ISSN 2043-8087
Journal of Experimental Psychopathology
 Volume 7, Issue 4, 655-670, 2016
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Moderators of Change in Social Anxiety During CBT in a Transdiagnostic, Naturalistic Treatment-Seeking Sample

  Anu Asnaani - University of Pennsylvania
  Antonia Kaczkurkin - University of Pennsylvania
  Hallie Tannahill - University of Pennsylvania
  Hayley Fitzgerald - University of Pennsylvania

Volume 7, Issue 4, 2016, Pages 655-670


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 disorder (SAD). Aims: This study examined the influence of specific constructs (i.e., anxiety sensitivity, ruminative thinking, and depressive symptoms) on reduction of SAD during a course of cognitive behavioral therapy (CBT). To better model potential causal relationships between observed moderators and social anxiety, time-lagged analyses between SAD and significant moderators were also explored. Methods: Participants (N=98) were patients seeking treatment in a fee-for-service clinic specializing in CBT for anxiety disorders, OCD and PTSD. Patients were repeatedly assessed for a variety of symptoms and potential moderators throughout treatment. Results: Even though anxiety sensitivity, rumination and depression showed significant within- and between-person relationships with SAD, only rumination was found to uniquely moderate change in SAD symptoms over the course of treatment. Specifically, those with higher average levels of ruminative thinking tended to improve faster on SAD symptoms than those with lower levels throughout treatment, although rumination did not appear to have a time lagged effect on SAD symptoms. Further, this observed moderation effect was not found to significantly influence OCD, generalized anxiety, or PTSD symptoms. Conclusions: High levels of ruminative thinking do not appear to be an impediment to improvement in SAD symptoms in a naturalistic, treatment-seeking sample of individuals with anxiety disorders.

Table of Contents
Material and methods
  Social Phobia Inventory
  Anxiety Sensitivity Index-3
  Beck Depressive Inventory-II
  Rumination-Reflection Questionnaire
  Penn State Worry Questionnaire
  Posttraumatic Diagnostic Scale–5
  Obsessive Compulsive Inventory–Revised
 Cognitive Behavioral Treatment
 Data Analysis
 Treatment Course and Dropouts
 Reduction in SPIN over the Course of Treatment
 Relationship between SPIN and Other Symptom Measures
 Moderators of the Change in SPIN over Time
 Specificity of Moderating Effect of Rumination on SAD
 Lagged Effects of Rumination on SPIN

Correspondence to
Anu Asnaani, Ph.D, Department of Psychiatry, Center for the Treatment and Study of Anxiety, 3535 Market St., Suite 600 North, Philadelphia, PA 19104

social anxiety disorder, moderators, rumination, anxiety sensitivity, depression, naturalistic treatment

Received 1 Feb 2016; Revised 5 May 2016; Accepted 5 May 2016; In Press 16 May 2016

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