Hostname: page-component-78c5997874-8bhkd Total loading time: 0 Render date: 2024-11-10T08:24:02.878Z Has data issue: false hasContentIssue false

Effectiveness of Group Cognitive Therapy for Social Anxiety Disorder in Routine Care

Published online by Cambridge University Press:  23 December 2020

Helen Colhoun
Affiliation:
Anxiety Disorders Service, CDHB, Christchurch, New Zealand
Lee Kannis-Dymand*
Affiliation:
Anxiety Disorders Service, CDHB, Christchurch, New Zealand Thompson Institute, University of the Sunshine Coast, Queensland, Australia University of the Sunshine Coast, School of Health and Behavioural Sciences, Queensland, Australia
Marion Rudge
Affiliation:
Anxiety Disorders Service, CDHB, Christchurch, New Zealand
Dianne Le Compte
Affiliation:
Anxiety Disorders Service, CDHB, Christchurch, New Zealand
Sarah J. O'Flaherty
Affiliation:
University of the Sunshine Coast, School of Health and Behavioural Sciences, Queensland, Australia
Claire Gilbert
Affiliation:
Anxiety Disorders Service, CDHB, Christchurch, New Zealand
Monique Jones
Affiliation:
Anxiety Disorders Service, CDHB, Christchurch, New Zealand Thompson Institute, University of the Sunshine Coast, Queensland, Australia
Sarah-Eve Harrow
Affiliation:
Anxiety Disorders Service, CDHB, Christchurch, New Zealand
Ron Chambers
Affiliation:
Anxiety Disorders Service, CDHB, Christchurch, New Zealand
Colette Woolcock
Affiliation:
Anxiety Disorders Service, CDHB, Christchurch, New Zealand
Juliet Macleod
Affiliation:
Anxiety Disorders Service, CDHB, Christchurch, New Zealand
Geoff P Lovell
Affiliation:
University of the Sunshine Coast, School of Health and Behavioural Sciences, Queensland, Australia Department of Sport, Hartpury University, Gloucestershire, UK
Caroline Bell
Affiliation:
Christchurch School of Medicine and Health Sciences, University of Otago, Christchurch, New Zealand
*
*Corresponding author: Lee Kannis-Dymand, University of the Sunshine Coast, 12 Innovation Parkway, Birtinya, QLD4557, Australia. Email: lkannisd@usc.edu.au
Get access

Abstract

Social anxiety disorder (SAD) is a prevalent chronic condition with a large demand for treatment. This community outpatient study examined the effectiveness of a group intervention version of the established one-to-one cognitive therapy derived from the Clark and Wells model for SAD. Questionnaires were completed pre-treatment and post-treatment for SAD symptoms (Social Phobia Scale, Social Interaction Anxiety Scale), depressive symptoms (BDI-II), self-focused attention, safety behaviours (Social Phobia Weekly Summary Scale and Subtle Avoidance Frequency Examination), and impaired functioning (Work and Social Adjustment Scale). From an initial sample of 159 participants, 101 completed at least seven of the nine weekly group sessions (Mage = 34.1 years, SDage = 10.8 years, 53% female). Significant improvements were demonstrated on all measures. Large effect sizes were found for social anxiety symptoms and safety behaviour use. Self-focused attention, depressive symptoms, and impaired functioning had moderate effect sizes. Effect sizes for anxiety (d = 1.00 and 1.32) and mood measures (d = 0.71) were as high, or in some cases, higher than previous group treatment studies. Results suggest group cognitive therapy for SAD based on the Clark and Wells model is effective in a clinical setting for individuals with moderate/severe and treatment-resistant social anxiety.

