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Cited by 30Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesMindfulness and Compassion InterventionsPsychotherapy Techniques and Applications

Changes in Decentering Across Cognitive Behavioral Group Therapy for Social Anxiety Disorder

Open access
Hayes-Skelton, Sarah A., Lee, Carol S.·2018·Behavior Therapy
DOI 10.1016/j.beth.2018.01.005PMC PMC6112177
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Abstract

To further improve treatments, we need to better understand potential common treatment mechanisms, such as decentering, or the ability to observe thoughts and feelings as objective events in the mind rather than personally identifying with them (Safran & Segal, 1990). Therefore, this study examined whether 12 sessions of Cognitive Behavioral Group Therapy (CBGT) for 63 clients (57.6% female, 50.8% White) diagnosed with social anxiety disorder led to increases in decentering and whether increased decentering was associated with improved outcome. Furthermore, this study examined whether decentering was associated with outcome over and above a competing mechanism—cognitive reappraisal. Overall, results indicated that CBGT in this study led to similar outcomes compared to previous studies and decentering increased over CBGT (d's from 0.81 to 2.23). Change in decentering predicted improvement on most, but not all, measures of outcome and those who no longer met criteria for social anxiety disorder at posttreatment had significantly greater change in decentering across therapy and significantly higher decentering scores at post-treatment compared to those who retained a social anxiety disorder diagnosis at posttreatment. Finally, changes in decentering predicted outcome over and above changes in reappraisal on all outcome measures. These results largely support the role of decentering in CBGT for social anxiety; however, the implications of the inconsistencies in results based on which outcome measure was used are discussed. © 2018

Integrity signals

Registry

Crossref · 10.1016/j.beth.2018.01.005

Cites

97 of 97 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

9 of 40 cited sources checked · 6 supported · 1 flagged · accuracy not yet measured

  • Premisecitation

    During self-focused attention, individuals with social anxiety hold excessively negative self-images as true.

    “when engaged in self-focused attention, individuals with social anxiety experience excessively negative self-images, which they believe are accurate (Hackmann, Suraway, & Clark, 1998; Hofmann & Heinrichs, 2003).”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites Hackmann, Suraway, & Clark, 1998 source
    • cites Hofmann & Heinrichs, 2003 source

      The Discussion explicitly says the results are inconsistent with the notion that heightened self-focused attention automatically produces negative self-perception in people with social phobia. Under mirror exposure, participants with generalized social phobia made fewer, not more, negative statements about socially relevant characteristics. The paper does not establish that participants believed negative self-images were accurate. (LLM, conf=0.87)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
  • Premisecitation

    People with social anxiety divert attention away from positive cues.

    “while also diverting attention away from positive cues (Taylor, Bomyea, & Amir, 2010)”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Taylor, Bomyea, & Amir, 2010 source
  • Premisecitation

    The reliable change percentages (51.8% to 80.4%) are consistent with other reliable change numbers for CBGT (Blanco et al., 2010; Heimberg et al., 1990; Kocovski et al., 2013).

    “These numbers are consistent with other reliable change numbers for CBGT (Blanco et al., 2010; Heimberg et al., 1990; Kocovski et al., 2013).”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites Blanco et al., 2010 source

      The Results (Continuation Phase; page not available) report a 52.9% response rate for CBGT, which falls within the cited 51.8%–80.4% range. But the Methods (Statistical Analyses; page not available) define response using the CGI-I, not a reliable-change measure; this paper therefore does not establish the claimed comparison of reliable-change percentages. (LLM, conf=0.81)

      Experimental — accuracy not yet measured
    • cites Heimberg et al., 1990 source
    • cites Kocovski et al., 2013 source
  • Findingown data

    Participants who achieved diagnostic remission after treatment had higher decentering scores at post-treatment than those who remained diagnosed.

