Moderators of Change in Social Anxiety during CBT in a Transdiagnostic, Naturalistic Treatment-Seeking Sample

Abstract

Background: There are a number of hypothesized underlying factors that, while present across a range of anxiety and fear-based disorders, are proposed to be specifically influential in the maintenance of social anxiety (SA) symptoms. Aims: This study examined the influence of specific constructs (i.e., anxiety sensitivity, ruminative thinking, and depressive symptoms) on reduction of SA symptoms during a course of cognitive behavioral therapy (CBT). To better model potential causal relationships between observed moderators and social anxiety, time-lagged analyses between SA and significant moderators were also explored. Methods: Participants (N = 107) were patients seeking treatment in a fee-for-service clinic specializing in CBT for anxiety disorders, OCD and PTSD. Participants were repeatedly assessed for a variety of symptoms and potential moderators throughout treatment. Results: Even though anxiety sensitivity regarding social concerns, rumination, reflection, and depression showed significant withinand between-person relationships with SA symptoms, only rumination was found to uniquely moderate change in SA symptoms over the course of treatment. Specifically, those with higher average levels of ruminative thinking tended to improve greater on SA symptoms than those with lower levels throughout treatment. Further, this observed moderation effect was not found to significantly influence OCD, generalized anxiety, or PTSD symptoms. Finally, a bi-directional relationship was found between rumination and SA with rumination predicting subsequent changes in SA and vice versa. Conclusions: High levels of ruminative thinking do not appear to be an impediment to improvement in SA symptoms in a naturalistic, treatment-seeking sample of individuals with anxiety disorders.

Transdiagnostic psychiatry: a systematic review

“…Most studies (45%) were investigating interventions (of which 50% were controlled, 48% uncontrolled, and 2% unclear). Less than half (46%) of the interventional studies were randomized.…”

“…The exact definition of the transdiagnostic construct per study is provided in Table . Only a minority of constructs (36%) involved multiple processes. Most studies (81%) were descriptive in nature.…”

“…A substantial proportion of studies (40%) did not acknowledge an a priori protocol. There were very few studies reporting industry involvement (4%).…”

Innovations in our Understanding of the Development, Maintenance, and Treatment of Social Anxiety: Introduction to the Special Issue

“…Rumination shares many features with future-oriented (anticipatory processing) and past-focused (PEP) repetitive negative thinking in social anxiety (Ehring & Watkins, 2008;McEvoy, Mahoney, & Moulds, 2010), so these associations with symptoms before and during treatment are consistent with cognitive behavioural theory Rapee & Heimberg, 1997). Asnaani et al (2016, this issue) used a multi-level analytic method for disaggregating between-and within-participant effects, finding much overlap but also differences in factors associated with symptoms at these different levels. Between-participant effects tell us about relationships amongst individual difference factors, but clinicians are most interested in the factors associated with symptom change for their individual clients while they are in treatment.…”

Award for Distinguished Scientific Early Career Contributions to Psychology: Anu Asnaani.

“…After years of resistance to centrally examining such variables, Anu started to regard her ability to study these issues within "mainstream psychology" as a way to actually move the needle on how anxiety phenomenology could be better understood and treated among a much larger segment of the population than was currently being done in the field at that time. Thus, with support from Stefan, she started to incorporate questions related to these diversity considerations into her research and kept a keener eye for them in her rich clinical training at the Center for Anxiety and Related Disorders and the Boston Veterans Affairs Medical Center, culminating in a pivotal article examining the integration of such issues into evidence-based treatments (Asnaani & Hofmann, 2012) (Asnaani et al, 2016(Asnaani et al, , 2018. Anu also started acting on a professional desire that had been growing around testing practical applications of evidence-based approaches in more diverse community settings.…”