Does Behavioral Treatment of Social Phobia Lead to Cognitive Changes?

Newman, Michelle G.; Hofmann, Stefan G.; Trabert, Werner; Roth, Walton T.; Taylor, C. Barr

doi:10.2139/ssrn.2555312

Cited by 16 publications

(26 citation statements)

References 37 publications

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“…This is consistent with an earlier study that reported changes in cognitions during the course of a behavioral treatment without explicit cognitive strategies (Newman et al, 1994). Psychotherapy is a complex and interactive process to promote change in clients through means of communication.…”

Section: Discussionsupporting

confidence: 92%

“…These findings support the notion that treatments that are directly aimed at changing dysfunctional cognitions have a more lasting effect on social anxiety (e.g., Butler, 1985;Butler et al, 1984;Stopa & Clark, 1993). It should be noted that the EGT protocol was developed by Stefan G. Hofmann and successfully applied in a number of previous trials (Hofmann, 2000a;Hofmann et al, 1995;Newman et al, 1994). An earlier version of the EGT protocol was further included in three meta-analyses (Feske & Chambless, 1995;Gould et al, 1997;Taylor, 1996), which reported that it was comparable in its efficacy to other interventions, including CBGT.…”

Section: Discussionsupporting

confidence: 82%

“…This inclusion criterion was chosen because repeated exposure to speech situations was an important component of one of the treatment protocols (exposure group therapy). Although this intervention utilizes only public speaking situations as in-session exposure practices, we found in previous studies that the treatment effects easily generalize to other social situations (Hofmann, Newman, Becker, Taylor, & Roth, 1995;Newman, Hofmann, Trabert, Roth, & Taylor, 1994). The majority of individuals with social phobia who presented at the center for treatment (88.9%) met all study criteria and were invited to participate in the study.…”

Section: Methods Participantsmentioning

confidence: 99%

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Cognitive Mediation of Treatment Change in Social Phobia.

Hofmann¹

2004

Journal of Consulting and Clinical Psychology

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261

126

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Ninety individuals with social phobia (social anxiety disorder) participated in a randomized controlled trial and completed cognitive-behavioral group therapy, exposure group therapy without explicit cognitive interventions, or a wait-list control condition. Both treatments were superior to the wait-list group in reducing social anxiety but did not differ from one another at posttest. Changes in estimated social cost mediated treatment changes in both treatment conditions from pre-to posttest. However, only participants who received cognitive-behavioral therapy showed continued improvement from posttest to 6-month follow-up, which was associated with a reduction of estimated social cost from pretest to posttest. These results suggest that cognitive intervention leads to better maintenance of treatment gains, which is mediated through changes in estimated social cost.Social phobia is the most common type of anxiety disorder and the third most common mental disorder in the U.S. population (Kessler et al., 1994). Numerous studies have demonstrated the efficacy of psychological treatments for social phobia, especially cognitive-behavioral therapy and exposure therapy (e.g., Clark et al., 2003;Feske & Chambless, 1995;Heimberg et al., 1998;Taylor, 1996). It has been argued that social phobia treatments involving explicit cognitive strategies should be superior to pure exposure therapy because cognitive interventions are directly aimed at changing dysfunctional thinking (Butler, 1985;Butler, Cullington, Munby, Amies, & Gelder, 1984;Stopa & Clark, 1993). This assumption, however, is not clearly supported by the empirical data. There are eight controlled clinical studies in the literature in which investigators directly compared cognitive-behavioral therapy with exposure therapy without explicit cognitive interventions (Butler et al., 1984;Emmelkamp, Mersch, Vissia, & van der Helm, 1985;Gelernter et al., 1991;Hope, Heimberg, & Bruch, 1995;Mattick & Peters, 1988;Mattick, Peters, & Clark, 1989;Scholing & Emmelkamp, 1993a, 1993b. In only two of the trials did the effects of cognitive-behavioral therapy exceed those of exposure alone at posttreatment (Butler et al., 1984;Mattick & Peters, 1988). Furthermore, a number of meta-analyses suggested that both cognitive-behavioral therapy and exposure therapy produce very similar dropouts and pre/post and pre/follow-up effects for self-report measures of social phobia, cognitive symptoms, and depressed-anxious mood (Feske & Chambless, 1995;Gould, Buckminster, Pollack, Otto, & Yap, 1997;Taylor, 1996). Finally, the results of a dismantling study conducted by Hope, Heimberg, and Bruch (1995) suggest that exposure alone is at least as effective as exposure plus cognitive intervention in the treatment of social phobia.These findings raise important questions about the mechanism of treatment changes and the variables that are involved in this change process (i.e., the mediators of change). The cognitive model of social phobia posits that certain beliefs about the social situation...

