Carleton R Nicholas, Teale Sapach Michelle J N, Oriet Chris, LeBouthillier Daniel M
a Department of Psychology , University of Regina , Regina , Canada.
Cogn Behav Ther. 2017 Jan;46(1):44-59. doi: 10.1080/16506073.2016.1214173. Epub 2016 Aug 15.
Social anxiety disorder (SAD) models posit vigilance for external social threat cues and exacerbated self-focused attention as key in disorder development and maintenance. Evidence indicates a modified dot-probe protocol may reduce symptoms of SAD; however, the efficacy when compared to a standard protocol and long-term maintenance of treatment gains remains unclear. Furthermore, the efficacy of such protocols on SAD-related constructs remains relatively unknown. The current investigation clarified these associations using a randomized control trial replicating and extending previous research. Participants with SAD (n = 113; 71% women) were randomized to complete a standard (i.e. control) or modified (i.e. active) dot-probe protocol consisting of 15-min sessions twice weekly for four weeks. Self-reported symptoms were measured at baseline, post-treatment, and 4-month and 8-month follow-ups. Hierarchical linear modeling indicated significant self-reported reductions in symptoms of social anxiety, fear of negative evaluation, trait anxiety, and depression, but no such reductions in fear of positive evaluation. Symptom changes did not differ based on condition and were maintained at 8-month follow-up. Attentional biases during the dot-probe task were not related to symptom change. Overall, our results replicate support for the efficacy of both protocols in reducing symptoms of SAD and specific related constructs, and suggest a role of exposure, expectancy, or practice effects, rather than attention modification, in effecting such reductions. The current results also support distinct relationships between fears of negative and positive evaluation and social anxiety. Further research focused on identifying the mechanisms of change in attention modification protocols appears warranted.
社交焦虑障碍（SAD）模型认为，对外部社交威胁线索保持警惕以及加剧的自我关注是该障碍发展和维持的关键因素。有证据表明，一种改良的点探测实验程序可能会减轻社交焦虑障碍的症状；然而，与标准程序相比的疗效以及治疗效果的长期维持情况仍不明确。此外，此类程序对与社交焦虑障碍相关的构念的疗效仍相对未知。当前的研究通过一项随机对照试验对这些关联进行了阐明，该试验重复并扩展了先前的研究。患有社交焦虑障碍的参与者（n = 113；71%为女性）被随机分配，以完成一种标准（即对照）或改良（即主动）的点探测实验程序，该程序包括每周两次、每次15分钟的疗程，共四周。在基线、治疗后、4个月和8个月随访时测量自我报告的症状。分层线性模型表明，自我报告的社交焦虑、对负面评价的恐惧、特质焦虑和抑郁症状有显著减轻，但对正面评价的恐惧没有减轻。症状变化在不同条件下没有差异，并且在8个月随访时得以维持。点探测任务中的注意偏向与症状变化无关。总体而言，我们的结果再次支持了两种程序在减轻社交焦虑障碍症状和特定相关构念方面的疗效，并表明在实现这种减轻方面，暴露、预期或练习效应而非注意修正起到了作用。当前结果还支持了对负面和正面评价的恐惧与社交焦虑之间的不同关系。进一步研究关注确定注意修正程序中的变化机制似乎是有必要的。