Type
Standard Paper
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Albano, AM and Hayward, C (2004). Social anxiety disorder. In Ollendick, T and March, J (Eds.), Phobic and anxiety disorders in children and adolescents: A clinician's guide to effective psychosocial and pharmacological interventions (pp. 198235). New York: Oxford University Press.CrossRefGoogle Scholar
Allen, LB, White, KS, Barlow, DH, Shear, MK, Gorman, JM and Woods, SW (2009). Cognitive-behavior therapy (CBT) for panic disorder: Relationship of anxiety and depression comorbidity with treatment outcome. Journal of Psychopathology and Behavioral Assessment, 32, 185192. doi:10.1007/s10862-009-9151-3CrossRefGoogle ScholarPubMed
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.Google Scholar
Bados, A, Balaguer, G and Saldaña, C (2007). The efficacy of cognitive–behavioral therapy and the problem of drop-out. Journal of Clinical Psychology, 63, 585592. doi:10.1002/jclp.20368CrossRefGoogle ScholarPubMed
Beck, AT, Steer, RA and Brown, GK (1996). Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation.Google Scholar
Beesdo-Baum, K, Knappe, S, Fehm, L, Höfler, M, Lieb, R, Hofmann, SG and Wittchen, HU (2012). The natural course of social anxiety disorder among adolescents and young adults. Acta Psychiatrica Scandinavica, 126, 411425. doi:10.1111/j.1600-0447.2012.01886.xCrossRefGoogle ScholarPubMed
Bell, C, Colhoun, H, Carter, F and Frampton, C (2012). Effectiveness of computerised cognitive behavioural therapy for anxiety disorders in secondary care. Australian and New Zealand Journal of Psychiatry, 46, 630640. doi:10.1177/0004867412437345CrossRefGoogle ScholarPubMed
Bennett, DA (2001). How can I deal with missing data in my study? Australian and New Zealand Journal of Public Health, 25, 464. doi:10.1111/j.1467-842X.2001.tb00294.xCrossRefGoogle Scholar
Bögels, SM and Mansell, W (2004). Attention processes in the maintenance and treatment of social phobia: Hypervigilance, avoidance and self-focused attention. Clinical Psychology Review, 24, 827856. doi:10.1016/j.cpr.2004.06.005CrossRefGoogle ScholarPubMed
Clark, DM and Wells, A (1995). A cognitive model of social phobia. In Heimberg, R (Ed.), Social phobia: Diagnosis, assessment, and treatment (pp. 6993). New York: Guilford Press.Google Scholar
Clark, DM, Ehlers, A, McManus, F, Hackmann, A, Fennell, M, Campbell, H, … Louis, B (2003). Cognitive therapy versus fluoxetine in generalized social phobia: A randomized placebo-controlled trial. Journal of Consulting and Clinical Psychology, 71, 10581067. doi:10.1037/0022-006X.71.6.1058CrossRefGoogle ScholarPubMed
Clark, DM, Deale, A, Grey, N, Liness, S, Murray, H, Turner, C and Wild, J. (2004). Brief cognitive therapy for social phobia. Unpublished Manual. London: Centre for Anxiety Disorders and Trauma, Maudsley Hospital & Department of Psychology, Institute of Psychiatry, King's College London.Google Scholar
Clark, DM, Ehlers, A, Hackmann, A, McManus, F, Fennell, M, Grey, N, … Wild, J (2006). Cognitive therapy versus exposure and applied relaxation in social phobia: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 74, 568578. doi:10.1037/0022-006X.74.3.568CrossRefGoogle ScholarPubMed
Cohen, J (1988). Statistical power analysis for the behavioral sciences (2nd ed.). New York: Routledge.Google Scholar
