Emotion Beliefs and Cognitive Behavioural Therapy for Social Anxiety Disorder

Abstract

Despite strong support for the efficacy of cognitive behavioural therapy (CBT) for social anxiety disorder (SAD), little is known about mechanisms of change in treatment. Within the context of a randomized controlled trial of CBT, this study examined patients' beliefs about the fixed versus malleable nature of anxiety—their ‘implicit theories’—as a key variable in CBT for SAD. Compared to waitlist (n = 29; 58% female), CBT (n = 24; 52% female) led to significantly lower levels of fixed beliefs about anxiety (M_baseline = 11.70 vs. M_Post = 7.08, d = 1.27). These implicit beliefs indirectly explained CBT-related changes in social anxiety symptoms (κ² = .28, [95% CI = 0.12, 0.46]). Implicit beliefs also uniquely predicted treatment outcomes when controlling for baseline social anxiety and other kinds of maladaptive beliefs (perceived social costs, perceived social self-efficacy, and maladaptive interpersonal beliefs). Finally, implicit beliefs continued to predict social anxiety symptoms at 12 months post-treatment. These findings suggest that changes in patients' beliefs about their emotions may play an important role in CBT for SAD.

Keywords::

• implicit theories
• beliefs
• social anxiety
• emotion
• CBT

Acknowledgements

We wish to thank Ihno Lee for her assistance with the statistical analyses presented in this manuscript. This research was supported by the NIMH under grant MH76074 to James Gross. Richard G. Heimberg, PhD, is one of the authors of the commercially available CBT protocol which was utilized in this study.

Disclosure statement: The authors have declared that no conflict of interest exists.

Notes

^1. The Baron and Kenny (1986) causal steps approach to mediation requires that the effects of X on Y (path c), X on M (path a), and M on Y (path b) are significant, as well as that the effect of X on Y controlling for M (path c′) is smaller than c by a non-trivial amount. However, mediation effects may still be observed in the absence of a significant total effect (path c) and/or a direct effect (path c′).