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Cited by 11Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychological Treatments and AssessmentsPsychotherapy Techniques and Applications

Trial-Based Cognitive Therapy: Efficacy of a New CBT Approach for Treating Social Anxiety Disorder with Comorbid Depression.

Open access
Caetano, Kátia A. S., Depreeuw, Barbara, Papenfuss, Inka, Curtiss, Joshua, Langwerden, Robbert J., Hofmann, Stefan G., Neufeld, Carmem B.·2018·International Journal of Cognitive Therapy
DOI 10.1007/s41811-018-0028-7
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Abstract

The present study aims to evaluate the efficacy of Trial-Based Cognitive Therapy (TBCT), a new cognitive-behavioral therapy approach, for generalized social anxiety disorder (GSAD) in a population with high rates of comorbid disorders, especially depression. This two-arm randomized clinical trial included 39 adults (TBCT = 18; waitlist group = 21) diagnosed with GSAD. The TBCT group received 16 weekly sessions of individual TBCT. Symptom severity was assessed at pre- and post-treatment. Participants in the TBCT group showed reduction in social anxiety, social avoidance, and depression, all associated with a large effect size. No differences between pre- and post-treatment scores were observed in the waitlist condition. Results also showed that comorbidity significantly moderated treatment efficacy. Patients with comorbid conditions showed greater reductions in social anxiety symptoms across treatment than those with SAD only. In summary, TBCT was effective in reducing social anxiety and depressive symptoms, particularly for patients with comorbidity.

Integrity signals

Registry

Crossref · 10.1007/s41811-018-0028-7

Cites

81 of 81 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

17 of 58 cited sources checked · 10 supported · 0 flagged · accuracy not yet measured

  • Study design and conductcitation

    The Social Phobia Inventory (SPIN) is a reliable measure for evaluating treatment change in social anxiety symptoms.

    “The SPIN distinguishes socially anxious individuals from normal controls by using a 19-point cut-off and is a reliable measure for evaluating treatment change in social anxiety symptoms (Connor et al. 2000;Osório et al. 2009).”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites Connor et al. 2000 source
    • cites Osório et al. 2009 source
  • Premisecitation

    Current literature has suggested that cognitive factors function as maintenance factors in SAD.

    “Indeed, current literature has suggested that cognitive factors function as maintenance factors in SAD (Hofmann 2007).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Hofmann 2007 source
  • Premisecitation

    In that randomized clinical trial, TBCT was more efficacious than CBT in reducing fear of negative evaluation, social avoidance, and distress.

    “Results indicated that TBCT was just as efficacious as conventional CBT techniques in reducing social anxiety symptoms and improving quality of life, and more efficacious than CBT in reducing fear of negative evaluation, social avoidance, and distress (de Oliveira et al. 2012b;Powell et al. 2013).”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites de Oliveira et al. 2012b

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Powell et al. 2013 source

      The Discussion reports significantly lower fear-of-negative-evaluation scores with the trial-based thought record (TBTR) than with conventional cognitive therapy (CCT). It does not report a comparative result for social avoidance or distress; the Introduction says other clinical outcomes were detailed in an earlier publication. The trial tested TBTR against specified CCT techniques, rather than the broader TBCT approach against CBT generally. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
  • Study design and conductcitation

    Another limitation is related to potential therapist effects, which has implications for evaluating the treatment outcome.

    “Another limitation is related to potential therapist effects, which has implications for evaluating the treatment outcome (Thompson et al. 2012;Walwyn and Roberts 2010).”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites Thompson et al. 2012 source
    • cites Walwyn and Roberts 2010 source
  • Premisecitation

    There is a lower therapist effect when interventions follow a manual-based treatment or protocol, when therapists receive solid training in the intervention and have considerable clinical experience.

    “However, there is a lower therapist effect when interventions follow a manual-based treatment or protocol, when therapists receive solid training in the intervention and have a considerable clinical experience (Thompson et al. 2012).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Thompson et al. 2012 source

      The Introduction says evidence suggests therapist effects are less likely with highly standardized, manual-based treatments or highly skilled, experienced, well-trained therapists. The claim presents this as an established lower therapist effect, whereas the source describes a lower likelihood and qualifies the evidence. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
  • May combine two claims. 34
  • Classified as probably not a substantial claim. 18
  • The quote only partly states this claim. 1

  • May combine two claims.

    Premisecitation

    In a randomized clinical trial comparing TBCT techniques to conventional CBT techniques for GSAD, TBCT was just as efficacious as conventional CBT in reducing social anxiety symptoms and improving quality of life.