Cox, BJ, Ross, L, Swinson, RP and Direnfeld, DM (1998). A comparison of social phobia outcome measures in cognitive-behavioral group therapy. Behavior Modification, 22, 285297. doi:10.1177/01454455980223004CrossRefGoogle ScholarPubMed
Cuming, S, Rapee, RM, Kemp, N, Abbott, MJ, Peters, L and Gaston, JE (2009). A self-report measure of subtle avoidance and safety behaviors relevant to social anxiety: Development and psychometric properties. Journal of Anxiety Disorders, 23, 879883. doi:10.1016/j.janxdis.2009.05.002CrossRefGoogle ScholarPubMed
Dong, Y and Peng, C-YJ (2013). Principled missing data methods for researchers. SpringerPlus, 2, 117. doi:10.1186/2193-1801-2-222CrossRefGoogle ScholarPubMed
Fedoroff, IC and Taylor, S (2001). Psychological and pharmacological treatments of social phobia: A meta-analysis. Journal of Clinical Psychopharmacology, 3, 311324.CrossRefGoogle Scholar
Field, A (2013). Discovering statistics using IBM SPSS statistics. London: Sage Publications Ltd.Google Scholar
Furukawa, TA, Nakano, Y, Funayama, T, Ogawa, S, Ietsugu, T, Noda, Y, … Akechi, T (2013). Cognitive–behavioral therapy modifies the naturalistic course of social anxiety disorder: Findings from an ABA design study in routine clinical practices. Psychiatry and Clinical Neurosciences, 67, 139147. doi:10.1111/pcn.12035CrossRefGoogle ScholarPubMed
Gaston, JE, Abbott, MJ, Rapee, RM and Neary, SA (2006). Do empirically supported treatments generalize to private practice? A benchmark study of a cognitive-behavioural group treatment programme for social phobia. British Journal of Clinical Psychology, 45, 3348. doi:10.1348/014466505X35146CrossRefGoogle ScholarPubMed
Goldin, PR, Morrison, A, Jazaieri, H, Brozovich, F, Heimberg, R and Gross, JJ (2016). Group CBT versus MBSR for social anxiety disorder: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 84, 427437. doi:10.1037/ccp0000092CrossRefGoogle ScholarPubMed
Gunter, RW and Whittal, ML (2010). Dissemination of cognitive-behavioral treatments for anxiety disorders: Overcoming barriers and improving patient access. Clinical Psychology Review, 30, 194202. doi:10.1016/j.cpr.2009.11.001CrossRefGoogle ScholarPubMed
Hafner, RJ and Marks, IM (1976). Exposure in vivo of agoraphobics: Contributions of diazepam, group exposure, and anxiety evocation. Psychological Medicine, 6, 7188. doi:10.1017/S0033291700007510CrossRefGoogle ScholarPubMed
Hauksson, P, Ingibergsdóttir, S, Gunnarsdóttir, T and Jónsdóttir, IH (2017). Effectiveness of cognitive behaviour therapy for treatment-resistant depression with psychiatric comorbidity: Comparison of individual versus group CBT in an interdisciplinary rehabilitation setting. Nordic Journal of Psychiatry, 71, 465472. doi:10.1080/08039488.2017.1331263CrossRefGoogle Scholar
Hedman, E, Mörtberg, E, Hesser, H, Clark, DM, Lekander, M, Andersson, E and Ljótsson, B (2013). Mediators in psychological treatment of social anxiety disorder: Individual cognitive therapy compared to cognitive behavioral group therapy. Behaviour Research and Therapy, 51, 696705. doi:10.1016/j.brat.2013.07.006CrossRefGoogle ScholarPubMed
Iancu, I, Levin, J, Hermesh, H, Dannon, P, Poreh, A, Ben-Yehuda, Y, … Kotler, M (2006). Social phobia symptoms: Prevalence, sociodemographic correlates, and overlap with specific phobia symptoms. Comprehensive Psychiatry, 47, 399405. doi:10.1016/j.comppsych.2006.01.008CrossRefGoogle ScholarPubMed
