Treatment specific competence predicts outcome in cognitive therapy for social anxiety disorder

Abstract

Several studies have demonstrated a positive relationship between competence and outcome in CBT for depression but studies of CBT for anxiety disorders are lacking. The present study explores the relationship between competence and outcome in cognitive therapy (CT) for social anxiety disorder, using hierarchical linear modeling analyses (HLM). Data were drawn from a multicenter randomized controlled trial. Five trained raters evaluated videotapes of two therapy sessions per patient using the Cognitive Therapy Competence Scale for Social Phobia (CTCS-SP). Overall adherence to the treatment manual and patient difficulty were also assessed. Patient outcome was rated by other assessors using the Clinical Global Impression Improvement Scale (CGI-I) and the Liebowitz Social Anxiety Scale (LSAS). Results indicated that competence significantly predicted patient outcome on the CGI-I (β = .79) and LSAS (β = .59). Patient difficulty and adherence did not further improve prediction. The findings support the view that competence influences outcome and should be a focus of training programs. Further research is needed to compare different ways of assessing competence and to understand the complex relationships between competence and other therapy factors that are likely to influence outcome.

Cognitive Behavioral Therapy for Patients with Social Anxiety Disorder Who Remain Symptomatic following Antidepressant Treatment: A Randomized, Assessor-Blinded, Controlled Trial

“…We should also consider the results of the Cognitive Therapy Competence Scale (CTCS) against other studies, given that evidence suggests that competence predicts outcome in CBT for SAD [37]. Although we did not evaluate the CTCS, when we calculated the pre-post effect size of the CBT arm by the same formula [(M pre-CBT  -  M post-CBT )/SD pooled ] using raw data from each study, our effect size of 2.00 for the LSAS was comparable to those in previous studies on individual-based CBT using the model of Clark and Wells [19] (1.22-2.17) [12,30,31,35].…”

Paroxetine, Cognitive Therapy or Their Combination in the Treatment of Social Anxiety Disorder with and without Avoidant Personality Disorder: A Randomized Clinical Trial

“…CT of SAD is dependent on the quality of and compliance with treatment [40] and is relatively costly and resource demanding. Availability of well-trained therapists in CT is low, and poorly performed CT, which normally includes video feedback and self-exposure techniques, may backfire and make the patient worse.…”

Psychotherapeutische Kompetenzen in der kognitiven Verhaltenstherapie

“…Eine Studie der eigenen Arbeitsgruppe zur kognitiven Behandlung von sozialer Angststörung (Stangier et al 2011) erfasste sowohl Kompetenz als auch Adhärenz in kognitiver Therapie nach Clark und Wells (Ginzburg et al 2012). Die hierbei verwendete Rating-Skala (s. unten) stellt eine Modifikation der CTS, mit Erweiterung um einige behandlungsspezifische Items zur sozialen Angststörung, dar (Von Consbruch et al 2012).…”

“…Während sich diese als spezifische Kompetenzen bezeichneten Aspekte, die die Konzeptualisierung, therapeutische Strategien und Techniken betreffen, verändert haben, sind die allgemeinen Kompetenzen, die sich auf die Strukturierung der Arbeitsweise beziehen, weiterhin eine Grundlage der kognitiven Therapie. Vergleicht man die Korrelationen von allgemeinen und spezifischen Kompetenzaspekten zum Therapieerfolg, findet man für die kognitive Therapie der sozialen Angststörung jeweils Zusammenhänge in vergleichbarer Höhe (Ginzburg et al 2012;Stangier et al 2014). Ähnlich sind die Ergebnisse für die kognitiv-behaviorale Behandlung von Depression (Trepka et al 2004).…”