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Shifting the Focus of One's Attention Mediates Improvement in Cognitive Therapy for Social Anxiety Disorder

Published online by Cambridge University Press:  28 August 2013

Ewa Mörtberg ,
Asle Hoffart ,
Benjamin Boecking  and
David M. Clark
Ewa Mörtberg*
Affiliation:
Stockholm University, and Karolinska Institute, Sweden
Asle Hoffart
Affiliation:
Research Institute Modum Bad, and University of Oslo, Norway
Benjamin Boecking
Affiliation:
NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, Kings College London, UK
David M. Clark
Affiliation:
University of Oxford, UK
*
Reprint requests to Ewa Mörtberg, Stockholm University, Department of Psychology, SE-106 91 Stockholm, Stockholm, Sweden. E-mail: [email protected]
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Abstract

Background: Cognitive therapy is an effective treatment for social anxiety disorder but little is known about the mechanisms by which the treatment achieves its effects. Aims: This study investigated the potential role of self-focused attention and social phobia related negative automatic thoughts as mediators of clinical improvement. Method: Twenty-nine patients with social phobia received individual cognitive therapy (ICT) in a randomized controlled trial. Weekly process and outcome measures were analysed using multilevel mediation models. Results: Change from self-focused to externally focused attention mediated improvements in social anxiety one week later. In contrast, change in frequency of, or belief in, negative social phobia related negative automatic thoughts did not predict social anxiety one week later. Conclusions: Change in self-focused attention mediate therapeutic improvement in ICT. Therapists should therefore target self-focused attention.

Keywords

Social phobiacognitive therapyattentionbeliefsindividual CBT
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 43 , Issue 1 , January 2015 , pp. 63 - 73
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2013 