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 82%

Section: Methods Participantsmentioning

confidence: 99%

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Cognitive Mediation of Treatment Change in Social Phobia.

Hofmann¹

2004

Journal of Consulting and Clinical Psychology

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261

126

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“…We limited the exposure situations of the EGT group to repeated public speaking situations because public speaking is the most commonly feared social situation that can easily be created in a group setting. Previous studies have shown that treatments that primarily target public speaking anxiety generalize to other social fears in that they have similar acute treatment effects on generalized social anxiety symptoms as more comprehensive treatments (e.g., Newman, Hofmann, Trabert, Roth, & Taylor, 1994). Moreover, we modified the topic or setting of the situation to elicit at least moderate anxiety even in participants who did not rate public speaking as their main social fear.…”

Section: Treatmentsmentioning

confidence: 99%

Sudden gains during therapy of social phobia.

Hofmann

Schulz

Meuret

et al. 2006

Journal of Consulting and Clinical Psychology

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104

109

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The present study investigated the phenomenon of sudden gains in 107 participants with social phobia (social anxiety disorder) who received either cognitive-behavioral group therapy or exposure group therapy without explicit cognitive interventions, which primarily used public speaking situations as exposure tasks. Twenty-two out of 967 session-to-session intervals met criteria for sudden gains, which most frequently occurred in Session 5. Individuals with sudden gains showed similar improvements in the 2 treatment groups. Although cognitive-behavioral therapy was associated with more cognitive changes than exposure therapy, cognitive changes did not precede sudden gains. In general, the results of this study question the clinical significance of sudden gains in social phobia treatment.Keywords sudden gains; social anxiety disorder; social phobia; cognitive-behavioral therapy; exposure therapyIn recent years, psychotherapy researchers have investigated the phenomenon of large, rapid, and stable decreases in symptomatology during treatment, which has been referred to as sudden gains (Tang & DeRubeis, 1999b). Sudden gains are typically defined by a set of three quantitative criteria: (a) the sudden gain must be large in absolute terms, (b) the sudden gain must represent at least a 25% reduction from the level of symptomatology before the gain occurred, and (c) the mean level of symptomatology in the three therapy sessions preceding the gain must be significantly higher than the mean level of symptomatology in the three postgain sessions. Most studies of sudden gains have examined treatment changes in depression with the Beck Depression Inventory (BDI; Beck, Ward, Mendelson, Mock, & Erbaugh, 1961; but see also Stiles et al., 2003;Vittengl, Clark, & Jarrett, 2005).When applying these criteria, Tang and DeRubeis (1999b) found that sudden gains occurred in more than 50% of individuals who responded to cognitive-behavioral therapy for depression and that these gains accounted for more than 50% of these individuals' total improvement in depression. Compared with participants who did not experience sudden gains at posttreatment, individuals with sudden gains showed better outcome at posttreatment and at 6-month and 18-month follow-ups.The initial study by Tang and DeRubeis (1999b) was followed by a number of other studies examining sudden gains (Gaynor et al., 2003;Hardy et al., 2005;Kelly, Roberts, & Ciesla, 2005;Tang, DeRubeis, Beberman, & Pham, 2005;Tang, Luborsky, & Andrusyna, 2002;Vittengl, Clark, & Jarrett, 2005). Interventions in these studies ranged from traditional cognitive therapy to supportive expressive therapy or pharmacotherapy. Although sudden gains were primarily assessed in efficacy trials of time-limited individual treatments (e.g., Tang NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript DeRubeis, 1999b;Vittengl et al., 2005), their incidence was also assessed in group therapy for depression (Kelly et al., 2005) and individuals with mixed psychiatric diagnoses who were g...

