Group Cbt For Social Phobia Test

Social anxiety is a common mental disorder among adolescents and is associated with detrimental long term outcomes. Therefore, this study investigated the efficacy of two possible early interventions for adolescent social anxiety and test anxiety. An internet-based cognitive bias modification (CBM; n = 86) was compared to a school-based cognitive behavioral group training (CBT; n = 84) and a control group (n = 70) in reducing symptoms of social and test anxiety in high socially and/or test anxious adolescents aged 13-15 years. Participants (n = 240) were randomized at school level over the three conditions. CBM consisted of a 20-session at home internet-delivered training; CBT was a 10-session at school group training with homework assignments; the control group received no training. Participants were assessed before and after the intervention and at 6 and 12 month follow-up. At 6 month follow-up CBT resulted in lower social anxiety than the control condition, while for CBM, this effect was only trend-significant. At 12 month follow-up this initial benefit was no longer present. Test anxiety decreased more in the CBT condition relative to the control condition in both short and long term. Interestingly, in the long term, participants in the CBM condition improved more with regard to automatic threat-related associations than both other conditions. The results indicate that the interventions resulted in a faster decline of social anxiety symptoms, whereas the eventual end point of social anxiety was not affected. Test anxiety was influenced in the long term by the CBT intervention, and CBM lead to increased positive automatic threat-related associations.

group cbt for social phobia test

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Dr. Thomas A. Richards currently runs all our treatment programs and is a leading clinical authority on the treatment of social anxiety disorder. Dr. Richards began seeing patients with social anxiety in the early 1990s and has seen thousands of patients since that time. The first CBT therapy group for social anxiety started in 1994. International therapy groups began in 1998.

Cognitive behavioral therapy for social anxiety disorder must be comprehensive and cover all aspects of social anxiety. Our groups are active, structured groups that work on anti-anxiety strategies on a daily, consistent basis. Cognitive therapy includes strategies to learn how to think and believe differently about ourselves. Behavioral therapy puts the cognitive strategies into place in your daily life.

Guided internet-delivered cognitive behavior therapy (ICBT) has been tested in several trials on social anxiety disorder (SAD) with moderate to large effects. The aims of this study were threefold. First, to compare the effects of ICBT including online discussion forum with a moderated online discussion forum only. Second, to investigate if knowledge about SAD increased following treatment and third to compare the effects of inexperienced versus experienced therapists on patient outcomes.

The mechanisms of change in ICBT for SAD are not well known, even if it is possible that cognitive aspects are involved as has been found in face-to-face CBT [67]. The ICBT tested in this trial includes both cognitive and behavioral components, but is based on a CBT model that underscores the importance of attention focused on the self, safety behaviors, and beliefs about social situations [68]. Mediators of change in ICBT for SAD have not been investigated and the specificity of the findings can be questioned as other treatments such as applied relaxation [12] and interpersonal psychotherapy [69] also lead to reduced symptoms even if they may be less effective than CBT.

To date, even though the earliest onset of SAD has been reported at age 7 [19] to 9.2 years [2], almost all group CBT programs have been developed for adolescents starting at 12 years of age. Importantly, Halldorsson and Creswell [20] point out that preadolescents differ developmentally from adolescents. Only a few group treatments have focused on SAD in children [21, 22]. These studies showed substantial and stable therapeutic effects, but a large number of patients did not respond to the treatment. Thus, therapeutic effects may be enhanced if treatment programs include more exposure, which has been confirmed as the method of choice for adult patients with anxiety disorders [23,24,25,26]. The above mentioned treatments only used a low level form of exposure during social skills training, as homework [22] or as a short element in combination with cognitive restructuring [27]. Current studies suggest that exposure therapy is a key element in changing cognitions as negative expectations are challenged, attention biases corrected and positive cognitions applied [23].

