Examining the dynamic relationships between exposure tasks and cognitive restructuring in CBT for SAD: Outcomes and moderating influences

J Anxiety Disord. 2016 Apr;39:10-20. doi: 10.1016/j.janxdis.2016.01.010. Epub 2016 Feb 4.


Meta-analyses indicate that cognitive behavioral therapy (CBT) for social anxiety disorder (SAD) leads to substantial symptom alleviation. Although there is an emphasis on engaging in exposure and cognitive restructuring during treatment, the longitudinal relationship between skill use and symptom alleviation is not well understood. Furthermore, treatment response may be attenuated by pre-existing patient vulnerabilities. This study examined the longitudinal association of skill use (i.e. exposure (EX), thought record use (TR)), symptom reduction and the potential moderating influence of perfectionism during a 12-session, manual-based CBT for SAD intervention for 100 patients (51% female) meeting DSM-IV criteria for SAD. Results obtained from Latent Difference Score (LDS) models indicated that the frequency of both EX and TR skill use led to subsequent symptom alleviation; however, this varied based on the type of skill used. Further, although both EX and TR interventions were associated with subsequent symptom reduction, the association of EX and subsequent symptom alleviation was greater than the association of TR and subsequent symptom alleviation. Finally, higher pre-treatment perfectionism was associated with greater initial skill use, followed by significantly reduced skill use in later sessions. These preliminary results suggest that perfectionistic individuals demonstrate differential engagement in EX and TR interventions during treatment.

Keywords: Cognitive behavioral therapy; Cognitive restructuring; Exposure; Latent difference score analysis; Perfectionism; Skill use; Social anxiety disorder; Thought records.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Cognition
  • Cognitive Behavioral Therapy / standards*
  • Diagnostic and Statistical Manual of Mental Disorders
  • Female
  • Humans
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Models, Statistical
  • Outcome Assessment, Health Care / methods*
  • Phobia, Social / therapy*
  • Self Report
  • Thinking
  • Young Adult