    “those who no longer met criteria for social anxiety disorder at post-treatment had significantly greater change in decentering across therapy and significantly higher decentering scores at post-treatment compared to those who retained a social anxiety disorder diagnosis at post-treatment.”
    Quote in the paperSubstantial claim
  • Findingown data

    Greater change in decentering forecast improvement on the majority, though not every, outcome measure.

    “Change in decentering predicted improvement on most, but not all measures of outcome”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim. 40
  • May combine two claims. 31

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

    Premisecitation

    According to the metacognitive processes model, decentering comprises meta-awareness, a separation from internal experiences, and less reactivity to thought content.

    “According to the metacognitive processes model of decentering (Bernstein et al., 2015), decentering involves meta-awareness, disidentification from internal experiences, and reduced reactivity to thought content.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Bernstein et al., 2015 source

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

    Premisecitation

    Decentering and defusion overlap in reduced emotional reactivity but differ in that decentering may involve disidentification from internal experiences.

    “Of note, decentering also shares some conceptual overlap (i.e., reduced emotional reactivity) with the related construct of defusion (see Bernstein et al., 2015); however, they”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Bernstein et al., 2015 source

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

    Premisecitation

    In mindfulness-based stress reduction for generalized anxiety disorder, decentering acted as a mediator of outcome.

    “another showed that decentering mediated outcome in mindfulness-based stress reduction for generalized anxiety disorder (Hoge et al., 2015).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Hoge et al., 2015 source

  • May combine two claims.

    Premisecitation

    Decentering increases during cognitive behavioral therapy and mindfulness-based cognitive therapy for depression relapse prevention.

    “Teatment studies have shown that decentering increases across both CBT (Fresco, Segal, Buis, & Kennedy, 2007) and Mindfulness-Based Cognitive Therapy (MBCT; Teasdale et al., 2002) for depression relapse prevention”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites Fresco, Segal, Buis, & Kennedy, 2007 source
    • cites Teasdale et al., 2002 source

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

    Premisecitation

    For GAD, decentering preceded symptom change in applied relaxation and acceptance-based behavior therapy, and the reverse pattern was not significant.

    “To examine the time course of change in decentering, decentering was a leading indicator of symptom change for individuals receiving either applied relaxation or an acceptance-based behavior therapy for GAD, with no evidence for the reverse pattern (symptoms leading to decentering) being significant (Hayes-Skelton, Calloway, Roemer, & Orsillo, 2015).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Hayes-Skelton, Calloway, Roemer, & Orsillo, 2015 source

  • Classified as probably not a substantial claim.

    Premisecitation

    Previous research reported that an unselected undergraduate population scored an average of 37.51 (SD=3.58) on the EQ decentering scale (Fresco, Moore, et al., 2007).

    “To put this in context, previous research has reported that an unselected undergraduate population scored an average of 37.51 (SD=3.58) on this scale (Fresco, Moore, et al., 2007).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Fresco, Moore, et al., 2007 source

      The Study 1 method (p. 3) describes undergraduates participating in a university mass-testing procedure. The Sample 2 decentering item means in Table 2 (Results, p. 6) sum to 37.51, but the table gives item-level standard deviations, not an SD of 3.58 for the total scale score. Our copy therefore supports the population and mean, but not the claimed SD. (LLM, conf=0.84)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingown data

    Decentering increased across cognitive behavioral group therapy, with effect sizes ranging from 0.81 to 2.23.

    “Overall, results indicated that CBGT in this study led to similar outcomes compared to previous studies and decentering increased over CBGT (d’s from 0.81 to 2.23).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    MRM models showed significant large effects for Time on clinician-rated SAD severity, SPAI, LSAS, BFNE, and SUDS during BATs, indicating social anxiety symptoms significantly decreased across treatment.

    “The MRM models for clinician rated severity of SAD, self-report measures of social anxiety (SPAI, LSAS, BFNE), and SUDS during the BATS showed significant (large) effects for Time indicating that clients’ social anxiety symptoms significantly decreased across treatment.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    There was a significant effect for Time on QOLI, indicating increasing quality of life, with a small effect size.

