April 3, 2019

Dear Colleagues,

The National Social Anxiety Center (NSAC) provides information about relevant research in service of disseminating and promoting evidence-based treatment. This month’s summary, by Tony Bates, LSW from NSAC Chicago, focuses on a new RCT comparing traditional cognitive behavior therapy (tCBT) with acceptance and commitment therapy (ACT) in the treatment of social anxiety.

Herbert et al. (2018) conducted a replication trial to build on past efforts comparing tCBT with ACT. This is the first RCT to examine effects on observer-rated behavioral outcomes and to control for exposure dose. Participants in the exercise (88 adults seeking treatment for social anxiety disorder) were randomly assigned to one of two treatment groups. The tCBT group received 12 individual weekly sessions based on a modified version of the CBT for SAD manual by Ledley, Foa, & Huppert (2005). The ACT group received 12 individual weekly sessions that integrated exposure exercises within an ACT framework. Measures were taken to ensure the dosage of exposure treatment remained consistent across both treatment groups.

Participants who completed tCBT reported significantly greater improvement in self-reported and clinician-rated symptoms and functioning with large effect sizes, and a larger proportion of participants in the tCBT group achieved clinically significant improvement than participants in the ACT group. Participants in the ACT group demonstrated greater improvements in behavioral social skills (as rated by blinded observers), although those effects were not statistically significant.

The authors suggest these findings may be explained in part by the stated goals of each treatment: while tCBT is consistent with prevailing Western cultural norms that emphasize symptom reduction and subjective well-being, ACT’s goals focus on reducing attempts to control negative internal experiences and instead to enhance willingness to experience them in the pursuit of values-driven behavior. These goals are consistent with trends observed in the study: ACT participants saw improvements in behavioral performance but less improvement in self-reported symptoms.

How do you change your treatment approach, if at all, based on client goals? To what extent do you outline treatment options, and how do clients tend to respond?

Herbert, J. D., Forman, E. M., Kaye, J. L., Gershkovich, M., Goetter, E., Yuen, E. K., Marando-Blanck, S. (2018). Randomized controlled trial of acceptance and commitment therapy versus traditional cognitive behavior therapy for social anxiety disorder: Symptomatic and behavioral outcomes. Journal of Contextual Behavior Science , 9, 88-96.

Tony Bates, LSW
Staff Therapist
NSAC Chicago
(Depression and Anxiety Specialty Clinic of Chicago)


Robert Yeilding, Psy.D.
Clinical Psychologist
Representative of NSAC Newport Beach / Orange County
(Anxiety and Depression Center)