigating the use of exposure for the treatment and targeted prevention of anxiety and related disorders in young people

“…Two small experiments found exposure treatments to be less or no more efficacious than an alternative treatment (Kim, 2008 ; Possis et al., 2013 ). In university students with elevated social anxiety ( n = 61), Possis et al.…”

“…In university students with elevated social anxiety ( n = 61), Possis et al. ( 2013 ) found that compared to a psychoeducation control, one session of cognitive restructuring (without exposure) was more efficacious at reducing social anxiety than one behavioural experiment (involving exposure). Further, there was no significant difference between improvisation‐assisted desensitisation (involving graded imaginal exposure) or music‐assisted progressive muscle relaxation (6 weekly sessions of 30 min) in reducing performance anxiety in young pianists ( n = 30; Kim, 2008 ).…”

“…Two small experiments found exposure treatments to be less or no more efficacious than an alternative treatment (Kim, 2008;Possis et al, 2013). In university students with elevated social anxiety (n = 61), Possis et al (2013) found that compared to a psychoeducation control, one session of cognitive restructuring (without exposure) was more efficacious at reducing social anxiety than one behavioural experiment (involving exposure).…”