    “There was a significant effect for Time on the QOLI, indicating increasing quality of life; however, this effect size was small.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    CBGT generally led to positive outcomes with large effect sizes across a range of self-report, behavioral, and interviewer-administered measures of social anxiety (d's from 0.81 to 2.23), comparable to other studies.

    “As expected, CBGT generally led to positive outcomes for the clients in this study with large effect sizes across a range of self-report, behavioral, and interviewer administered measures of social anxiety (d’s from 0.81 to 2.23), which are comparable to those reported in other studies.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In a freely estimated growth model, EQ-decentering showed little change over the first 3 sessions, a rapid increase as exposure was introduced, relative consistency through the middle of therapy, and another increase at the end of treatment.

    “As is shown in Figure 2, there was little change in EQ over the first 3 sessions. However, as exposure was introduced, there was a rapid increase in decentering. Decentering scores then remained relatively consistent through the middle of therapy before increasing again at the end of treatment.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In a linear growth curve model, EQ-decentering intercept was 34.99 at session 1 and slope was 0.66, corresponding to an average increase from 34.99 to 42.25 over sessions 1 to 12.

    “For EQ-decentering, the intercept, or average EQ score at session 1, was 34.99 and the slope was 0.66. In other words, on average clients’ reported EQ score increased from 34.99 at session 1 to 42.25 at the end of therapy (0.66 points per sessions from sessions 1 to 12).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    With both EQ-decentering and TCQ-reappraisal in the model, Betas for EQ-decentering were significant in predicting SPAI, LSAS, BFNE, and mean SUDS (p's from .007 to < .001), with a trend-level effect for QOLI (p=.052).

    “With both the EQ-decentering and TCQ-reappraisal in the model (Step 2), the Betas for EQ-decentering were significant in predicting SPAI, LSAS, BFNE, and mean SUDS (p’s from .007 to <.001) with there being a trend level effect for QOLI (p=.052).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The biggest increase in decentering happened between sessions three and five, with additional change from approximately session nine onward.

    “Interestingly the biggest increase in decentering happened between sessions three and five, with additional change happening from approximately session nine onward.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Cognitive reappraisal was inconsistently related to outcome, with the relation only reaching statistical significance on two measures and a third being trend level.

    “Interesting, cognitive reappraisal was inconsistently related to outcome, with the relation only reaching statistical significance on two of our measures with a third being a trend level relation.”
    Quote in the paperSubstantial claim

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

    Premisecitation

    Decentering has been proposed as a mechanism of action in cognitive behavioral therapy and in acceptance and mindfulness-based therapies.

    “Decentering, or the ability to observe thoughts and feelings as objective events in the mind, rather than personally identifying with them (Safran & Segal, 1990), has been hypothesized as a mechanism of action in both CBT (Beck et al., 1979; Teasdale, 1999) and acceptance and mindfulness based therapies (AMBT) (Bishop et al., 2004).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Safran & Segal, 1990

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

    • cites Beck et al., 1979; Teasdale, 1999

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

    • cites Bishop et al., 2004 source

  • Classified as probably not a substantial claim.

    Premisecitation

    Cognitive restructuring, particularly viewing thoughts as psychological events, is thought to be a distancing strategy that may promote decentering (Beck, 1979).

    “For example, cognitive restructuring, in particular viewing thoughts as psychological events, is thought of as a distancing strategy that may promote decentering (Beck, 1979).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Beck, 1979

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

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

    Premisecitation

    The QOLI has good internal consistency and excellent reliability.

    “Frisch et al. (1992) report good internal consistency (α’s = .77 – .89) and excellent reliability (r’s= .80–.91).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Frisch et al. (1992) source

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    Only participants who completed the post-treatment assessment were included in the hierarchical regressions.

    “Because the focus of the mechanism analysis was on how decentering and reappraisal were related to treatment outcome, only participants who completed the post-treatment assessment were included in the hierarchical regressions.”
    Quote in the paperSubstantial claim

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

    Study design and conductown data

    The SPAI showed excellent internal consistency in this sample (pre-treatment α = .98, post-treatment α = .99).