    “Results indicated that TBCT was just as efficacious as conventional CBT techniques in reducing social anxiety symptoms and improving quality of life, and more efficacious than CBT in reducing fear of negative evaluation, social avoidance, and distress (de Oliveira et al. 2012b;Powell et al. 2013).”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites de Oliveira et al. 2012b

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Powell et al. 2013 source

      The Methods describe a randomized comparison of trial-based thought record (TBTR) and conventional cognitive therapy in patients with generalized social anxiety disorder. The Results and Discussion report that both approaches improved several quality-of-life domains, with TBTR outperforming the comparator in some domains. This paper does not establish that they were equally effective at reducing social anxiety symptoms; the Introduction says detailed clinical outcomes were published elsewhere. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    The combination of SAD and depression is associated with more severe suffering and impairment, making it more difficult to treat.

    “Furthermore, the combination of the two disorders has been associated with more severe suffering and impairment (Dalrymple and Zimmerman 2007), making it more difficult to treat (Belzer and Schneier 2004;Fracalanza et al. 2014).”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites Dalrymple and Zimmerman 2007 source
    • cites Belzer and Schneier 2004 source
    • cites Fracalanza et al. 2014 source

  • May combine two claims.

    Premisecitation

    Despite the well-established efficacy of CBT as the gold treatment for SAD, a significant portion of patients do not improve after treatment.

    “Despite the well-established efficacy of CBT as the gold treatment for SAD, a significant portion of patients do not improve after treatment (Hofmann 2007).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Hofmann 2007 source

  • May combine two claims.

    Premisecitation

    In 30 patients with different diagnoses, TBCT effectively decreased the attachment to dysfunctional CBs, as well as the emotional intensity, during a session.

    “In 30 patients with different diagnoses, this treatment effectively decreased the attachment to the dysfunctional CBs, as well as the emotional intensity, during a session (de Oliveira 2008).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites de Oliveira 2008 source

  • May combine two claims.

    Premisecitation

    TBCT was effective for 39 patients with different diagnoses, substantiating TBCT as a putative transdiagnostic intervention.

    “Another study showed that TBCT was effective for 39 patients with different diagnoses, substantiating TBCT as a putative transdiagnostic intervention (Delavechia et al. 2016).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Delavechia et al. 2016 source

      The Methods describe 39 outpatients with varied psychiatric diagnoses receiving one session of trial-based thought record (TBTR), and the Results report reduced adherence to negative core beliefs and related emotions. The study tested this TBCT technique, not TBCT as a whole, and the Discussion identifies the heterogeneous sample and single-session observation as limitations. It therefore does not establish TBCT's effectiveness as a transdiagnostic intervention. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    In a recent trial comparing The Trial to conventional CBT techniques for generalized SAD, The Trial was as effective as conventional CBT tools, with a large within-group effect size (d = 1.01 for TBCT vs d = 0.83 for conventional CBT).

    “In a recent trial that evaluated the effect of the main TBCT technique (The Trial) compared to conventional CBT techniques for generalized SAD, it was observed that The Trial was as effective as conventional CBT tools, with a large within-group effect size (d = 1.01 for the TBCT technique vs d = 0.83 for conventional CBT tools) (de Oliveira et al. 2012b;Powell et al. 2013).”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites de Oliveira et al. 2012b

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Powell et al. 2013 source

      The Methods describe a randomized comparison of TBTR with conventional cognitive therapy in patients with generalized SAD, and the Abstract concludes that TBTR was at least as effective for several quality-of-life domains. However, Table 2 and the Discussion report domain-specific effect sizes, not the claimed within-group values of d = 1.01 and d = 0.83; the paper says detailed clinical outcomes were published elsewhere. Page numbers are unavailable in our copy. (LLM, conf=0.90)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Studies show that The Trial technique is effective in reducing attachment to dysfunctional core beliefs and associated emotional intensity, as well as social anxiety symptoms.

    “Studies that evaluated the effect of The Trial technique in various psychiatric disorders (de Oliveira 2008;de Oliveira et al. 2012a, b;Delavechia et al. 2016), and also in generalized SAD (de Oliveira et al. 2012b;Powell et al. 2013) show that this technique is effective in reducing the attachment to dysfunctional CBs and the associated emotional intensity, as well as social anxiety symptoms.”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites de Oliveira 2008 source

      The Results report significant within-session reductions in belief in core beliefs and the intensity of corresponding emotions. The Discussion calls this a small, preliminary study and says randomized trials are needed before firm conclusions about effectiveness; the unqualified effectiveness claim therefore overstates this source. The citing sentence attaches the social-anxiety-symptom claim to later citations, not to the 2008 paper. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
    • cites de Oliveira et al. 2012a source
    • cites Delavechia et al. 2016 source

  • May combine two claims.

