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.

Conflict of interest statement

None of the other authors have any direct or indirect conflicts of interest, financial or personal relationships or affiliations to disclose.

Figures

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.