    “The SPAI demonstrated excellent internal consistency in our sample (Pre: α = .98, Post: α = .99).”
    Quote in the paperNot a substantial claim

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

    Study design and conductown data

    25% of the adherence-rated sessions were rated by a second rater with adequate reliability (α=.58).

    “Additionally, of the thirty sessions rated for adherence, 25% of these sessions were rated by a second rater with adequate reliability (α= .58).”
    Quote in the paperNot a substantial claim

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

    Study design and conductown data

    Allowed adherence components were typically rated as addressed effectively, with means from 4.40 to 5.00.

    “The allowed components were typically rated as being addressed effectively [means from 4.40 (SD= 0.89) to 5.00 (SD= 0.00)].”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    All cases were included in the MRM and growth models to avoid bias.

    “To avoid bias, all cases were included in the MRM and growth models.”
    Quote in the paperSubstantial claim

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

    Study design and conductown data

    Only one of the rated sessions had a forbidden strategy.

    “Only one session had a forbidden strategy (limiting experiential control and using psychodynamic themes).”
    Quote in the paperNot a substantial claim

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

    Study design and conductnone given

    One participant did not complete the pre-treatment SPAI.

    “One participant did not complete the pre-treatment SPAI.”
    Quote in the paperNot a substantial claim

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

    Study design and conductown data

    The LSAS-SR showed excellent internal consistency in this sample (pre-treatment α = .96, post-treatment α = .97).

    “The LSAS demonstrated excellent internal consistency in our sample (Pre: α= .96, Post: α= .97).”
    Quote in the paperNot a substantial claim

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

    Study design and conductnone given

    Certification for ADIS-IV assessors required agreement with a senior interviewer's diagnoses across three consecutive interviews.

    “To be certified, assessors were required to match a senior interviewer’s diagnoses on three consecutive interviews.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The self-report LSAS is highly correlated with the clinician-administered version and has high internal consistency and good test-retest reliability.

    “Both studies demonstrated that the self-report version is highly correlated with the clinician version, and that the self-report version has high internal consistency and good test-retest reliability of the self-report version.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Baker, Heinrichs, Kim & Hofmann, 2002 source
    • cites Fresco et al., 2001 source

  • May combine two claims.

    Premisecitation

    Intentionally increasing self-focused attention leads to more negative thoughts and greater subjective anxiety.

    “Further, intentionally manipulating increases in self-focused attention results in increased negative thoughts and subjective anxiety (Spurr & Stopa, 2003; Wells & Papageorgiou, 2001).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Spurr & Stopa, 2003

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

    • cites Wells & Papageorgiou, 2001 source

  • May combine two claims.

    Premisecitation

    Taking a distanced perspective reduces distress and the believability of negative thoughts.

    “Experimental results have shown that taking a distanced perspective decreases distress (e.g., Davis, Gross, & Ochsner, 2011) and the believability of negative thoughts (e.g., Masuda et al., 2010).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Davis, Gross, & Ochsner, 2011 source
    • cites Masuda et al., 2010 source

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

    Study design and conductown data

    Analyses with and without the BFNE outlier did not change results, so the outlier was retained.

    “Therefore, analyses were run with and without this participant. However, the results did not change and so this participant’s data was retained.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    ADIS-IV diagnostic assessments were conducted by independent assessors who were unaware of participants' pre- or post-treatment status.

    “Independent assessors gave the ADIS-IV at pre-treatment and post-treatment assessments. Independent assessors were graduate students, unaware of pre- or post-treatment status, trained in the administration and scoring of the ADIS.”
    Quote in the paperSubstantial claim

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

    Premisecitation

    In CBT and ACT, defusion was a mediator of post-treatment worry and quality of life.

