Change in quality of life and their predictors in the long-term follow-up after group cognitive behavioral therapy for social anxiety disorder: a prospective cohort study

Abstract

BackgroundSocial anxiety disorder (SAD) is one of the most common anxiety disorders. The efficacy of cognitive behaviour therapy (CBT) has been examined but to date its effects on Quality of Life (QoL) have not been appropriately evaluated especially in the long term.The study aimed to examine, in the long term, what aspects of Quality of Life (QoL) changed among social anxiety disorder (SAD) patients treated with group cognitive behaviour therapy (CBT) and what predictors at baseline were associated with QoL.MethodsOutpatients diagnosed with SAD were enrolled into group CBT, and assessed at follow-ups for up to 12 months in a typical clinical setting. QoL was evaluated using the Short Form 36. Various aspects of SAD symptomatology were also assessed. Each of the QoL domains and scores on symptomatology were quantified and compared with those at baseline. Baseline predictors of QoL outcomes at follow-up were investigated.ResultsFifty-seven outpatients were enrolled into group CBT for SAD, 48 completed the whole program, and 44 and 40 completed assessments at the 3-month and 12-month follow-ups, respectively. All aspects of SAD symptomatology and psychological subscales of the QoL showed statistically significant improvement throughout follow-ups for up to 12 months. In terms of social functioning, no statistically significant improvement was observed at either follow-up point except for post-treatment. No consistently significant pre-treatment predictors were observed.ConclusionsAfter group CBT, SAD symptomatology and some aspects of QoL improved and this improvement was maintained for up to 12 months, but the social functioning domain did not prove any significant change statistically. Considering the limited effects of CBT on QoL, especially for social functioning, more powerful treatments are needed.

Changing core beliefs with trial-based cognitive therapy may improve quality of life in social phobia: a randomized study

“…The Cohen's d ESs seen in the CCT group in the present study (Table 2) were similar or slightly larger than those found in the aforementioned study. 12 However, TBTR had large to very large ESs at post-treatment in the mental health (ES = 1.09) and social functioning (ES = 1.41) domains, as well as large ESs in the social functioning domains (ES = 0.76) at follow-up, and these results were not accomplished neither in the CCT contrast group of our study nor in that study. 12 A possible explanation for this finding is that TBTR had a more significant effect on fear of negative evaluation (FNE) scores than CCT techniques, as shown in a previous publication of this study.…”

“…12 However, TBTR had large to very large ESs at post-treatment in the mental health (ES = 1.09) and social functioning (ES = 1.41) domains, as well as large ESs in the social functioning domains (ES = 0.76) at follow-up, and these results were not accomplished neither in the CCT contrast group of our study nor in that study. 12 A possible explanation for this finding is that TBTR had a more significant effect on fear of negative evaluation (FNE) scores than CCT techniques, as shown in a previous publication of this study. 16 The one-way ANCOVA showed a significant treatment effect (F[1, 33] = 5.47; p = 0.03) at midtreatment and at post-treatment, with participants in the TBTR group scoring lower on FNE assessments than participants in the CCT group.…”

“…An earlier study 12 of SAD patients found modest improvement in aspects of QoL following treatment, which were maintained at the 12-month follow-up. The Cohen's d ESs seen in the CCT group in the present study (Table 2) were similar or slightly larger than those found in the aforementioned study.…”

“…11 A more recent study of SAD patients who received 12 to 20 2-hour CBGT sessions concluded that, although symptoms of SAD and some aspects of QoL improved for up to 12 months after CBGT, the social functioning domain did not change, suggesting the need for better treatments for this condition. 12 The trial-based thought record (TBTR), 13 a novel approach used in trial-based cognitive therapy (TBCT), 14 was developed to address negative core beliefs (CBs) in CBT. In TBTR, the therapist engages the patient in a simulation of a legal trial, stimulating the activation of negative CBs and associated negative emotions, with the aim of reducing their effect with disconfirming evidence.…”

Issues and controversies surrounding the diagnosis and treatment of social anxiety disorder

“…Fortunately, there are several efficacious treatments for SAD. Cognitive behavior therapy (CBT) is the most studied psychotherapy for SAD; several studies have demonstrated its efficacy both in the short term and long term [84], with moderate-tolarge effect sizes at post-treatment compared with control conditions [85]. Evidence also supports the use of cognitive therapy (CT) [86] and internet-delivered CBT for SAD [87].…”