    Findingown data

    Diagnostic interviews revealed that 24 participants had at least one additional comorbid condition, with depression being the most common additional diagnosis (n = 16).

    “Diagnostic interviews revealed that 24 participants had at least one additional comorbid condition, with depression being the most common additional diagnosis (n = 16).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In this study, there was a large within-group effect size for the social anxiety measure (d = 2.1), with a similar sample size and drop-out rates as previous studies.

    “In our study, we also found a large within-group effect size for the social anxiety measure (d = 2.1), with a similar sample size and drop-out rates as previous studies.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Individuals in the waitlist control group did not evidence significant change from pre-treatment to post-treatment, and all of the effect sizes were in the small range.

    “Individuals in the waitlist control group did not evidence significant change from pre-treatment to post-treatment, and all of the effect sizes were in the small range.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Treatment condition significantly predicted the latent change score for social anxiety symptoms (γ = -22.73, P < .01), indicating that individuals in the TBCT condition experienced significantly greater reductions in social anxiety symptoms relative to waitlist control.

    “Our primary hypothesis was corroborated, as treatment condition significantly predicted the latent change score (γ = -22.73,P < .01).This suggests that, on average, individuals in the TBCT condition experienced significantly greater reductions in social anxiety symptoms relative to waitlist control.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    TBCT was effective in reducing symptoms of social avoidance and distress, with a larger effect size (d = 1.07) than previously found.

    “We also found that TBCT was effective in reducing symptoms of social avoidance and distress, although with a larger effect size (d = 1.07) than previously found.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Treatment condition significantly predicted the latent change score for depression symptoms (γ = -11.15, P < .01), indicating that individuals in the TBCT condition experienced significantly greater reductions in depression symptoms relative to waitlist control.

    “Furthermore, the hypothesis for differential efficacy for depression outcome was supported, as treatment condition significantly predicted the latent change score (γ = -11.15,P < .01).This suggests that, on average, individuals in the TBCT condition experienced significantly greater reductions in depression symptoms relative to waitlist control.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    TBCT is effective in reducing social anxiety symptoms and depression symptoms.

    “This study suggests that TBCT is effective in reducing social anxiety symptoms and depression symptoms,”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The original conditional latent change score model for depression symptoms exhibited mediocre fit with a significant chi-square statistic (χ2 = 12.95, P = .01) and poor fit indices (CFI = 0.35; TLI = 0.00; RMSEA = 0.29).

    “The original conditional latent change score model for depression symptoms exhibited mediocre fit with a significant chi-square statistic (χ 2 = 12.95, P = .01),as well as poor fit indices (i.e., CFI = 0.35; TLI = 0.00; and RMSEA = 0.29).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    After controlling for baseline differences, the effects of treatment condition on changes in symptoms of social anxiety and depression remained significant (γ = -20.70, P < .01; γ = -10.90, P < .01, respectively).

    “These analyses were re-conducted controlling for baseline differences.The effects of treatment condition on changes in symptoms of social anxiety and depression remained significant (γ = -20.70,P < .01;γ = -10.90,P < .01,respectively).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    None of the other interaction effects were significant, including age, gender, prior history of a social anxiety disorder diagnosis, or psychotropic medication intake.

    “None of the other interaction effects were significant, including age (γ = 0.38, P = .44),gender (γ = -5.69,P = .35),prior history of a social anxiety disorder diagnosis (γ = -5.30,P = .95),or psychotropic medication intake (γ = -6.86,P = .26).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Individuals in the TBCT group with comorbid conditions evidenced greater reductions in social anxiety symptoms than those with SAD only and were those most benefited by the treatment.

    “The individuals in the TBCT group with comorbid conditions evidenced greater reductions in social anxiety symptoms than those with SAD only and were those most benefited by the treatment.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    CBT is considered the gold-standard treatment for SAD.

    “Although pharmacotherapy is effective for SAD (Curtiss et al. 2017), cognitivebehavioral therapy (CBT) is considered the gold-standard treatment (Rodebaugh et al. 2004).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Curtiss et al. 2017 source
    • cites Rodebaugh et al. 2004 source

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductown data

    Participants were randomly assigned to TBCT or waitlist by an independent researcher not participating in the study.

