Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
J Anxiety Disord. 2019 Oct;67:102118. doi: 10.1016/j.janxdis.2019.102118. Epub 2019 Jul 27.
Although cognitive behavior therapy (CBT) is an effective treatment for social anxiety disorder, little is known about the processes during treatment that bring about change. The aim of this study was to investigate whether the proposed processes of change according to the cognitive model of social anxiety disorder predicted subsequent symptom reduction in CBT delivered as therapist-guided bibliotherapy. We analyzed data from patients with social anxiety disorder (N = 61) who participated in an effectiveness trial of CBT in primary care. Seven putative processes and outcome (i.e., social anxiety) were assessed on a weekly basis throughout treatment. We used linear mixed models to analyze within-person relations between processes and outcome. The results showed a unidirectional effect of reduced avoidance on subsequent decrease in social anxiety. Further, we found support for reciprocal influences between four of the proposed processes (i.e., estimated probability and cost of adverse outcome, self-focused attention, and safety behaviors) and social anxiety. The remaining two processes, (i.e., anticipatory and post-event processing) did not predict subsequent social anxiety, but were predicted by prior symptom reduction. The findings support that several of the change processes according to the cognitive model of social anxiety disorder are involved in symptom improvement.
尽管认知行为疗法（CBT）是治疗社交焦虑症的有效方法，但对于治疗过程中导致变化的机制知之甚少。本研究旨在探讨根据社交焦虑症的认知模型提出的变化过程是否可以预测作为治疗师指导的自助式认知行为疗法治疗后的症状减轻。我们分析了参加初级保健中 CBT 有效性试验的社交焦虑症患者（N=61）的数据。在整个治疗过程中每周评估七个假定的过程和结果（即社交焦虑）。我们使用线性混合模型分析了过程和结果之间的个体内关系。结果表明，回避行为的减少对随后社交焦虑的减轻有单向影响。此外，我们还发现了四个提议的过程（即不良后果的估计概率和代价、自我关注和安全行为）和社交焦虑之间存在相互影响的支持。其余两个过程（即预期和事件后处理）不能预测随后的社交焦虑，但可以由先前的症状减轻来预测。这些发现支持了社交焦虑认知模型中的几个变化过程与症状改善有关。