Kirsch, I, Deacon, BJ, Huedo-Medina, TB, Scoboria, A, Moore, TJ and Johnson, BT (2008). Initial severity and antidepressant benefits: A meta-analysis of data submitted to the Food and Drug Administration. PLoS Medicine, 5, e45. doi:10.1371/journal.pmed.0050045CrossRefGoogle ScholarPubMed
Lincoln, TM, Rief, W, Hahlweg, K, Frank, M, von Witzleben, I, Schroeder, B and Fiegenbaum, W (2003). Effectiveness of an empirically supported treatment for social phobia in the field. Behaviour Research and Therapy, 41, 12511269. doi:10.1016/S0005-7967(03)00038-XCrossRefGoogle ScholarPubMed
Mattick, RP and Clarke, JC (1998). Development and validation of measures of social phobia scrutiny fear and social interaction anxiety. Behaviour Research and Therapy, 36, 455470. doi:10.1016/S0005-7967(97)10031-6CrossRefGoogle ScholarPubMed
Mavranezouli, I, Mayo-Wison, E, Dias, S, Kew, K, Clark, DM, Ades, AE and Pilling, S (2015). The cost effectiveness of psychological and pharmacological interventions for social anxiety disorder: A model-based economic analysis. PLoS ONE, 10, e0140704. doi:10.1371/journal.pone.0140704CrossRefGoogle ScholarPubMed
Mayo-Wilson, E, Dias, S, Mavranezouli, I, Kew, K, Clark, DM, Ades, AE and Pilling, S (2014). Psychological and pharmacological interventions for social anxiety disorder in adults: A systematic review and network meta-analysis. The Lancet Psychiatry, 1, 368376. doi:10.1016/S2215-0366(14)70329-3CrossRefGoogle ScholarPubMed
McCarthy, O, Hevey, D, Brogan, A and Kelly, BD (2013). Effectiveness of a cognitive behavioural group therapy (CBGT) for social anxiety disorder: Immediate and long-term benefits. The Cognitive Behaviour Therapist, 6, 113. doi:10.1017/S1754470X13000111CrossRefGoogle Scholar
McEvoy, P (2007). Effectiveness of cognitive behavioural group therapy for social phobia in a community clinic: A benchmarking study. Behaviour Research and Therapy, 45, 30303040. doi:10.1016/j.brat.2007.08.002CrossRefGoogle Scholar
Ministry of Health (2012). The Health of NZ Adults 2011/12: Key findings of the New Zealand Health Survey. Wellington: Ministry of Health.Google Scholar
Mörtberg, E, Karlsson, A, Fyring, C and Sundin, Ö (2006). Intensive cognitive-behavioral group treatment (CBGT) of social phobia: A randomized controlled study. Journal of Anxiety Disorders, 20, 646660. doi:10.1016/j.janxdis.2005.07.005CrossRefGoogle ScholarPubMed
Mörtberg, E, Hoffart, A, Boecking, B and Clark, DM (2013). Shifting the focus of one's attention mediates improvement in cognitive therapy for social anxiety disorder. Behavioural and Cognitive Psychotherapy, 43, 6373. doi:10.1017/S1352465813000738CrossRefGoogle ScholarPubMed
Moscovitch, DA, Rowa, K, Paulitzki, JR, Ierullo, MD, Chiang, B, Antony, MM and McCabe, RE (2013). Self-portrayal concerns and their relation to safety behaviors and negative affect in social anxiety disorder. Behaviour Research and Therapy, 51, 476486. doi:10.1016/j.brat.2013.05.002CrossRefGoogle ScholarPubMed
Mundt, JC, Marks, IM, Shear, MK and Greist, JM (2002). The Work and Social Adjustment Scale: A simple measure of impairment in functioning. The British Journal of Psychiatry, 180, 461464. doi:10.1192/bjp.180.5.461CrossRefGoogle ScholarPubMed
National Institute for Health and Care Excellence (2013). Social anxiety disorder: Recognition, assessment and treatment of social anxiety disorder. London: Clinical Guideline, No. 159. Retrieved from https://www.nice.org.uk/guidance/cg159Google Scholar