    “Others have found evidence supporting the common mechanism hypothesis in that defusion mediated post-treatment worry and quality of life in CBT and ACT (Arch, Wolitzky-Taylor, Eifert, & Craske, 2012).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Arch, Wolitzky-Taylor, Eifert, & Craske, 2012 source

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

    Study design and conductown data

    On average, clients completed 9.22 of the 12 CBGT sessions.

    “On average, clients completed 9.22 of the 12 sessions.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Missingness could be assumed to be completely random (Little's MCAR chi square = 980.76, p = .52), indicating maximum likelihood estimation was appropriate.

    “Analyses indicated that missingness could be assumed to be completely random (Little’s MCAR chi square = 980.76, p = .52), indicating that maximum likelihood estimation was an appropriate method for analyzing these data.”
    Quote in the paperSubstantial claim

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

    Premisecitation

    The BFNE has excellent internal consistency, reliability, validity, and good test-retest reliability.

    “The BFNE has been shown to have excellent internal consistency (α= .96) and excellent reliability and validity (Leary, 1983). Studies have also demonstrated that the BFNE has good test re-test reliability (r= .75) and good convergent and divergent validity (Leary, 1983).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Leary, 1983 source

  • May combine two claims.

    Study design and conductown data

    At each session, between 1.7% and 35.6% of participants were absent, with 24.2% missing per session on average.

    “At each session between 1.7% and 35.6% of participants were absent and therefore did not complete session measures (24.2% were missing per session on average).”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    The TCQ has acceptable internal consistency and good test-retest reliability.

    “The TCQ has demonstrated acceptable internal consistency (α= .67) and good test-retest reliability (Wells & Davies, 1994).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Wells & Davies, 1994 source

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

    Premisecitation

    Decentering change forecast depression symptom change.

    “and changes in decentering predicted changes in symptoms of depression (Bieling et al., 2012).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Bieling et al., 2012 source

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

    Study design and conductown data

    Twenty percent of ADIS-IV interviews were scored by a second rater, and the interclass correlation between raters on SAD clinician severity rating was .964.

    “Additionally, 20% of interviews were scored by a second rater, with an interclass correlation (ICC) between raters on CSR for SAD of .964.”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    The ADIS-IV has shown adequate reliability when used to diagnose social anxiety disorder.

    “For SAD, the ADIS-IV has demonstrated adequate reliability (Brown, DiNardo, Lehmann, & Campbell, 2001).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Brown, DiNardo, Lehmann, & Campbell, 2001 source

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

    Study design and conductown data

    A total of 30 sessions, 20% of all sessions, were rated for adherence.

    “A total of 30 sessions (20% of all sessions) were rated for adherence by doctoral students in clinical psychology.”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    The SPAI is a commonly used, reliable, and valid 45-item self-report instrument for social anxiety that also accounts for agoraphobia.

    “Social Phobia Anxiety Inventory (SPAI: Turner, Beidel, & Dancu, 1996) is a widely used, reliable, and valid 45-item self-report measure of social anxiety, accounting for agoraphobia.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Turner, Beidel, & Dancu, 1996

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

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

    Study design and conductown data

    The QOLI showed good internal consistency in this sample (pre-treatment α = .81, post-treatment α = .88).

    “The QOLI demonstrated good internal consistency in our sample at all time points (Pre: α = .81, Post: α = .88).”
    Quote in the paperNot a substantial claim

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

    Study design and conductown data

    48 of 59 participants (81.4%) completed post-treatment self-report measures.

    “Additionally, 48 of 59 participants (81.4%) completed the post-treatment self-report measures.”
    Quote in the paperNot a substantial claim

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

    Study design and conductown data

    Therapists were trained and supervised weekly by the first author.

    “Therapists for this study were the first author, a licensed clinical psychologist, or advanced doctoral students (n = 9) trained and supervised on a weekly basis by the first author.”
    Quote in the paperNot a substantial claim

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

    Study design and conductown data

    The TCQ-reappraisal subscale showed good internal consistency in this sample (pre-treatment α = .81, post-treatment α = .88).