    “An independent researcher who was not participating in the study provided the randomization schedule of the participants between the two conditions.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    Psychotropic medication intake and previous SAD diagnosis were entered as covariates in subsequent analyses, as well as other demographic variables.

    “Thus, psychotropic medication intake and previous SAD diagnosis were entered as covariates in subsequent analyses, as well as other demographic variables.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    TBCT has its own specific cognitive conceptualization, techniques, and instruments, making it a unique and distinct intervention.

    “However, this variation of the CBT approach has its own specific cognitive conceptualization, techniques, and instruments, making it a unique and distinct intervention (de Oliveira 2015; de Oliveira et al. 2015;Morrison et al. 2015).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites de Oliveira 2015

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites de Oliveira et al. 2015
    • cites Morrison et al. 2015 source

  • May combine two claims.

    Premisecitation

    Forty percent of patients request subsequent treatment within a year after having received CBT, and just 48% of the patients are classified as responders after the termination of treatment.

    “Forty percent of patients request subsequent treatment within a year after having received CBT (Gilian et al. 1984), and just 48% of the patients are classified as responders after the termination of treatment (Heimberg et al. 1998).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Gilian et al. 1984 source
    • cites Heimberg et al. 1998 source

  • Classified as probably not a substantial claim.

    Study design and conductown data

    All P values were submitted to false discovery rate correction.

    “To address multiple comparisons, all P values were submitted to false discovery rate correction.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    SAD diagnosis was determined using the SAD module of the Structured Clinical Interview for DSM-IV-Research Version (SCID-I/P 2.0).

    “We used the SAD module of the Structured Clinical Interview for DSM-IV-Research Version (SCID-I/P 2.0), developed by First et al. (2002) to determine SAD diagnosis.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites First et al. (2002)

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    Several randomized clinical trials corroborate the efficacy of CBT for SAD, with a mean effect size of .70.

    “Several randomized clinical trials corroborate the efficacy of CBT for SAD (Barkowski et al. 2016;Hofmann and Smits 2008;Hofmann et al. 2013;Olatunji et al. 2010;Otte 2011;Ponniah and Hollon 2008), with a mean effect size of .70 (Acarturk et al. 2009).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Barkowski et al. 2016 source
    • cites Acarturk et al. 2009 source

  • May combine two claims.

    Premisecitation

    CBT for comorbid SAD and depression reduces anxiety symptoms, yet the symptoms of depression remain elevated.

    “Research shows that CBT for comorbid SAD and depression reduces anxiety symptoms, yet the symptoms of depression remain elevated (Joormann et al. 2005).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Joormann et al. 2005 source

  • May combine two claims.

    Study design and conductown data

    No other group differences were observed in the demographic variables, nor were there any differences present between assessment measures at baseline.

    “No other group differences were observed in the demographic variables, nor were there any differences present between assessment measures at baseline.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    SAD is a significant risk factor for the subsequent occurrence of depressive symptoms, with anxiety onset typically preceding that of depression.

    “Thus, SAD is a significant risk factor for the subsequent occurrence of depressive symptoms, with anxiety onset typically preceding that of depression (Kessler et al. 1999).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Kessler et al. 1999 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    All 18 patients in the TBCT group included in the analyses received at least 85% of the treatment.

    “Thus, all the 18 patients in the TBCT group included in the analyses received at least 85% of the treatment (1 patient received 14 sessions and 17 patients received 16 sessions).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Participants in the TBCT condition differed from the waitlist control regarding psychotropic medication intake and previous SAD diagnosis, with more patients in the treated group taking medication and having received a previous SAD diagnosis.

    “Participants in the TBCT condition differed from the waitlist control regarding psychotropic medication intake and previous SAD diagnosis.There were more patients in the treated group that were taking this type of medication [χ 2 (1) = 7.84, P = .005]and had received a previous SAD diagnosis [χ 2 (1) = 4.70, P = .03].”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Of 27 participants assigned to TBCT, 9 were excluded from analysis (1 withdrew after random allocation, 1 was excluded after the first session for receiving other psychotherapy simultaneously, and 7 withdrew before finishing half of the treatment).

    “Of the 27 participants who were assigned to TBCT treatment, 9 were excluded from the analysis for the following reasons: 1 participant withdrew after the random allocation, 1 participant was excluded after the first session for receiving other psychotherapy simultaneously, and 7 withdrew before finishing half of the treatment (these participants received less than 7”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Missing data were accommodated with full-information maximum likelihood estimation.