For these reasons, we aimed to examine the effects of exposure-based CBT on children with SAD with both reports of social anxiety and an assessment of social anxiety during a laboratory task. The study was designed as a randomized controlled trial, in which half of the participants were allocated to an experimental group (CBT) receiving immediate treatment and the other half to a waitlist control (WLC) group receiving therapy about 16 weeks later. We tested laboratory and diagnostic data: We expected that compared to the WLC group and the first TSST-C before treatment, children in the CBT group would (a) report more positive and fewer negative cognitions (measured by the Social Interaction Self-Statement Test-Public Speaking, SISST-PS; [43]), (b) perceive their performance as less nervous (measured by the Performance Questionnaire for Children, PQ-C; [44]), and (c) show a change in heart rate. We did not expect differences concerning the affective part of social stress as the TSST-C is a very strong stressor, even inducing high social anxiety in nonclinical samples [45]. Further, (d) two different measures for children were used to examine a decrease in self-reported social anxiety symptoms in the CBT group after receiving treatment (questionnaires). This effect was expected to be confirmed by (e) parent report (questionnaire) and (f) a decrease in the severity index of a clinical diagnosis (interview).

Flowchart of study participants for diagnostic data. SAD social anxiety disorder, HC healthy controls, n1 research center 1, n2 research center 2, FU follow-up. Analyzed data refer to questionnaires. Final sample sizes for all other analyses may vary due to single missing data points. Further detail is provided in the Method section. Results from the follow-up analyses are reported in the online supplements. Note: a healthy control group was recruited to address issues not covered in this manuscript (see Trial design) and is listed here for the sake of completeness

For the main analyses ofFootnote 4 all laboratory data, IBM SPSS Statistics (version 24) was used. For treatment effects on state anxiety, we conducted an analysis of variance (ANOVA) with repeated measures on phase (anxietybase, anxietystress) and time (pre-treatment/waiting, post-treatment/waiting), using group (CBT, WLC) as a between-subjects factor and anxiety after the social stress task as dependent variable.Footnote 5 For treatment effects on cognitions, we conducted a multivariate ANOVA (MANOVA) with repeated measures on time (pre-treatment/waiting, post-treatment/waiting), using group (CBT, WLC) as a between-subjects factor and SISST-PS scores (negative, positive) as dependent variables. For treatment effects on behavior, we conducted a MANOVA with repeated measures on time (pre-treatment/waiting, post-treatment/waiting), using group (CBT, WLC) as a between-subjects factor and PQ-C scores (microbehaviors, nervousness, global impression) as dependent variables. For treatment effects on physiology, we conducted an ANOVA with repeated measures on time (pre-treatment/waiting, post-treatment/waiting), using group (CBT/WLC) as a between-subjects factor and heart rate scores for narrating the story and performing the calculation as dependent variables.

While our study was carefully planned, several limitations apply. A comparison to individual treatment, not examined in this study, should be examined in future research. Previous studies comparing individual to group CBT did not show a clear preference for either [13, 14]. Still, our aim was not to demonstrate the superiority of group CBT over individual CBT but rather to provide empirical evidence for an efficient group treatment program. Additionally, the TSST-C is a highly potent stressor and, therefore, possibly not the best choice to examine treatment success. Previous studies with adult participants showed that even healthy people do not easily adapt or habituate to a second exposure to the TSST (for an overview see [45]). As mentioned before, it is even more remarkable that our results can be cautiously interpreted into the direction that children with SAD were able to change their cognitive coping with this highly stressful situation. To understand moderators and mediators of change, a follow-up TSST or other social stress task could provide insight on the mechanisms: Possibly, cognitions change after treatment while changes in behavioral, physiological, and affective factors follow several months later.

The study aimed to assess CBT treatment success of child SAD not only by social anxiety reports but also by cognitive, behavioral, and physiological components of social stress. Children with SAD participated in a standardized social stress test before and after treatment or a waitlist control period. The CBT group showed a trend toward a significant increase in positive cognitions under social stress after treatment, while these cognitions decreased in the WLC group. No significant results appeared for behavior and physiology. Children in the CBT group, but not parents, further reported less social anxiety in one questionnaire from pre- to post-treatment. A structured interview confirmed a decrease in severity of SAD in the CBT group. While the gold standard of a blind interview showed efficacy of treatment, not all trait and state measures demonstrated similar success patterns. Therefore, this randomized controlled trial of an exposure-based treatment approach in a group setting showed this treatment as partly effective intervention for childhood SAD. A strong focus on exposure produced a trend toward significant change in cognitions during socially stressful situations. However, modifications of both the treatment group setting and the assessment of outcomes, including the use of multiple measures of social anxiety and experimental paradigms, warrant further research. Treatment of SAD needs etiologically based interventions, and possible effective modules in addition to exposure remain to be empirically verified. 2ff7e9595c