    “The TCQ – reappraisal demonstrated good internal consistency in our sample (Pre: α= .81, Post: α= .88).”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    The EQ's decentering factor has shown adequate-to-good internal consistency and evidence of convergent and divergent validity.

    “The decentering factor of the EQ has been shown to have adequate to good internal consistency as well as convergent and divergent validity (Fresco et al., 2007).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Fresco et al., 2007

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

  • May combine two claims.

    Study design and conductown data

    The ICC for session-by-session EQ-decentering was higher (.17), so growth curve analyses nested participants into treatment groups.

    “However, the ICC for session-by-session EQ-decentering was higher (.17), indicating that there may be issues related to dependency when examining the session-by-session data. Therefore, in the growth curve analyses examining the session-by-session data, participants were nested into their treatment groups.”
    Quote in the paperSubstantial claim

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

    Study design and conductown data

    Post-treatment diagnostic interviews were conducted with 50 of 59 participants (84.7%).

    “Post-treatment diagnostic interviews were conducted with 50 of 59 participants (84.7%).”
    Quote in the paperNot a substantial claim

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

    Study design and conductown data

    The BFNE showed acceptable to excellent internal consistency in this sample (α from .69 at session 1 to .90 at session 11).

    “The BFNE demonstrated acceptable to excellent internal consistency in our sample (α’s from .69 at session 1 to .90 at session 11).”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    Fresco et al. (2007) reported an average per-item score of 3.45 (SD=0.49) on the decentering subscale of the EQ for a college student sample.

    “By comparison, Fresco et al. (2007) reported an average per item score of 3.45 (SD=0.49) in the decentering subscale of the EQ for a sample of college students.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Fresco et al. (2007)

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

  • May combine two claims.

    Interpretationreasoning

    Clients began treatment almost a standard deviation below the undergraduate mean and ended treatment over a standard deviation above this mean, indicating they experienced more decentering at the end of treatment than the average population.

    “In other words, clients began treatment almost a standard deviation below this mean and ended treatment over a standard deviation above this mean, indicating that clients are experiencing more decentering at the end of treatment than the average population.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    Decentering is likely just one of several important mechanisms, as it does not perfectly differentiate those who do and do not have SAD at the end of treatment.

    “However, it is important to note that decentering is likely just one of several important mechanisms as it does not perfectly differentiate those who do and who do not have SAD at the end of treatment.”
    Quote in the paperSubstantial claim

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

    Premisecitation

    New learning and willingness to engage in anxiety-provoking situations are well-documented as important mechanisms in SAD (Craske et al., 2008).

    “In particular, this model does not incorporate the clinical benefits of new learning and willingness to engage in anxiety-provoking situations that has been well-documented as important mechanisms in SAD (Craske et al., 2008).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Craske et al., 2008 source

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

    Interpretationreasoning

    Clients typically complete their first exposure exercises between sessions three and five, suggesting a potential link between exposure exercises and decentering.

    “In looking at the treatment protocol, clients typically complete their first exposure exercises between sessions three and five, speaking to the potential link between exposure exercises and decentering.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    There was no comparison treatment group in this study, so it is not possible to evaluate whether changes were specific to CBGT or to treatment in general.

    “Additionally, there was no comparison treatment group in this study and so it is not possible to evaluate whether these changes were specific to CBGT or to treatment in general.”
    Quote in the paperSubstantial claim

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

    Interpretationreasoning

    The weaker influence on the behavioral measure may be due to differences in measurement, such as a bias toward responding to all self-report measures similarly.

    “This may in part be because of the differences in measurement. For example, there may be a bias towards responding to all self-report measures similarly.”
    Quote in the paperNot a substantial claim

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

    Interpretationnone given

    Decentering is only one of several potential mechanisms (e.g., self-focused attention, reduced social cost biases, emotional processing, new learning).

    “Of course, decentering is only one of several potential mechanisms (e.g., self-focused attention, reduced social cost biases, emotional processing, new learning to name a few) and the relative role of decentering compared to these other potential mechanisms needs to be evaluated.”
    Quote in the paperNot a substantial claim
59 of 59

  • The authors state this as an assumption.

