Moderators of Change in Social Anxiety during CBT in a Transdiagnostic, Naturalistic Treatment-Seeking Sample

Abstract

Background: There are a number of hypothesized underlying factors that, while present across a range of anxiety and fear-based disorders, are proposed to be specifically influential in the maintenance of social anxiety (SA) symptoms. Aims: This study examined the influence of specific constructs (i.e., anxiety sensitivity, ruminative thinking, and depressive symptoms) on reduction of SA symptoms during a course of cognitive behavioral therapy (CBT). To better model potential causal relationships between observed moderators and social anxiety, time-lagged analyses between SA and significant moderators were also explored. Methods: Participants (N = 107) were patients seeking treatment in a fee-for-service clinic specializing in CBT for anxiety disorders, OCD and PTSD. Participants were repeatedly assessed for a variety of symptoms and potential moderators throughout treatment. Results: Even though anxiety sensitivity regarding social concerns, rumination, reflection, and depression showed significant within-and between-person relationships with SA symptoms, only rumination was found to uniquely moderate change in SA symptoms over the course of treatment. Specifically, those with higher average levels of ruminative thinking tended to improve greater on SA symptoms than those with lower levels throughout treatment. Further, this observed moderation effect was not found to significantly influence OCD, generalized anxiety, or PTSD symptoms. Finally, a bi-directional relationship was found between rumination and SA with rumination predicting subsequent changes in SA and vice versa. Conclusions: High levels of ruminative thinking do not appear to be an impediment to improvement in SA symptoms in a naturalistic, treatment-seeking sample of individuals with anxiety disorders.