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Cited by 14Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychotherapy Techniques and ApplicationsPsychological Treatments and Assessments

Examining the Interrelation Among Change Processes: Decentering and Anticipatory Processing Across Cognitive Behavioral Therapy for Social Anxiety Disorder.

Open access
Hayes-Skelton, Sarah A., Marando-Blanck, Stephanie·2019·Behavior Therapy
DOI 10.1016/j.beth.2019.03.004PMC PMC6866667
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Abstract

As evidence grows supporting certain mechanisms of change in psychological treatments and we improve statistical approaches to measuring them, it is important that we also explore how mechanisms and processes are related to each other, and how they together affect treatment outcomes. To answer these questions about interrelating processes and mechanisms, we need to take advantage of frequent assessment and modeling techniques that allow for an examination of the influence of one mechanism on another over time. Within cognitive behavioral therapy, studies have shown support for both decentering, the ability to observe thoughts and feelings as objective events in the mind, and anticipatory processing, the repetitive thinking about upcoming social situations, as potentially related mechanisms of change. Therefore, the current study examined weekly ratings of decentering and a single-item anticipatory processing question to examine the interrelation among these change mechanisms in 59 individuals who received a 12-weeks of Cognitive Behavioral Group Therapy for social anxiety disorder. Overall, these results found that both anticipatory processing and decentering changed over the course therapy for clients. Change in both anticipatory processing and decentering was related to outcome. The bivariate latent difference score analysis showed that anticipatory processing was a leading indicator of change in decentering, but not the reverse, indicating that change in anticipatory processing is leading to change in decentering. It may be that with the focus on cognitive reappraisal in this treatment, that reducing anticipatory processing is freeing up the cognitive resources for decentering to occur.

Integrity signals

Registry

Crossref · 10.1016/j.beth.2019.03.004

Cites

53 of 53 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

8 of 26 cited sources checked · 5 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    Multiple studies report moderate-to-large negative correlations between decentering and rumination in nonclinical and clinical anxiety samples.

    “several studies have shown a moderate to large negative correlation between decentering and rumination, in both nonclinical samples and a clinical sample diagnosed with an anxiety disorder (Fresco et al., 2007; Kaiser, Andrews-Hanna, Metcalf, & Dimidjian, 2015; Mori, & Tanno, 2015; Naragon-Gainey & DeMarree, 2017).”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites Fresco et al., 2007

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

    • cites Kaiser, Andrews-Hanna, Metcalf, & Dimidjian, 2015 source
    • cites Mori, & Tanno, 2015 source

      The Results report a negative correlation between decentering and self-rumination (r = −.37) in a nonclinical sample. The Participants section identifies the sample as Japanese undergraduates, and the Discussion says the findings need replication in clinical samples. This paper therefore supports the nonclinical association, but not the claim about a diagnosed anxiety sample or moderate-to-large correlations across multiple samples. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
  • Premisecitation

    An earlier analysis of this study's data found that decentering change predicted improvement on most outcome measures.

    “an initial investigation of the data presented in the current study showed that change in decentering predicted improvement on most outcome measures”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Hayes-Skelton & Lee, 2018 source
  • Findingown data

    Model 4 also fit significantly worse than Model 2 (Δχ2/Δdf = 14.77/1, p < .001).

    “Similarly, Model 4 also provided a significant degradation in fit compared to Model 2 (Δχ2/Δdf = 14.77/1, p < .001).”
    Quote in the paperSubstantial claim
  • Findingown data

    By post-treatment, the average Clinician Severity Rating had fallen below the clinical cutoff (mean = 3.77, SD = 1.23, range 1-6).

    “On average, the CSR for social anxiety disorder decreased to below the clinical cutoff by post-treatment (mean = 3.77, SD = 1.23, range 1–6).”
    Quote in the paperNot a substantial claim
  • Findingown data

    All clients began treatment with social anxiety in the clinical range on the Clinician Severity Rating (mean = 5.54, SD = 0.80, range 4-7).

    “All clients in this study began treatment with clinically significant social anxiety based on the Clinician Severity Rating (CSR) for social anxiety disorder (mean = 5.54, SD = 0.80, range 4–7).”
    Quote in the paperNot a substantial claim
  • Classified as probably not a substantial claim. 20
  • May combine two claims. 20

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

    Study design and conductcitation

    Sessions were rated as adherent overall.