Ollendick, TH and Hirshfeld-Becker, DR (2002). The developmental psychopathology of social anxiety disorder. Biological Psychiatry, 51, 4458. doi:10.1016/S0006-3223(01)01305-1CrossRefGoogle ScholarPubMed
Rapaport, MH, Clary, C, Fayyad, R and Endicott, J (2005). Quality-of-life impairment in depressive and anxiety disorders. American Journal of Psychiatry, 162, 11711178. doi:10.1176/appi.ajp.162.6.1171CrossRefGoogle ScholarPubMed
Rapee, RM and Heimberg, R (1997). A cognitive-behavioral model of anxiety in social phobia. Behaviour Research and Therapy, 35, 741756. doi:10.1016/S0005-7967(97)00022-3CrossRefGoogle ScholarPubMed
Ruscio, AM, Brown, TA, Chiu, WT, Sareen, J, Stein, MB and Kessler, RC (2008). Social fears and social phobia in the USA: Results from the National Comorbidity Survey Replication. Psychological Medicine, 38, 1528. doi:10.1017/S0033291707001699CrossRefGoogle ScholarPubMed
Sato, H and Kawahara, J (2011). Selective bias in retrospective self-reports of negative mood states. Anxiety, Stress & Coping, 24, 359367. doi:10.1080/10615806.2010.543132CrossRefGoogle ScholarPubMed
Shafran, R, Clark, DM, Fairburn, CG, Arntz, A, Barlow, DH, Ehlers, A, … Wilson, GT (2009). Mind the gap: Improving the dissemination of CBT. Behaviour Research and Therapy, 47, 902909. doi:10.1016/j.brat.2009.07.003CrossRefGoogle ScholarPubMed
Slade, T, Johnston, A, Oakley Browne, MA, Andrews, G and Whiteford, H (2009). 2007 National Survey of Mental Health and Wellbeing: Methods and key findings. Australian & New Zealand Journal of Psychiatry, 43, 594605. doi:10.1080/00048670902970882CrossRefGoogle ScholarPubMed
Sloan, DM, Feinstein, BA, Gallagher, MW, Beck, JG and Keane, TM (2013). Efficacy of group treatment for posttraumatic stress disorder symptoms: A meta-analysis. Psychological Trauma: Theory, Research, Practice, and Policy, 5, 176183. doi:10.1037/a0026291CrossRefGoogle Scholar
Sochting, I (2014). Cognitive behavioral group therapy: Challenges and opportunities. Chichester, UK: Wiley.CrossRefGoogle Scholar
Spijker, J, Muntingh, A and Batelaan, N (2020). Advice for clinicians on how to treat comorbid anxiety and depression. JAMA Psychiatry. Advance online publication. doi:10.1001/jamapsychiatry.2020.0601CrossRefGoogle ScholarPubMed
Stangier, U, Heidenreich, T, Peitz, M, Lauterbach, W and Clark, DM (2003). Cognitive therapy for social phobia: Individual versus group treatment. Behaviour Research and Therapy, 41, 9911007. doi:10.1016/S0005-7967(02)00176-6CrossRefGoogle ScholarPubMed
Turner, SM, Beidel, DC, Dancu, CV and Stanley, MA (1989). An empirically derived inventory to measure social fears and anxiety: The Social Phobia and Anxiety Inventory. Psychological Assessment: A Journal of Consulting and Clinical Psychology, 1, 3540. doi:10.1037/1040-3590.1.1.35CrossRefGoogle Scholar
Wersebe, H, Sijbrandij, M and Cuijpers, P (2013). Psychological group-treatments of social anxiety disorder: A meta-analysis. PLoS ONE, 8, 17. doi:10.1371/journal.pone.0079034CrossRefGoogle ScholarPubMed
Wittchen, HU, Jacobi, F, Rehm, J, Gustavsson, A, Svensson, M, Jönsson, B, … Steinhausen, HC (2011). The size and burden of mental disorders and other disorders of the brain in Europe 2010. European Neuropsychopharmacology, 21, 655679. doi:10.1016/j.euroneuro.2011.07.018CrossRefGoogle ScholarPubMed