Cognitive reappraisal self-efficacy mediates the effects of individual cognitive-behavioral therapy for social anxiety disorder

Abstract

Objective: To examine whether changes in cognitive reappraisal self-efficacy (CR-SE) mediate the effects of individually administered cognitive-behavioral therapy (I-CBT) for social anxiety disorder (SAD) on severity of social anxiety symptoms.

Method: A randomized controlled trial in which 75 adult patients (21-55 years of age; 53% male; 57% Caucasian) with a principal diagnosis of generalized SAD were randomly assigned to 16 sessions of I-CBT (n = 38) or a wait-list control (WL) group (n = 37). All patients completed self-report inventories measuring CR-SE and social anxiety symptoms at baseline and post-I-CBT/post-WL, and I-CBT completers were also assessed at 1-year posttreatment.

Results: Compared with WL, I-CBT resulted in greater increases in CR-SE and greater decreases in social anxiety. Increases in CR-SE during I-CBT mediated the effect of I-CBT on social anxiety. Gains achieved by patients receiving I-CBT were maintained 1-year posttreatment, and I-CBT-related increases in CR-SE were also associated with reduction in social anxiety at the 1-year follow-up.

Conclusions: Increasing CR-SE may be an important mechanism by which I-CBT for SAD produces both immediate and long-term reductions in social anxiety.

Figure 1

Consolidated Standards of Reporting Trials diagram for a Randomized Controlled Trial of Individual Cognitive-Behavioral Therapy (I-CBT) vs. Waitlist (WL) Control. (ITT = Intent-to-Treat Analyses; tx = treatment).

Figure 2

Relationship of pre-to-post changes in CR-SE and LSAS-SR. Gray circles = waitlist control group, black diamonds = Individual cognitive-behavioral therapy, CR-SE = cognitive reappraisal self-efficacy, LSAS-SR = Liebowitz Social Anxiety Scale - Self-Report.