    “Overall, sessions were rated as adherent (see Hayes-Skelton & Lee, 2018 for a detailed description of adherence procedures).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Hayes-Skelton & Lee, 2018 source

  • May combine two claims.

    Premisecitation

    In that earlier analysis, clients who lost the SAD diagnosis after treatment showed greater decentering change during therapy and higher post-treatment decentering than those who kept the diagnosis.

    “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 (Hayes-Skelton & Lee, 2018).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Hayes-Skelton & Lee, 2018 source

  • Classified as probably not a substantial claim.

    Premisecitation

    Decentering changes correlate with worry changes in GAD clients.

    “changes in decentering are related to changes in worry in clients with generalized anxiety disorder (Hayes-Skelton et al., 2015)”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Hayes-Skelton et al., 2015 source

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

    Premisecitation

    The Decentering subscale showed good internal consistency in nonclinical and clinical samples, with alphas of .83 and .84.

    “The Decentering subscale has demonstrated good internal consistency in both nonclinical and clinical samples with alpha coefficients of .83 and .84, respectively (Fresco, Moore, et al., 2007; Fresco, Segal, et al., 2007).”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites Fresco, Moore, et al., 2007 source

      The Results (p. 3) report good internal consistency for the Decentering factor in a student sample (α = .83). The General Discussion (p. 10) says it had adequate to good internal consistency in undergraduate and clinical samples, but the passages retrieved from our copy do not establish the claimed clinical-sample α of .84. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
    • cites Fresco, Segal, et al., 2007

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

  • May combine two claims.

    Premisecitation

    Repetitive negative thinking had a moderate negative correlation with decentering on the Experiences Questionnaire but not on the Toronto Mindfulness Questionnaire.

    “authors found a moderate negative correlation between repetitive negative thinking and decentering using one (Experiences Questionnaire; Ehring et al., 2011), but not another decentering measure (Toronto Mindfulness Questionnaire; Naragon-Gainey, & DeMarree, 2017).”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites Ehring et al., 2011 source

      The citation to Ehring et al. is attached to the Experiences Questionnaire finding, not the Toronto Mindfulness Questionnaire comparison. The Study 1 and Study 2 Methods and results discuss correlations between the PTQ and other measures of repetitive negative thinking, but our copy provides no decentering correlation using the Experiences Questionnaire (searched: “Experiences Questionnaire” and “decentering”; pages unavailable). (LLM, conf=0.72)

      Experimental — accuracy not yet measured
    • cites Naragon-Gainey, & DeMarree, 2017 source

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

    Premisecitation

    Decentering rises during CBT and MBCT for depression relapse prevention.

    “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 paperNot a substantial claim1 of 2 sources checked
    • cites Fresco, Segal, Buis, & Kennedy, 2007 source
    • cites Teasdale et al., 2002 source

  • May combine two claims.

    Findingown data

    A model with only the decentering-to-anticipatory-processing coupling (Model 3) fit significantly worse than Model 1 (p < .001), so the anticipatory-processing-to-decentering coupling should be kept.

    “Comparing this model to Model 1, the chi-square difference test was significant (p < .001), indicating that removing the coupling of anticipatory processing leading to decentering did significantly degrade the model fit and therefore this coupling should be retained, providing evidence that anticipatory processing may be a leading indicator of change in decentering.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The model retaining only the anticipatory-processing-to-decentering coupling (Model 2) was the best-fitting and most parsimonious.

    “Taken together, Model 2, with couplings from anticipatory processing to decentering, was retained as the best fitting, most parsimonious model (see Table 6), indicating that anticipatory processing is a leading indicator of change in decentering, while decentering is not a leading indicator of change in anticipatory processing.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In the bivariate latent difference score analysis, anticipatory processing predicted later change in decentering, but decentering did not predict later change in anticipatory processing.

    “The bivariate latent difference score analysis showed that anticipatory processing was a leading indicator of change in decentering, but not the reverse”
    Quote in the paperSubstantial claim

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

    Findingown data

    At pre-treatment, clients' LSAS scores averaged 121.18 (SD = 25.77), reflecting high social anxiety.

    “Similarly, client’s LSAS scores were 121.18 (SD = 25.77) at pre-treatment, indicating a high level of social anxiety.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    A model with only the anticipatory-processing-to-decentering coupling (Model 2) fit equivalently to the full bidirectional model (Model 1), with a non-significant chi-square difference test (p = .41).

