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Cognitive behavior therapy (CBT) is effective for most patients with a social anxiety disorder (SAD) but a substantial proportion fails to remit. Experimental and clinical research suggests that enhancing CBT using imagery-based techniques could improve outcomes. It was hypothesized that imagery-enhanced CBT (IE-CBT) would be superior to verbally-based CBT (VB-CBT) on pre-registered outcomes.
A randomized controlled trial of IE-CBT v. VB-CBT for social anxiety was completed in a community mental health clinic setting. Participants were randomized to IE (n = 53) or VB (n = 54) CBT, with 1-month (primary end point) and 6-month follow-up assessments. Participants completed 12, 2-hour, weekly sessions of IE-CBT or VB-CBT plus 1-month follow-up.
Intention to treat analyses showed very large within-treatment effect sizes on the social interaction anxiety at all time points (ds = 2.09–2.62), with no between-treatment differences on this outcome or clinician-rated severity [1-month OR = 1.45 (0.45, 4.62), p = 0.53; 6-month OR = 1.31 (0.42, 4.08), p = 0.65], SAD remission (1-month: IE = 61.04%, VB = 55.09%, p = 0.59); 6-month: IE = 58.73%, VB = 61.89%, p = 0.77), or secondary outcomes. Three adverse events were noted (substance abuse, n = 1 in IE-CBT; temporary increase in suicide risk, n = 1 in each condition, with one being withdrawn at 1-month follow-up).
Group IE-CBT and VB-CBT were safe and there were no significant differences in outcomes. Both treatments were associated with very large within-group effect sizes and the majority of patients remitted following treatment.
Post-event processing (PEP), the act of engaging in a detailed, self-focused, and negative analysis of a prior social situation, has been hypothesised to contribute to the maintenance of social phobia (Clark & Wells, 1995). In light of this proposal, the present study investigated whether deliberate engagement in PEP as opposed to distraction following a speech task elicits unhelpful effects on emotion, cognition, and behaviour in a subsequent speech task in high and low socially anxious participants. The PEP manipulation instructed participants to focus on the anxious thoughts, images, feelings, and somatic sensations relating to the first speech. Contrary to hypotheses, results demonstrated that engaging in PEP as opposed to distraction led to a number of constructive outcomes such as: increased willingness among low socially anxious participants to give the second speech, a reduction in negative performance appraisals and underestimation of performance among high socially anxious participants, and better self-perceived speech quality irrespective of social anxiety level. However, there were no effects of response condition on anxiety, performance appraisals, observable behaviour, and negative cognitions. The findings underscore the need for additional research identifying the precise contents, construals, and processing modes that distinguish between adaptive and maladaptive forms of PEP.
Background: The pervasive tendency to avoid perceived risks has been recently implicated in the maintenance of anxiety pathology, and more specifically, social phobia. Social anxiety symptoms are thus hypothesised to be associated with a global risk-avoidant decision-making bias. Aim: This study investigated: (1) the relationship between risk-avoidance and social anxiety symptoms using both self-report and behavioural measures of risk-taking; and (2) whether risk-avoidance mediates the relationship between a dispositional vulnerability to anxiety (Behavioural Inhibition System [BIS] sensitivity) and social anxiety symptoms. Method: Fifty-five undergraduate students completed self-report measures assessing for social anxiety symptoms, risk-taking across various domains, and BIS sensitivity. Risk-avoidance was also assessed using a behavioural computer task. Results: As hypothesised, risk-avoidance correlated significantly with both social anxiety and BIS. Multiple regression analyses revealed that risk-avoidance served as a partial mediator between BIS and social anxiety. Conclusion: These results confirm the hypothesised relationship between BIS, risk-avoidance, and social anxiety symptoms. Risk-avoidance is one possible mechanism by which personality characteristics may be linked to anxiety pathology.
Existing neuropsychological studies of obsessive–compulsive disorder
(OCD) are cross-sectional and do not provide evidence of whether deficits
are trait-related (antecedent and independent of symptomatology) or
state-related (a consequence, dependent on symptomatology).
To investigate whether there are premorbid neuropsychological deficits
associated with adult OCD.
Longitudinal data were collected from participants of the Dunedin
Multidisciplinary Health and Developmental study. Neuropsychological data
collected at age 13 were linked with age 32 diagnosis of OCD.
The group who had OCD at age 32 differed significantly from the control
group with no OCD on their performance at age 13 on neuropsychological
tests of visuospatial, visuoconstructive and visuomotor skills,
controlling for gender and socioeconomic status, but did not differ on
tests of general IQ or verbal ability. Performance of the group with OCD
on tests of executive functioning was mixed.
Individuals with OCD have premorbid impairment in visuospatial abilities
and some forms of executive functioning, consistent with biological
models of OCD.
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