    “Missing data were accommodated with full-information maximum likelihood estimation.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Comorbid disorders are the rule rather than the exception for SAD, with major depressive disorder frequently co-occurring with SAD.

    “Comorbid disorders are the rule rather than the exception for SAD, with major depressive disorder frequently co-occurring with SAD (Erwin et al. 2002;Klemanski et al. 2016;Ohayon and Schatzberg 2010).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Erwin et al. 2002 source
    • cites Klemanski et al. 2016

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Ohayon and Schatzberg 2010 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Of 35 participants assigned to waitlist control, 14 were excluded from analysis (1 for taking anxiolytic medication during the pre- and post-test interval and 13 withdrew after the pre-test assessment).

    “Of the 35 participants who were assigned to the waitlist control, 14 were excluded from the analysis for the following reasons: 1 participant was excluded for taking anxiolytic medication during the pre-and post-test interval and 13 withdrew after the pre-test assessment.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Results support TBCT as a promising intervention to treat not only SAD, but also the comorbid symptoms.

    “Alongside the large effect size found for TBCT on depression symptoms, results support TBCT as a promising intervention to treat not only SAD, but also the comorbid symptoms.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    This is the first two-arm randomized clinical trial comparing TBCT and a control condition (waitlist group) for the treatment of generalized SAD.

    “It is the first two-arm randomized clinical trial comparing TBCT and a control condition (waitlist group) for the treatment of generalized SAD.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    TBCT may be effective not only in reducing social anxiety symptoms, but other comorbid conditions as well, especially depression.

    “These results indicate that TBCT may be effective not only in reducing social anxiety symptoms, but other comorbid conditions as well, especially depression.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    The baseline differences in psychotropic medication intake and previous SAD diagnosis may indicate that patients randomized to the TBCT group may have experienced a more chronic and severe form of SAD, which may impact the treatment response.

    “This may indicate that the patients randomized to the TBCT group may have experienced a more chronic and severe form of SAD, which may impact the treatment response.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    The reliance on self-report measures to assess primary outcomes might be a limitation.

    “Additionally, the reliance on self-report measures to assess primary outcomes might be a limitation.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Self-report instruments are amenable to response biases such as social desirability and consistency seeking.

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    A further limitation of this study is the small sample size.

    “Finally, a further limitation of this study is the small sample size.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Study design and conductreasoning

    The results must be interpreted as preliminary.

    “Thus, the results must be interpreted as preliminary.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    The main TBCT technique (The Trial) is a novel approach in the field designed to challenge and restructure dysfunctional core beliefs.

    “Although TBCT contains CBT techniques, such as psychoeducation, evaluation of automatic thoughts, and exposure, the main TBCT technique (The Trial) is a novel approach in the field designed to challenge and restructure dysfunctional CBs (de Oliveira 2015; de Oliveira et al. 2015).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites de Oliveira 2015

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites de Oliveira et al. 2015

  • Probably not a substantial claim: may not pass S2 (checkable).

    Premisecitation

    Data based on effects of the waitlist condition may be helpful as a benchmark in pilot studies that evaluate new treatments.

    “Additionally, it is important to highlight that data based on effects of the waitlist condition may be helpful as a benchmark in pilot studies that evaluate new treatments (Steinert et al. 2017).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Steinert et al. 2017 source

  • May combine two claims.

    Study design and conductnone given

    In the current study, a manualized protocol was used, and the therapist received extensive training in the intervention.

    “In the current study, a manualized protocol was used, and the therapist received extensive training in the intervention.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Individuals with SAD randomized to the waitlist condition exhibit small changes waiting for the intervention and remain symptomatic after this period.

    “Research suggests that individuals with SAD randomized to the waitlist condition exhibit small changes waiting for the intervention, and remain symptomatic after this period (Steinert et al. in press).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Steinert et al. in press

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Interpretationreasoning

    The waitlist condition in this study may be more appropriate because this is the first randomized clinical trial that evaluated the effect of TBCT for generalized SAD.

    “This may make the waitlist condition in this study more appropriate, as this is the first randomized clinical trial that evaluated the effect of TBCT for generalized SAD.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: This is the first randomized clinical trial evaluating TBCT for generalized SAD.

  • The quote only partly states this claim.