    “The non-significant chi-square difference test (p = .41) indicates that the more parsimonious Model 2 was an equivalent fitting model to the full Model, indicating that the coupling from decentering to anticipatory processing does not significantly add to the model and can be dropped leaving the couplings from anticipatory processing to decentering.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Improvements in anticipatory processing and decentering each correlated with treatment outcome.

    “Change in both anticipatory processing and decentering was related to outcome.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In the bivariate latent difference score model, the slopes of anticipatory processing and decentering had a medium-sized correlation that was not statistically significant.

    “Similar to the parallel process model, there was a medium sized correlation between the slopes of AP and EQ, although in this model this correlation did not reach statistical significance.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Change in decentering explained 22.0% of the change in LSAS and 10.8% of the change in CSR.

    “The change in EQ is responsible for 22.0% of the change in LSAS and 10.8% of the change in CSR.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Change in anticipatory processing explained 43.3% of the change in LSAS and 17.2% of the change in CSR.

    “The change in AP is responsible for 43.3% of the change in LSAS and 17.2% of the change in CSR.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Both anticipatory processing and decentering changed across therapy for clients.

    “Overall, these results found that both anticipatory processing and decentering changed over the course therapy for clients.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Decentering change explained 10.8% to 22% of outcome variance, while anticipatory processing change explained 17.2% to 43.3%.

    “Relatedly, the change in decentering accounted for 10.8% to 22% of the variance in outcome, while anticipatory processing accounted for an even larger 17.2% to 43.3% of the variance in outcome.”
    Quote in the paperSubstantial claim

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

    Study design and conductown data

    Missing data ranged from 1.7% to 37.3% of cases at any time point.

    “Data were missing for 1.7–37.3% of cases at any time point.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    The bivariate latent difference score model indicated that anticipatory processing led decentering, but not the opposite.

    “These models showed that anticipatory processing was a leading indicator of decentering, but not the reverse.”
    Quote in the paperSubstantial claim

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

    Premisecitation

    The self-report LSAS correlates highly with the clinician 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.

    Interpretationown data

    The path from decentering to anticipatory processing did not significantly improve model fit and could be removed.

    “The non-significant chi-square difference test (p = .41) indicates that the more parsimonious Model 2 was an equivalent fitting model to the full Model, indicating that the coupling from decentering to anticipatory processing does not significantly add to the model and can be dropped leaving the couplings from anticipatory processing to decentering.”
    Quote in the paperSubstantial claim

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

    Study design and conductown data

    Independent assessors were blind to pre- or post-treatment status and were trained and certified in ADIS administration and scoring.

    “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

  • May combine two claims.

    Interpretationown data

    Anticipatory processing acted as a leading indicator of later decentering, whereas decentering did not lead anticipatory processing.

    “Taken together, Model 2, with couplings from anticipatory processing to decentering, was retained as the best fitting, most parsimonious model (see Table 6), indicating that anticipatory processing is a leading indicator of change in decentering, while decentering is not a leading indicator of change in anticipatory processing.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Anticipatory processing and decentering are mechanisms of change rather than predictors of change.

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

    Study design and conductown data

    A second rater scored 20% of interviews, yielding an ICC of .964 for CSR for SAD.

    “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).

    Study design and conductnone given

    Using only one item to measure anticipatory processing restricts the conclusions that can be drawn from this study.

    “Additionally, the reliance on a single item to measure anticipatory processing limits the conclusions that can be made from this study.”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    Differences between the two decentering measures are common.

    “Of note, these differences between the two decentering measures are common (see Naragon-Gainey & DeMarree, 2017).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Naragon-Gainey & DeMarree, 2017 source

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

    Premisecitation

    The ADIS-IV has adequate reliability for SAD.

    “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).

    Premisecitation

    Decentering changes forecasted depression symptom changes after MBCT.

    “changes in decentering predicted changes in symptoms of depression following MBCT (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).

    Premisecitation

    In a mixed anxiety and depression sample, cognitive defusion mediated outcomes in both cognitive therapy and ACT.

    “the closely related construct of cognitive defusion was a mediator in both cognitive therapy and acceptance and commitment therapy (Forman et al., 2012).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Forman et al., 2012 source

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

    Study design and conductown data

    The LSAS had excellent internal consistency in this sample (pre α=.96, post 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).

