Fear, avoidance and physiological symptoms during cognitive-behavioral therapy for social anxiety disorder
Open accessAbstract
We examined fear, avoidance and physiological symptoms during cognitive-behavioral therapy (CBT) for social anxiety disorder (SAD). Participants were 177 individuals with generalized SAD who underwent a 14-week group CBT as part of a randomized controlled treatment trial. Participants filled out self-report measures of SAD symptoms at pre-treatment, week 4 of treatment, week 8 of treatment, and week 14 of treatment (post-treatment). Cross-lagged Structural Equation Modeling indicated that during the first 8 weeks of treatment avoidance predicted subsequent fear above and beyond previous fear, but fear did not predict subsequent avoidance beyond previous avoidance. However, during the last 6 weeks of treatment both fear and avoidance predicted changes in each other. In addition, changes in physiological symptoms occurred independently of changes in fear and avoidance. Our findings suggest that changes in avoidance spark the cycle of change in treatment of SAD, but the cycle may continue to maintain itself through reciprocal relationships between avoidance and fear. In addition, physiological symptoms may change through distinct processes that are independent from those involved in changes of fear and avoidance.
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Avoidance is expected to change faster than anxiety symptoms in a short-term exposure-based intervention.
“Given the specific relevance of a short-term, exposure-based intervention for reducing avoidance behaviors related to social anxiety, we made an a priori decision to examine the LSAS avoidance and the LSAS anxiety subscales in addition to the total score, as we expected avoidance to change faster than anxiety symptoms (Aderka et al., 2013).”
From Work-Related Cognitive Behavioral Therapy for racially and economically diverse unemployed persons with social anxiety: A randomized clinical trial (2024) · cites this paper as Aderka et al., 2013
The paper’s Abstract reports that, during the first eight weeks of a 14-week CBT course, avoidance predicted subsequent fear, and the Discussion suggests that changes in avoidance may initiate improvement. It does not establish that avoidance changes at a faster rate than anxiety symptoms in a short-term exposure-based intervention; temporal prediction is not a comparison of rates of change. (LLM, conf=0.84)
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References 67 · Cited by 49
Research works printed but not linked: 2
- Clark DM 2005 A Cognitive Perspective on Social Phobia The essential handbook of social anxiety for clinicians 193 218 New York, NY, US John Wiley & Sons Ltd
- Satorra A Bentler PM 1998 Scaling corrections for chi-square statistics in covariance structure analysis Proceedings of the American Statistical Association 308 313
- Authors
- Aderka, I. M., McLean, C. P., Huppert, J. D., Davidson, J. R. T., & Foa, E. B.
- Affiliations
- University of Haifa (IL)
- University of Pennsylvania (US)
- Hebrew University of Jerusalem (IL)
- Duke Medical Center (US)
- Corresponding author
- Aderka, Idan M.
- Venue
- Behaviour Research and Therapy
- Publisher
- Elsevier BV
- Published
- 2013-07
- Volume
- 51
- Issue
- 7
- Pages
- 352-358
- ISSN
- 0005-7967 (ISSN-L)
- PMC
- PMC3669252
- OpenAlex
- W1998358384
- Cited by
- 49
- References
- 67
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 10 · 2023: 4 · 2022: 3 · 2021: 4 · 2020: 5 · 2019: 7 · 2018: 1 · 2017: 4 · 2016: 3 · 2015: 1 · 2014: 1 · 2013: 1
- FWCI
- 2.70
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Behaviour Research and Therapy (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- DukeSpace (Duke University) (submittedVersion, cc-by-nc-nd)
- Funders
- National Institute of Mental Health (R01MH049339)
- 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, cognitive behavioral therapy, avoidance, fear, physiological symptoms, bidirectional relationship, treatment modification, group therapy, generalized social anxiety
- MeSH terms
- Adult, Anxiety Disorders, Avoidance Learning, Combined Modality Therapy, Fear, Female, Fluoxetine, Humans, Male, Cognitive Behavioral Therapy, Symptom Assessment
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