Work-related CBT versus vocational services as usual for unemployed persons with social anxiety disorder: A randomized controlled pilot trial
Open accessAbstract
We designed and pilot-tested a group-based, work-related cognitive-behavioral therapy (WCBT) for unemployed individuals with social anxiety disorder (SAD). WCBT, delivered in a vocational service setting by vocational service professionals, aims to reduce social anxiety and enable individuals to seek, obtain, and retain employment. We compared WCBT to a vocational services as usual control condition (VSAU). Participants were unemployed, homeless, largely African American, vocational service-seeking adults with SAD (N = 58), randomized to receive either eight sessions of WCBT plus VSAU or VSAU alone and followed three months post-treatment. Multilevel modeling revealed significantly greater reductions in social anxiety, general anxiety, depression, and functional impairment for WCBT compared to VSAU. Coefficients for job search activity and self-efficacy indicated greater increases for WCBT. Hours worked per week in the follow-up period did not differ between the groups, but small sample size and challenges associated with measuring work hours may have contributed to this finding. Overall, the results of this study suggest that unemployed persons with SAD can be effectively treated with specialized work-related CBT administered by vocational service professionals. Future testing of WCBT with a larger sample, a longer follow-up period, and adequate power to assess employment outcomes is warranted.
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The Mini-SPIN threshold of 5 or more was selected because previous research indicates it maximizes sensitivity and specificity and produces acceptable diagnostic accuracy.
“We selected a score of ≥ 5 on the Mini-SPIN as a screening threshold given that our previous research with this population indicates that a score of 5 or more maximizes sensitivity and specificity and produces an acceptable diagnostic accuracy rate (Himle et al., 2014).”
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 Himle et al., 2014
The Method > Measures passage says the study used a Mini-SPIN screening threshold of 4 or greater, not 5 or greater. It says research with this population found that a score of 4 maximized sensitivity and specificity, with a diagnostic accuracy rate of 83.4%. (LLM, conf=0.95)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredThis effect size is conservative compared to the LSAS total effect size of 1.10 at 3-month follow-up in the pilot randomized controlled trial.
“This effect size is conservative compared to the LSAS total effect size of 1.10 at 3-month follow-up in the pilot RCT (Himle et al., 2014).”
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 Himle et al., 2014
The Results (Outcomes by Condition over Time; page unavailable) report significant follow-up differences between work-related CBT and usual vocational services, with mental-health effect sizes ranging from d = −0.86 to −1.37. The Methods (Data Analysis; page unavailable) identify the follow-up as the point used to estimate condition effects. Our copy does not give an LSAS total effect size of 1.10, so the specific number cannot be verified. (LLM, conf=0.82)
Experimental — accuracy not yet measuredVSAU-alone improvement was not observed in the prior RCT.
“VSAU-alone improvement was not observed in our prior RCT (Himle et al., 2014).”
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 Himle et al., 2014
The Results (Outcomes by Condition over Time; page unavailable) report that the proportion meeting social anxiety disorder diagnostic criteria remained at 100% in the VSAU group, supporting no improvement on that measure. The claim does not specify an outcome, however, and the paper does not establish that VSAU showed no improvement on every measure. (LLM, conf=0.84)
Experimental — accuracy not yet measuredIn the pilot randomized controlled trial, gains were maintained at three-month follow-up.
“Gains were maintained at three-month follow-up (Himle et al., 2014).”
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 Himle et al., 2014
All primary and secondary outcome measures were successfully used in the prior randomized controlled trial of WCBT.
“All primary and secondary outcome measures were successfully used in our prior RCT of WCBT which included a sample primarily comprised of participants identifying as racial and/or ethnic minorities (Himle et al., 2014).”
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 Himle et al., 2014
In the pilot randomized controlled trial, participants randomized to WCBT+VSAU reported significantly greater improvements in social anxiety, depression, generalized anxiety, job search self-efficacy, and job search behaviors compared to those randomized to VSAU-alone.
“Participants randomized to WCBT+VSAU reported significantly greater improvements in social anxiety, depression, generalized anxiety, and job search self-efficacy and job search behaviors compared to those randomized to VSAU-alone.”
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 Himle et al., 2014
Social anxiety and avoidance at work can interfere with job retention.
“Finally, social anxiety and avoidance at work can interfere with job retention (Himle et al., 2014).”
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 Himle et al., 2014
Fidelity ratings were high and exceeded those in the pilot RCT, suggesting the computer program may have increased therapist adherence to WCBT.
“Fidelity ratings were high and exceeded those in our pilot RCT (Himle et al., 2014), suggesting that the computer program may have increased therapist adherence to WCBT.”
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 Himle et al., 2014
WCBT+VSAU effect sizes from baseline to 52-week follow-up for social anxiety were large, and baseline to 3-month outcomes were comparable to a prior report and to group-CBT for SAD in specialty mental health centers.
“WCBT+VSAU effect sizes from baseline to 52-week follow-up for social anxiety were large, and the baseline- to 3-month follow-up (longest common follow-up time point available) outcomes were comparable to our prior report (Himle et al., 2014) and to group-CBT for SAD delivered in specialty mental health centers (Colhoun et al., 2021).”
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 Himle et al., 2014
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Anxiety and employment discrimination: Implications for counseling and return to work practice
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Cognitive-Behavioral Therapy for Social Anxiety Disorder
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Unemployment and Mental Health
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Cognitive behavioural therapy interventions for depression in homeless populations: a meta-analysis
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- Authors
- Himle, J. A., Bybee, D., Steinberger, E., Laviolette, W. T., Weaver, A., Vlnka, S., Golenberg, Z., Levine, D. S., Heimberg, R. G., & O'Donnell, L. A.
- Affiliations
- University of Michigan (US)
- Michigan State University (US)
- Temple University (US)
- Corresponding author
- Himle, Joseph A.
- Venue
- Behaviour Research and Therapy
- Publisher
- Elsevier BV
- Published
- 2014-12
- Volume
- 63
- Pages
- 169-176
- ISSN
- 0005-7967 (ISSN-L)
- PMC
- PMC4416073
- OpenAlex
- W2070578705
- Cited by
- 62
- References
- 33
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 7 · 2023: 5 · 2022: 13 · 2021: 3 · 2020: 8 · 2019: 4 · 2018: 4 · 2017: 5 · 2016: 2 · 2015: 1 · 2014: 1
- FWCI
- 4.17
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Behaviour Research and Therapy (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (R34MH083031)
- 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, unemployment, vocational services, employment retention, job search behavior, self-efficacy, functional disability, depression, general anxiety, homeless adults, African American adults, group therapy
- MeSH terms
- Phobia, Social, Adult, Female, Humans, Male, Medically Underserved Area, Middle Aged, Pilot Projects, Psychotherapy, Group, Rehabilitation, Vocational, Unemployment, Cohort Studies, Cognitive Behavioral Therapy, Treatment Outcome, Young Adult
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