    Premisecitation

    People with high social anxiety reported more frequent negative thoughts about upcoming social events.

    “Individuals high in social anxiety reported more frequent negative thoughts about future social events (i.e., Hinrichsen & Clark, 2003; Vassilopoulos, 2004).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Hinrichsen & Clark, 2003 source
    • cites Vassilopoulos, 2004 source

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

    Study design and conductown data

    In this sample, EQ-Decentering internal consistency ranged from .84 at session 5 to .96 at session 12.

    “Internal consistencies in the current sample ranged from .84 (in session 5) to .96 (in session 12).”
    Quote in the paperNot a substantial claim

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

    Study design and conductown data

    Nested and non-nested models did not differ substantially, so results are reported without nesting.

    “However, there were no substantial differences between these models and so for parsimony and consistency with the LDSs, results are reported without nesting.”
    Quote in the paperNot a substantial claim

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

    Study design and conductown data

    Due to the small sample, change was modeled identically for all clients and the amount of change between sessions was held constant across therapy.

    “Given the small sample size, change was modeled in the same way for all clients and the amount of change between each session was constrained to be the same across therapy.”
    Quote in the paperSubstantial claim

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

    Study design and conductreasoning

    The measure of anticipatory processing consisted of one item from a complex construct.

    “For example, while the item does have face validity, it is a single item of a complex construct.”
    Quote in the paperNot a substantial claim
35 of 35

  • The paper relies on this without support.

    The single weekly anticipatory processing item validly measures anticipatory processing.

    “For the purpose of the current study, we used the single item from this measure that focused on anticipatory processing. Specifically, this item asked: “Over the past week how often have you gone over in your mind things that you think might go wrong in a social situation before entering the situation?””

  • The paper relies on this without support.

    Missing data are missing at random, as required for full maximum likelihood estimation to yield valid results.

    “All data were analyzed in Mplus Version 6.12 (Muthén & Muthén, 2010) using full maximum likelihood (ML) estimation procedures. Data were missing for 1.7–37.3% of cases at any time point.”

  • The paper relies on this without support.

    The sample of 59 participants provided sufficient statistical power for the modeled effects.

    “Participants are the 59 individuals who attended at least one of the 12-sessions of cognitive-behavioral group therapy for social anxiety”

  • The authors state this as an assumption.

    Anticipatory processing and decentering are mechanisms of change rather than predictors of change.

    “Of note, we would not expect the correlations involving the intercepts to be correlated as we conceptualize these variables as mechanisms of change and not predictors of change.”

  • The authors state this as an assumption.

    A treatment mechanism must directly impact outcome to be considered a mechanism rather than a facilitative process.

    “For a variable to be a mechanism of treatment and not just a facilitative process, it is important to show that it does in fact impact outcome directly.”
5 of 5

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  • Consistentz = 6.83reported p < .001 · recomputed p < .001

    “Z = 6.83, p < .001”

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Related

Authors
Hayes-Skelton, S. A., & Marando-Blanck, S.
Affiliations
University of Massachusetts Boston (US)
ORCID
Marando-Blanck, Stephanie
Venue
Behavior Therapy
Publisher
Elsevier BV
Published
2019-11
Volume
50
Issue
6
Pages
1075-1086
ISSN
0005-7894 (ISSN-L)
DOI
10.1016/j.beth.2019.03.004
PMC
PMC6866667
OpenAlex
W2940204300
Semantic Scholar
996dff77b5a7310b0ce6400eff6ce590310b1427
Cited by
14
References
57
Citations by year
2025: 3 · 2024: 2 · 2023: 2 · 2022: 2 · 2021: 3 · 2020: 1 · 2019: 1
FWCI
2.06
Type
journal article
Language
en
Open access
Licence
Locations
  • Behavior Therapy (publishedVersion)
  • PubMed (publishedVersion)
  • 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 › Psychotherapy Techniques and Applications
  • Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
Keywords
decentering, anticipatory processing, social anxiety disorder, cognitive behavioral therapy, mechanisms of change, cognitive reappraisal, group therapy, treatment outcomes, cognitive resources
MeSH terms
Phobia, Social, Adult, Anxiety, Emotions, Female, Humans, Male, Psychotherapy, Group, Cognitive Behavioral Therapy, Treatment Outcome, Young Adult

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