    Models were run assuming random intercepts and slopes.

    “Models were run assuming random intercepts and slopes.”

  • The authors state this as an assumption.

    Maximum likelihood estimation assumes data are missing at random.

    “MRM and growth models analyze data using maximum likelihood estimation to account for missing data, which assumes that data are “missing at random.””

  • The paper relies on this without support.

    Even gold-standard treatments for SAD such as CBGT fail to treat a high proportion of clients.

    “Even gold-standard treatments for SAD such as CBGT fail to treat a high proportion of clients, speaking to the need to continue to improve this treatment.”

  • The paper relies on this without support.

    Decentering may be a potential mechanism of change in treatments of social anxiety disorder, given attention biases that maintain social anxiety.

    “As has been shown in other disorders, namely depression and GAD, decentering may be a potential mechanism of change in treatments of social anxiety disorder, given the attention biases that maintain social anxiety.”

  • The paper relies on this without support.

    The EQ is the most common measure of decentering.

    “While these self-report ratings allowed for a frequent assessment of the mechanism and the EQ is the most common measure of decentering, completing a self-report measure of an internal process requires some psychological mindedness.”

  • The paper relies on this without support.

    Completing a self-report measure of an internal process requires some psychological mindedness.

    “While these self-report ratings allowed for a frequent assessment of the mechanism and the EQ is the most common measure of decentering, completing a self-report measure of an internal process requires some psychological mindedness.”

  • The paper relies on this without support.

    The BFNE specifically measures the cognitive component of SAD (i.e., fear of negative evaluations).

    “Given that the BFNE specifically measures the cognitive component of SAD (i.e., fear of negative evaluations), it may be that decentering has its greatest influence in the cognitive domain.”

  • The authors state this as an assumption.

    The first unconditional growth model assumed a linear slope.

    “First, an unconditional growth model was run where the intercept was set to EQ-decentering score at session 1 and the slope was linear.”
8 of 8

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Larger increases in decentering predict greater improvements in quality of life following group CBT for adults with anxiety disorders.

    “larger increases in decentering predicted greater improvements in QOL following group CBT for adults with anxiety disorders [49].”

    From Correlates of Quality of Life in Anxiety Disorders: Review of Recent Research (2021) · cites this paper as [49]

    The Results section (“Decentering’s Relations to Outcome”; page unavailable) reports that larger increases in decentering during group CBT predicted greater improvement in quality of life. The study examined clients with social anxiety disorder, not adults with anxiety disorders generally, so the citing sentence broadens the population studied. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • In adults with anxiety, EQ scores increase by 0.49-0.66 per CBT session and 1.5 per four ACT sessions; baseline EQ scores are around 29.32-34.99 and grow by 0.37-0.66 per session.

    “In adults with anxiety, EQ scores increased by a unit of 0.49–0.66 per session of CBT and 1.5 per four sessions of Acceptance and Commitment Therapy (ACT).”

    From Decentering as a core component in the psychological treatment and prevention of youth anxiety and depression: a narrative review and insight report (2021) · cites this paper as [70]

    The Results section, “Change in Decentering” (page unavailable), reports a baseline EQ score of 34.99 and an increase of 0.66 points per session during cognitive behavioral group therapy for social anxiety disorder. It does not report a 0.49-point CBT increase or a 1.5-point increase over four ACT sessions. The claimed broader baseline and per-session ranges are therefore only partly supported by this paper. (LLM, conf=0.90)

    Experimental — accuracy not yet measured

  • Treatment-related increases in decentering mediated the impact of mindfulness training on anxiety severity in adults with GAD; rate of decentering increase was associated with decreases in worry and stress; session-by-session increases predicted decreases in social anxiety in CBT.

    “Treatment-related increases in decentering mediated the impact of mindfulness training on anxiety severity in adults seeking treatment for generalized anxiety disorder (GAD) (37.6 ± 11.6 years)87.”