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“…No primeiro 45 , avaliando 36 pacientes com medo de falar em público, os resultados do pós-teste indicaram a superioridade da EXP sobre a LE. No segundo 46 , 31 pacientes com TAS com medo de ruborizar foram divididos randomicamente em um grupo de EXP, de TTC ou LE (Tabela 4).…”

Section: Tcomp Comparada à Le Exp E Associações Versus Leunclassified

Eficácia do tratamento cognitivo e/ou comportamental para o transtorno de ansiedade social

Mululo

Menezes

Fontenelle

et al. 2009

Rev. psiquiatr. Rio Gd. Sul

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ResumoObjetivo: Avaliar a efi cácia do tratamento cognitivo e/ou comportamental no transtorno de ansiedade social quando comparado a outras intervenções terapêuticas, incluindo farmacoterapia. Método: Realizamos análise sistemática de todos os ensaios clínicos controlados randomizados envolvendo terapia cognitiva e/ou comportamental versus outras formas de tratamento, publicados até março de 2009, indexados nas seguintes bases de dados: MEDLINE, PsycINFO, Registro Cochrane de Ensaios Controlados, LILACS e ISI/Web of Science. Resultados: Os estudos avaliados não demonstraram diferenças signifi cativas entre a terapia cognitiva e/ou comportamental e a farmacoterapia. Esses tratamentos combinados não apresentaram maior efi cácia do que as intervenções isoladamente. Quando comparada ao grupo controle, a terapia cognitiva e/ou comportamental é efi caz na redução dos sintomas de ansiedade social, tanto no seu formato padrão quanto nas novas formas de intervenção. A exceção foi o treino em habilidades sociais, que, isoladamente, não se mostrou efi caz. A terapia cognitiva e/ou comportamental também demonstrou ser superior aos outros tipos de psicoterapias. Conclusão: A terapia cognitiva e/ou comportamental mostrou-se efi caz na redução da ansiedade social em pacientes com transtorno de ansiedade social. No entanto, a heterogeneidade dos estudos avaliados, seja no que diz respeito a aspectos envolvendo o tratamento (duração do tratamento e protocolos utilizados) ou os pacientes avaliados (gravidade e forma de recrutamento), difi cultaram a comparação dos resultados. Novos estudos de tratamento cognitivo e/ou comportamental e novas revisões envolvendo essas abordagens são necessários para melhor avaliação de nossos achados. Descritores: Fobia social, terapia cognitiva, terapia comportamental, transtorno de ansiedade social, revisão. AbstractObjective: To ascertain whether cognitive and/or behavioral treatment of patients with social anxiety disorder is superior in terms of effi cacy than other types of therapeutic interventions, including pharmacotherapy. Method: Systematic analysis of all randomized clinical trials on cognitive and/or behavioral therapy vs. other forms of treatment, published until March 2009, indexed in the following databases: MEDLINE, PsycINFO, Cochrane Controlled Trials Register, LILACS and ISI Web of Science. Results: The reported results do not suggest signifi cant differences in the effi cacy of cognitive and/or behavioral therapy and pharmacotherapy. Such treatments combined did not show higher effi cacy than interventions alone. Compared with the control group, cognitive and/or behavioral therapy was superior in reducing social anxiety disorder, either in the classic model or in the newest propositions. The only exception was the social skills training, which was not effective for patients with social anxiety disorder. Cognitive and/or behavioral therapy was also superior to other psychotherapeutic interventions. Conclusion: Cognitive and/or behavioral therapy is an effective treatment for pati...

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Does Behavioral Treatment of Social Phobia Lead to Cognitive Changes?

Cited by 16 publications

References 37 publications

Cognitive Mediation of Treatment Change in Social Phobia.

Cognitive Mediation of Treatment Change in Social Phobia.

Sudden gains during therapy of social phobia.

Eficácia do tratamento cognitivo e/ou comportamental para o transtorno de ansiedade social

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