    Interpretationreasoning

    The individual-format mean effect size of .61 supports the efficacy of TBCT in treating SAD symptoms.

    “which additionally supports the efficacy of the TBCT in treating SAD symptoms.”
    Quote in the paperSubstantial claim
48 of 48

  • The authors state this as an assumption.

    The latent change score model assumes stability in changes across time (the pathway from T1 to the latent change score is fixed to 0).

    “Furthermore, the pathway from T1 to the latent change score was fixed to 0, which indicates stability in changes.If this assumption was not upheld, as indicated by poor model fit, then a covariance parameter between T1 and the latent change score was permitted.”

  • The paper relies on this without support.

    Comorbidity is common in SAD (the rule rather than the exception).

    “This is an important finding as the presence of comorbidity in SAD is the rule rather than the exception.”

  • The paper relies on this without support.

    This is the first randomized clinical trial evaluating TBCT for generalized SAD.

    “This may make the waitlist condition in this study more appropriate, as this is the first randomized clinical trial that evaluated the effect of TBCT for generalized SAD.”

  • The paper relies on this without support.

    Self-report instruments are amenable to response biases such as social desirability and consistency seeking.

    “Self-report instruments are amenable to a number of response biases (e.g., social desirability and consistency seeking).”

  • The paper relies on this without support.

    Clinicians treating SAD commonly have to deal with depression and other conditions associated with social anxiety.

    “Clinicians that treat patients with SAD commonly have to deal with depression and other conditions associated with social anxiety.”
5 of 5

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Stated condition coding reverses the interpretation of the change coefficient

    Minor

    With TBCT coded 1 and waitlist coded 2, the negative coefficient means the waitlist group has a lower latent change score. Because the score is defined as post-treatment minus pre-treatment, that coding implies a greater reduction for waitlist, opposite to the reported interpretation and the observed group means.

  • Reported chi-square improvement does not match the two models

    Minor

    Subtracting the new model's chi-square statistic of 2.40 from the original model's 12.95 gives 10.55, not the reported difference of 14.55. The corrected value would still support the stated P < .01 result for two degrees of freedom.

    Reported 14.55 · recomputed 10.55

  • Not every treatment effect size meets the paper's large-effect threshold

    Minor

    The paper defines a large effect as d = 0.80, but Table 2 reports a between-group FNE effect size of 0.60. Thus, the claim that all within- and between-group effect sizes were large is inconsistent with its own table.

  • Comorbidity count excludes eight participants

    Minor

    The analyzed sample contains 39 participants, and only 7 had GSAD alone, so 32-not 24-had at least one comorbid condition. Table 1 is consistent with 32: 24 had one comorbid disorder and 8 had two or more.

    Reported 24 · recomputed 32

4 of 4

Cites

Flagged first, then by citations

Research works printed but not linked: 2

  1. First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. N. (1996). Structured clinical interview for DSM-IV axis I disorders, clinician verson (SCID-CV). Washington D.C.: American Psychiatric Press, Inc.
  2. First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. N. (2002). Structured clinical interview for DSM-IV-TR axis I disorders, research verson, patient edition. (SCID-I/P). New York: Biometric Research, New York State, Psychiatric Institute.

Cited by

Sorted by citations

Related

Authors
Caetano, K. A. S., Depreeuw, B., Papenfuss, I., Curtiss, J., Langwerden, R. J., Hofmann, S. G., & Neufeld, C. B.
Affiliations
  • Boston University (US)
  • Universidade de São Paulo (BR)
ORCID
Venue
International Journal of Cognitive Therapy
Publisher
Springer Science and Business Media LLC
Published
2018-09
Volume
11
Issue
3
Pages
325-342
ISSN
  • 1937-1209 (ISSN-L)
  • 1937-1217
DOI
10.1007/s41811-018-0028-7
OpenAlex
W2893964253
Cited by
11
References
79
Citations by year
2025: 1 · 2024: 3 · 2023: 1 · 2022: 2 · 2021: 1 · 2020: 1 · 2019: 2
FWCI
1.31
Type
journal article
Language
en
Open access
Licence
www.springer.com/tdm (tdm)
Locations
  • International Journal of Cognitive Therapy (publishedVersion)
  • OpenBU (Boston University) (acceptedVersion)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, other-oa)
  • OpenBU (Boston University) (submittedVersion)
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Keywords
social anxiety disorder, generalized social anxiety disorder, comorbid depression, cognitive behavioral therapy, treatment efficacy, social avoidance, depressive symptoms

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-11.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-11.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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