    From Decentering as a core component in the psychological treatment and prevention of youth anxiety and depression: a narrative review and insight report (2021) · cites this paper as [70]

    Split into 3 atoms — 0 confirmed, 3 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

    Experimental — accuracy not yet measured

  • Change in decentering predicted outcome improvement over and above change in reappraisal.

    “It was further found that change in decentering predicted outcome improvement over and above change in reappraisal (Hayes-Skelton & Lee, 2018).”

    From Changes in Decentering and Reappraisal Temporally Precede Symptom Reduction During Emotion Regulation Therapy for Generalized Anxiety Disorder With and Without Co-Occurring Depression. (2019) · cites this paper as Hayes-Skelton & Lee, 2018

  • Session-by-session changes in decentering predicted pre- to posttreatment symptom improvement for social anxiety disorder during group CBT in an open trial.

    “session-by-session changes in decentering was recently found to predict pre- to posttreatment symptom improvement for individuals with social anxiety disorder during group CBT in an open trial.”

    From Changes in Decentering and Reappraisal Temporally Precede Symptom Reduction During Emotion Regulation Therapy for Generalized Anxiety Disorder With and Without Co-Occurring Depression. (2019) · cites this paper as Hayes-Skelton & Lee, 2018

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • Consistentz = 5.68reported p < .001 · recomputed p < .001

    “(z = 5.68, p < .001”

  • Consistentt(45) = 2.93reported p = .005 · recomputed p = .005

    “t(45)=2.93, p = .005”

  • Consistentt(46) = 2.96reported p = .005 · recomputed p = .005

    “t(46)=2.96, p = .005”

  • Consistentt(47) = 1.52reported p = .14 · recomputed p = .135

    “t(47)=1.52, p = .14”

4 of 4

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.

  • Abstract says outcomes improved over and above reappraisal on all measures, but Results limit significance

    Minor

    The Abstract claims decentering predicted outcome over and above change in reappraisal on all outcome measures. The Results section later says the EQ-decentering beta was not significant for SAD CSR and only showed a trend for QOLI, so the blanket statement overstates the reported results.

  • Number of distress ratings conflicts within the measure description

    Minor

    The description says the assessment yielded five SUDS scores, then says each participant's mean was calculated from ten scores.

  • Abstract gives the recruited count as the treatment count

    Minor

    The abstract describes CBGT as being provided to 81 clients, but the participant flow states that only 59 received treatment.

  • Reliable-change denominator conflicts with the treated count

    Minor

    The reliable-change analysis describes 56 people as those who completed at least one session. The participant flow says 59 people completed at least one session.

4 of 4

Cites

Flagged first, then by citations

8 of the 105 references couldn’t be matched to a known paper.

Cited by

Sorted by citations

Related

Authors
Hayes-Skelton, S. A., & Lee, C. S.
Affiliations
University of Massachusetts Boston (US)
ORCID
Lee, Carol S.
Venue
Behavior Therapy
Publisher
Elsevier BV
Published
2018-09
Volume
49
Issue
5
Pages
809-822
ISSN
0005-7894 (ISSN-L)
DOI
10.1016/j.beth.2018.01.005
PMC
PMC6112177
OpenAlex
W2794060993
Cited by
28
References
105
Citations by year
2025: 4 · 2024: 2 · 2023: 3 · 2022: 3 · 2021: 6 · 2020: 4 · 2019: 5 · 2018: 1
FWCI
5.24
Type
journal article
Language
en
Open access
Licence
Locations
  • Behavior Therapy (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Mental Health
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Keywords
decentering, group cognitive behavioral therapy, social anxiety disorder, cognitive reappraisal, therapeutic mechanisms, treatment outcome prediction
MeSH terms
Phobia, Social, Adult, Emotions, Fear, Female, Humans, Male, Psychotherapy, Group, Thinking, Cognitive Behavioral Therapy, Treatment Outcome

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 under definition version 3 (extract-v3) on 2026-09-28.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-09-28.

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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