The relationships among working alliance, group cohesion and homework engagement in group cognitive behaviour therapy for social anxiety disorder

ABSTRACT

Objective

Few studies have investigated the role of generic relational factors, such as group cohesion and working alliance, in group cognitive behaviour therapy (CBT) for social anxiety disorder (SAD). The aim of this study was to examine the temporal associations among working alliance, group cohesion, and an index of a CBT-specific factor, homework engagement, as correlates of fear of negative evaluation and symptoms of social anxiety in group CBT for SAD.

Method

There were 105 participants with a diagnosis of social anxiety disorder who were randomly assigned to 12 sessions of group imagery-enhanced or standard CBT. Participants completed measures at various time points during the 12-session interventions, and the relationship among variables was examined through random-intercept cross-lagged panel models.

Results

Group cohesion was significantly associated with social anxiety symptoms at the end of treatment, however there was no significant relationship with working alliance. Greater homework engagement predicted lower social interaction anxiety, but only during mid-treatment.

Conclusion

The results highlight the importance of supporting group cohesion and maximising homework engagement during core components of social anxiety treatment such as behavioural experiments.

Keywords:

• social anxiety
• group cohesion
• working alliance
• homework
• therapeutic relationship
• cognitive behaviour therapy

Acknowledgments

The authors acknowledge the clinicians at the Centre for Clinical Interventions, Perth, Western Australia, who facilitated the interventions: Mark Summers, Melissa Burgess, Adelln Sng, Olivia Carter, and Louise Pannekoek. The contributions of authors to the randomized controlled trial who were also grant awardees are also acknowledged: Lisa Saulsman, Michelle Moulds, Jessica Grisham, Emily Holmes, David Moscovitch, Ottmar Lipp and Ron Rapee.

Disclosure Statement

McEvoy receives royalties from Guilford Press (Imagery-Enhanced CBT for Social Anxiety Disorder). No other disclosures were reported.

Data sharing

Trial data from the randomized clinical trial are available in an open-access repository, Research Data Australia (see https://researchdata.ands.org.au/). Trial registration: www.anzctr.org.au, ACTRN12616000579493.

Author Contribution Statement

McEvoy was the lead author who obtained funding, designed the study, co-ordinated data collection, analysis, data interpretation, writing and editing of the manuscript. Bendlin contributed to the data analysis and writing of the manuscript. Johnson conducted data analysis, data interpretation and contributed to writing the manuscript. Kazantzis consulted on the design, data interpretation, and contributed to editing of the manuscript. Campbell and Bank contributed to manuscript drafting and editing. Egan contributed to data interpretation and to the first and subsequent drafts of the manuscript.

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This research was supported by a project grant from the National Health and Medical Research Council of Australia (NHMRC: APP1104007) awarded to McEvoy. The funding body had no role in design, data collection, analysis, interpretation or manuscript preparation.