Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Aug;57(8):1776-1782.
doi: 10.1002/eat.24191. Epub 2024 Mar 15.

Examining co-occurring social anxiety in cognitive behavioral therapy for eating disorders: Does it change and does it moderate eating disorder outcomes?

Pheobe L Ho  1   2 , David M Erceg-Hurn  1 , Peter M McEvoy  1   3   4 , Bruce N C Campbell  1 , Danielle C Mathersul  2   5   6 , Helen M Correia  2 , Bronwyn C Raykos  1
Affiliations

Examining co-occurring social anxiety in cognitive behavioral therapy for eating disorders: Does it change and does it moderate eating disorder outcomes?

Pheobe L Ho et al. Int J Eat Disord. 2024 Aug.

Abstract

Objective: Eating disorders (EDs) often co-occur with social anxiety disorder (SAD). However, little research has examined the influence of SAD symptoms on ED treatment outcomes in the context of individual outpatient cognitive-behavior therapy for eating disorders (CBT-ED). It is plausible that SAD symptom severity could improve as a result of ED treatment, given the high overlap between EDs and SAD. We sought to test whether baseline SAD symptoms moderate early response to CBT-ED or post-treatment outcomes in CBT-ED, and the degree to which SAD symptoms improve during therapy despite SAD not being an explicit treatment target.

Method: ED clients (N = 226) aged ≥16 years were treated with CBT-ED. Outcomes were ED symptoms, clinical impairment, and SAD symptoms measured at baseline, session 5 and post-treatment.

Results: Baseline SAD was a weak moderator of early and post-treatment ED symptoms and impairment. SAD symptoms improved moderately over treatment among clients who started with elevated levels of SAD symptomology.

Discussion: Clients with EDs can experience good therapeutic outcomes regardless of their social anxiety severity at pre-treatment. SAD symptoms reduced over CBT-ED, but protocol enhancements such as exposure-based strategies that directly target co-occurring social-evaluative concerns may help achieve larger reductions in SAD symptoms.

Public significance: Eating disorders often co-occur with anxiety disorders such as social anxiety. We found people who had both social anxiety and an eating disorder benefited as much from eating disorder treatment as people who did not have social anxiety. People who were socially anxious became less anxious as a by-product of receiving eating disorder treatment. It may be possible to reduce social anxiety further by enhancing eating disorder treatment protocols.

Keywords: anorexia nervosa; bulimia nervosa; cognitive behavior therapy; early response; eating disorder; moderation; social anxiety; social phobia.

PubMed Disclaimer

References

REFERENCES

    1. Abbate‐Daga, G., Marzola, E., De‐Bacco, C., Buzzichelli, S., Brustolin, A., Campisi, S., Amianto, F., Migliaretti, G., & Fassino, S. (2015). Day hospital treatment for anorexia nervosa: A 12‐month follow‐up study. European Eating Disorders Review, 23(5), 390–398. https://doi.org/10.1002/erv.2369
    1. Allen, H. N., & Craighead, L. W. (1999). Appetite monitoring in the treatment of binge eating disorder. Behavior Therapy, 30(2), 253–272. https://doi.org/10.1016/S0005-7894(99)80007-0
    1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.97808904255966
    1. Becker, A. E., Hadley Arrindell, A., Perloe, A., Fay, K., & Striegel‐Moore, R. H. (2010). A qualitative study of perceived social barriers to care for eating disorders: Perspectives from ethnically diverse health care consumers. The International Journal of Eating Disorders, 43(7), 633–647. https://doi.org/10.1002/eat.20755
    1. Bohn, K., & Fairburn, C. G. (2008). Clinical impairment assessment questionnaire (CIA). In C. Fairburn (Ed.), Cognitive behavioral therapy for eating disorders (pp. 315–317). Guildford Press.

LinkOut - more resources