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Cognitive Therapy and Research

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01.04.2013 | Original Article

Changes in Beliefs about the Social Competence of Self and Others Following Group Cognitive-Behavioral Treatment

verfasst von: Naomi Koerner, Martin M. Antony, Lisa Young, Randi E. McCabe

Erschienen in: Cognitive Therapy and Research | Ausgabe 2/2013

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Abstract

The current study examined changes in social anxiety thoughts and beliefs following cognitive-behavioral treatment (CBT). Participants (N = 77) were adults with a principal diagnosis of SAD who received 12, 2-h sessions of group CBT at a hospital-based outpatient anxiety disorders clinic. There were significant decreases from pretreatment to posttreatment in social anxiety symptoms and in symptoms of depression, nonspecific anxiety and tension, as well as significant improvements in social anxiety beliefs, as assessed via the Social Thoughts and Beliefs Scale (STABS; Turner et al., Psychol Assess 15:384–391, 2003). Change in social anxiety beliefs made a significant contribution to the prediction of social anxiety symptoms at posttreatment over and above pretreatment social anxiety symptoms and changes in depression, nonspecific anxiety and tension. A positive change in the belief that others are more socially-competent emerged as a significant unique predictor of social anxiety symptoms at posttreatment. The findings demonstrate that the STABS is sensitive to cognitive-behavioral treatment. The findings also suggest that social comparison processes in particular are a key aspect of improvement in social anxiety symptoms. This is an important direction for future research.

Noncompleters’ pretreatment scores on all measures were carried forward to posttreatment and all hypotheses were retested using the entire intent-to-treat sample. At posttreatment, completers (n = 77) produced significantly lower scores than did noncompleters (n = 39) on all measures with the exception of depressive symptoms (however, the mean scores were lower in completers than in noncompleters). The regression analyses that were performed in the completers were repeated in the entire intent-to-treat sample. The results showed that changes in the STABS scales, whether entered together or separately, led to a significant increment in the prediction of posttreatment SPIN scores, over and above pretreatment SPIN and changes in scores on the DASS scales. Consistent with our findings in the completer sample, change in the belief that others are more socially proficient (β = .36, p < .01) was a stronger unique predictor of outcome following CBT relative to change in beliefs about the self as socially inept (β = .24, p < .05) and changes in symptoms of depression (β = .09, n.s.), anxiety (β = .06, n.s.) and tension (β = .17, p < .05).

These analyses should be interpreted with caution for two reasons, however. First, posttreatment assessment of noncompleters is not a routine part of the clinical procedures at the outpatient setting at which the present study was carried out. Thus, the missing data for noncompleters was not random; but rather, systematic. Second, estimating the missing posttreatment data for the noncompleters based on their pretreatment data using data imputation methods such as last-observation-carried-forward (LOCF) could produce results that are potentially misleading. LOCF has received heavy criticism (e.g., Streiner 2002) and its use in the present study would be particularly questionable as it would assume absolutely no change from pretreatment to posttreatment in the noncompleter group.

A posthoc analysis was performed to explore the hypothesis that beliefs about the self as socially-inept may reflect depression symptoms. Individuals with SAD who reported a history of a mood disorder (n = 48) were compared to individuals with SAD with no history of a mood disorder (n = 29) on the SPIN total score and on the STABS subscales at baseline. The groups produced similar scores on the SPIN, t(75) = 1.71, p = .10 and on the STABS-SC subscale, t(75) = 1.22, p = .23. However, individuals with a history of a mood disorder produced significantly higher scores on the STABS-SI subscale than did individuals without a history of a mood disorder, t(75) = 2.56, p = .01. A subgroup analysis was also performed to examine symptom correlates of the SAD beliefs within individuals with comorbid diagnoses of social anxiety disorder and a mood disorder. STABS-SI was significantly associated with the SPIN total score (r = .64, p < .01) and DASS-D (r = .34, p < .05); whereas STABS-SC was significantly associated only with the SPIN total score (r = .62, p < .01).

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Titel: Changes in Beliefs about the Social Competence of Self and Others Following Group Cognitive-Behavioral Treatment
verfasst von: Naomi Koerner
Martin M. Antony
Lisa Young
Randi E. McCabe
Publikationsdatum: 01.04.2013
Verlag: Springer US
Erschienen in: Cognitive Therapy and Research / Ausgabe 2/2013
Print ISSN: 0147-5916
Elektronische ISSN: 1573-2819
DOI: https://doi.org/10.1007/s10608-012-9472-5

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