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References

Acarturk, C., Cuijpers, P., van Straten, A. and de Graaf, R. (2009). Psychological treatment of social anxiety disorder: a meta-analysis. Psychological Medicine, 39, 241–254.Google Scholar
American Psychiatric Association (APA) (1994). Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Washington, DC: APA.Google Scholar
Baker, S., Heinrichs, N., Kim, H.-J. and Hofmann, S. (2002). The Liebowitz Social Anxiety Scale as a self-report instrument: a preliminary psychometric analysis. Behaviour Research and Therapy, 40, 701–715.Google Scholar
Bauer, J. B., Preacher, K. J. and Gil, K. M. (2006). Conceptualizing and testing random indirect effects and moderated mediation in multilevel models: new procedures and recommendations. Psychological Methods, 11, 142–163.Google Scholar
Boden, M. T., John, O. P., Goldin, P. R., Werner, K., Heimberg, R. G. and Gross, J. J. (2012). The role of maladaptive beliefs in cognitive-behavioral therapy: evidence from social anxiety disorder. Behaviour Research and Therapy, 50, 287–291.Google Scholar
Boecking, B., Ehlers, A. and Clark, D. M. (2013). Cognitive Precursors of Symptom Reduction in Cognitive Therapy for Social Phobia. Manuscript submitted for publication.Google Scholar
Bögels, S. M. and Lamers, C. T. J. (2002). The causal role of self-awareness in blushing-anxious, socially-anxious and social phobic individuals. Behaviour Research and Therapy, 40, 1367–1384.Google Scholar
Bruce, S. E., Yonkers, K. A., Otto, M. W., Eisen, J. L., Weisberg, R. B., Pagano, M., et al. (2005). Influence of psychiatric comorbidity on recovery and recurrence in generalized anxiety disorder, social phobia, and panic disorder: a 12-year prospective study. American Journal of Psychiatry, 162, 1179–1187.Google Scholar
Chambless, D. L. and Hope, D. A. (1996). Cognitive Approaches to the Psychopathology of Social Phobia. New York: Guilford Press.Google Scholar
Clark, D.M. (1993). Cognitive mediation of panic attacks induced by biological challenge tests. Advances in Behaviour Research and Therapy, 15, 75–84.Google Scholar
Clark, D. M. (2001). A cognitive perspective on social phobia. In Crozier, R. W. and Alden, L. E. (Eds.), International Handbook of Social Anxiety (pp. 406–430). New York: John Wiley and Sons.Google Scholar
Clark, D. M., Ehlers, A., Hackmann, A., McManus, F., Fennell, M., Grey, N., et al. (2006). Cognitive therapy versus exposure and applied relaxation in social phobia: a randomized controlled trial. Journal of Consulting and Clinical Psychology, 74, 568–578.Google Scholar
Clark, D. M., Ehlers, A., McManus, F., Hackmann, A., Fennell, M., Campell, H., et al. (2003). Cognitive therapy vs. fluoxetine plus self exposure in the treatment of generalized social phobia (social anxiety disorder): a randomized placebo controlled trial. Journal of Consulting and Clinical Psychology, 71, 1058–1067.Google Scholar
Clark, D. M. and Wells, A. (1995). A cognitive model of social phobia. In Heimberg, M. R., Liebowitz, M., Hope, D.A. and Schneier, F.R. (Eds.), Social Phobia: diagnosis, assessment and treatment (pp. 69–93). New York: Guilford Press.Google Scholar
Fedoroff, I. C. and Taylor, S. (2001). Psychological and pharmacological treatments of social phobia: a meta-analysis. Journal of Clinical Psychopharmacology, 21, 311–324.Google Scholar
Feske, U. and Chambless, D. L. (1995). Cognitive behavioural versus exposure only treatment for social phobia: a meta-analysis. Behavior Therapy, 26, 695–720.Google Scholar
First, B. M., Spitzer, R. L., Gibbon, M. and Williams, J. B. W. (1995). User's Guide for the Structured Clinical Interview for DSM-IV Axis I Disorders: SCID-I clinician version. Washington, DC: American Psychiatric Press.Google Scholar
Gould, R. A., Buckminster, S., Pollack, M. H., Otto, M. W. and Yap, L. (1997). Cognitive-behavioral and pharmacological treatment for social phobia: a meta-analysis. Clinical Psychology: Science and Practice, 4, 291–306.Google Scholar
Hoffart, A., Borge, F. M., Sexton, H. and Clark, D. M. (2009). Change processes in residential cognitive and interpersonal psychotherapy for social phobia: a process-outcome. Behavior Therapy, 40, 10–22.Google Scholar
Hofmann, S. G. (2000). Self-focused attention before and after treatment of social phobia. Journal of Consulting and Clinical Psychology, 72, 588–596.Google Scholar
Kessler, R. C., Berglund, P., Demler, O., Jin, R. and Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 593–602.Google Scholar
Kraemer, H. C., Wilson, G. T., Fairburn, C. G. and Agras, W. S. (2002). Mediators and moderators of treatment effects in randomized clinical trials. Archives of General Psychiatry, 59, 877–883.CrossRefGoogle ScholarPubMed
Krull, J. L. and MacKinnon, D. P. (1999). Multilevel mediation modeling in group-based intervention studies. Journal of Consulting and Clinical Psychology, 68, 438–450.Google Scholar
Leichsenring, F. (2012). The Social Phobia Psychotherapy Research Network (SOPHONET): structure and preliminary results. Paper presented at the “Milestones in Research and Practice” Psychotherapy Congress, Medical University of Hannover, Germany.Google Scholar
McManus, F., Clark, D. M., Grey, N., Wild, J., Hirsch, C., Fenell, M., et al. (2009). A demonstration of the efficacy of two components of cognitive therapy for social phobia. Journal of Anxiety Disorders, 23, 201–209.Google Scholar
McManus, F., Sacadurab, C. and Clark, D. M. (2008). Why social anxiety persists: an experimental investigation of the role of safety behaviours as a maintaining factor. Journal of Behaviour Therapy and Experimental Psychiatry, 39, 147–161.Google Scholar
Mörtberg, E., Clark, D. M., Sundin, Ö. and Åberg Wistedt, A. (2007). Intensive group cognitive treatment and individual cognitive therapy versus treatment as usual in social phobia: a randomized controlled trial. Acta Psychiatrica Scandinavica, 115, 142–154.Google Scholar
Rapee, R. M., Gaston, J. E. and Abbott, M. J. (2009). Testing the efficacy of theoretically derived improvements in the treatment of social phobia. Journal of Consulting and Clinical Psychology, 77, 317–327.Google Scholar
Rapee, R. M. and Heimberg, R. G. (1997). A cognitive-behavioral model of anxiety in social anxiety disorder. Behaviour Research and Therapy, 35, 741–756.Google Scholar
Raudenbush, S. W. and Bryk, A. S. (2002). Hierarchical Linear Models: applications and data analysis methods. Newbury Park, CA: Sage.Google Scholar
Smits, J. J., Rosenfield, D., McDonald, R. and Telch, M. J. (2006). Cognitive mechanisms of social anxiety reduction: an examination of specificity and temporality. Journal of Consulting and Clinical Psychology, 74, 1203–1212.Google Scholar
Sobel, M. E. (1986). Some new results on indirect effects and their standard errors in covariance structure models. Sociological Methodology, 16, 159–186.Google Scholar
Stangier, U., Heidenreich, T., Peitz, M., Lauterbach, W. and Clark, D. M. (2003). Cognitive therapy for social phobia: individual versus group treatment. Behaviour Research and Therapy, 41, 991–1007.Google Scholar
Stangier, U., Schramm, E., Heidenreich, T., Berger, M. and Clark, D. M. (2011). Cognitive therapy vs interpersonal psychotherapy in social anxiety disorder: a randomized controlled trial. Archives of General Psychiatry, 68, 692–700.Google Scholar
Taylor, S. (1996). Meta-analysis of cognitive-behavioral treatments for social phobia. Journal of Behaviour Therapy and Experimental Psychiatry, 27, 1–9.Google Scholar
Wells, A., Clark, D. M., Salkovskis, P., Ludgate, J., Hackmann, A. and Gelder, M. (1995). Social phobia: the role of in-situation safety behaviours in maintaining anxiety and negative beliefs. Behavior Therapy, 29, 357–370.Google Scholar
Wells, A. and Papageorgiou, C. (1998). Social phobia: effects of external attention on anxiety, negative beliefs and perspective taking. Behavior Therapy, 29, 357–370.Google Scholar
Wells, A., Stopa, L., and Clark, D. M. (1993). The Social Cognitions Questionnaire. University of Oxford, unpublished manuscript.Google Scholar
Woody, S. R., Chambless, D. L. and Glass, C. R. (1997). Self-focused attention in the treatment of social phobia. Behaviour Research and Therapy, 35, 117–129.Google Scholar
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