Exploring the temporal associations between avoidance behavior and cognitions during the course of cognitive behavioral therapy for clients with symptoms of social anxiety disorder

Figures & data

Table I. Item content of primary instruments.

Avoidance behavior (AB)^a	Mean (SD) at T0
I avoid talking to people I don’t know.	2.87 (1.11)
I avoid going to parties.	2.71 (1.15)
I avoid activities in which I am the center of attention.	3.28 (1.21)
I avoid having to give speeches.	3.86 (1.23)
I avoid speaking to anyone in authority.	2.48 (1.24)
Cognitions (COG)^b
I will be clumsy in front of other people	4.64 (3.38)
My voice will be unsteady	4.67 (3.34)
Someone will think I'm odd	5.63 (3.48)
I will feel nervous in a social situation	6.59 (3.30)

^a Items from the Social Phobia Inventory (SPIN).

^b Items from the Social Probability and Cost Questionnaire (SPCQ).

Figure 1. Bivariate multiple indicator random intercept cross-lagged panel model (only 4 of 6 timepoints displayed). X_ij, Y_ij = observed indicators (i) for respectively AB (X) and COG (Y) at time j; FX_j, FY_j = latent factors for respectively AB(X) and COG (Y) at time j; RIX, RIY = random intercept for respectively AB(X) and COG (Y) – between part of the model; WFXj, WFYj = within-part of the model for respectively AB(X) and COG (Y) at time j; SX, SY = random slopes for respectively AB(X) and COG (Y) – LCM-SR model only; β_x, β_y = autoregressive coefficients; and γ_x, γ_y = reciprocal coefficients.

Table II. Unstandardized parameter estimates and model fit indices from different cross-lagged panel models for avoidance behavior (y) and cognitions (x).

Model	by (SE)	gy (SE)	bx (SE)	gx (SE)	CFI	RMSEA	AIC	BIC	df	#p
Model comparisons
CLPM	.90 (.03)***	.01 (.01)	.79 (.03)***	.27 (.08)**	.969	.031	37,723	38,498	754	191
RI-CLPM (best fit)	.74 (.08)***	.04 (.02)	.30 (.08)***	1.04 (.25)***	.975	.028	37,660	38,448	751	194
RI-CLPM, fixed slope	.74 (.08)***	.04 (.02)	.30 (.08)***	1.08 (.25)***	.971	.030	37,696	38,451	759	186
RI-CLPM, fixed slope, random time	.74 (.08)***	.05 (.02)	.29 (.09)**	1.16 (.25)***	-	-	37,700	38,455	-	186
LCM-SR†	.70 (.12)***	.04 (.03)	.27 (.09)**	1.13 (.30)***	.971	.030	37,700	38,467	756	189
LCM-SR, random time	.73 (.09)***	.05 (.03)	.26 (.11)*	1.32 (.26)***	-	-	37,699	38,482	-	193
Sensitivity analyses
RI-CLPM, MNAR	.76 (.08)***	.04 (.03)	.30 (.09)**	1.04 (.27)***	-	-	39,120	39,944	-	203
RI-CLPM, depression as covariate	.60 (.16)***	.04 (.03)	.30 (.10)**	.80 (.40)*	.961	.033	46,280	47,160	958	217

Note: CLPM = cross-lagged panel model, RI-CLPM = random intercept cross-lagged panel model, LCM-SR = Latent curve model with structured residuals. †variance of the slope for cognitions was set to zero because of estimation difficulties. b_y = autoregressive coefficient for AB, b_x = autoregressive coefficient for COG, g_y = reciprocal coefficient representing the effect of COG on AB, g_x = reciprocal coefficient representing the effect of AB on COG. ***p < .001, **p < .01 *p < .05.

Table III. Standardized parameter estimates from the multiple indicator random intercept cross-lagged panel model (RI-CLPM) for avoidance behavior (AB) and cognitions (COG).

Model	β	SE	95%CI	p-value
Autoregressive
ABt1 ON ABt0	.45	.11	.23, .67	<.001
ABt2 ON ABt1	.69	.08	.54, .84	<.001
ABt3 ON ABt2	.78	.07	.64, .93	<.001
ABt4 ON ABt3	.72	.09	.54, .90	<.001
ABt5 ON ABt4	.74	.09	.57, .91	<.001
SACOGt1 ON SACOGt0	.34	.07	.19, .48	<.001
COGt2 ON COGt1	.34	.10	.14, .54	.001
COGt3 ON COGt2	.30	.09	.12, .47	.001
COGt4 ON COGt3	.33	.09	.14, .52	.001
COGt5 ON COGt4	.30	.09	.15, .46	<.001
Reciprocal
ABt1 ON COGt0	.14	.08	−.01, .30	.07
ABt2 ON COGt1	.12	.07	−.02, .26	.09
ABt3 ON COGt2	.11	.07	−.03, .25	.11
ABt4 ON COGt3	.11	.07	−.02, .25	.11
ABt5 ON COGt4	.10	.06	−.02, .23	.10
COGt1 ON ABt0	.21	.07	.06, .35	.004
COGt2 ON ABt1	.39	.09	.22, .56	<.001
COGt3 ON ABt2	.40	.09	.22, .58	<.001
COGt4 ON ABt3	.41	.09	.24, .59	<.001
COGt5 ON ABt4	.42	.09	.25, .60	<.001
Other estimates
Correlation at T0	.33	.15	.04, .63	.03
Residual correlation T1	.53	.10	.35, .72	<.001
Residual correlation T2	.32	.10	.13, .52	.001
Residual correlation T3	.53	.11	.31, .75	<.001
Residual correlation T4	.62	.09	.44, .80	<.001
Residual correlation T5	.51	.13	.26, .76	<.001
Between-person correlation	.56	.07	.42, .70	<.001