July 30, 2018

Dear Colleagues,

The National Social Anxiety Center (NSAC) provides information about relevant and current research in service of disseminating and promoting evidence-based treatment. This month’s summary focuses on therapy outcomes and mechanisms in the treatment of social anxiety.

Alden et al (2018) recently published a treatment outcome study comparing cognitive behavior therapy regimen augmented by a relational focus (CBT-R), graduated exposure-applied relaxation (GEAR), and a wait list control group. Participants (100 adults seeking treatment for social anxiety disorder) were randomly assigned to one of the three conditions. Those in treatment conditions (CBT-R and GEAR) received 14 sessions of group treatment. The CBT-R treatment included identification and carrying out of behavioral experiments related to interpersonal principles, beliefs and safety behaviors. Social initiation, relationship satisfaction, and symptoms of social anxiety were measured prior to treatment, following treatment, and at 6 and 12-month follow-ups.

Participants who received CBT-R had significantly greater improvement of avoidance behaviors and anxiety symptoms, relative to those in the GEAR condition. Only those who received CBT-R showed significant improvements in relationship satisfaction. These differences were maintained at the 12-month follow up period. Safety behavior reduction acted as a partial mediator, predicting changes in relationship satisfaction and anxiety symptoms.

Eliminating safety behaviors is often a target of treatment in CBT. However, various beliefs can result in consumers being unwilling to eliminate safety behaviors. What effective strategies have you used to increase client willingness to eliminate safety behaviors? What positive outcomes have you observed when these behaviors are eliminated?

KAlden, L. E., Buhr, K., Robichaud, M., Trew, J. L., & Plasencia, M. L. (2018). Treatment of social approach processes in adults with social anxiety disorder. Journal Of Consulting And Clinical Psychology, 86 (6), 505-517. Link to abstract.

Michelle Dexter, PhD, ACT
Clinical Psychologist

Representative of NSAC Los Angeles (Behavioral Associates, Los Angeles)