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Cited by 4Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychological Treatments and AssessmentsEmployment and Welfare Studies

Work-Related Cognitive Behavioral Therapy for racially and economically diverse unemployed persons with social anxiety: A randomized clinical trial

Open access
Himle, Joseph A., LeBeau, Richard T., Jester, Jennifer M., Kilbourne, Amy M., Weaver, Addie, Brydon, Daphne M., Tucker, Katherine M., Hamameh, Nicole +2 more·2024·Journal of Anxiety Disorders
DOI 10.1016/j.janxdis.2024.102875PMC PMC11639394
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Abstract

Individuals with Social Anxiety Disorder (SAD) are at risk for employment problems. This multi-site trial examined the efficacy of Work-Related Cognitive Behavioral Therapy provided alongside vocational services as usual (WCBT+VSAU), a group-based treatment designed to improve mental health and employment outcomes for individuals with SAD. Vocational service-seeking participants with SAD (N = 250) were randomized to either WCBT+VSAU or VSAU-alone. Hypotheses were that participants randomized to WCBT+VSAU would report less social anxiety, less depression, and more hours worked than participants randomized to VSAU-alone. WCBT+VSAU participants had significantly greater improvements on the Liebowitz Social Anxiety Scale (LSAS; d=−.25, CI=−0.49 to −0.02, p = .03) at post-assessment compared to VSAU-alone. The conditions did not differ on any variable at later time points or on secondary outcomes. Unexpectedly, participants randomized to VSAU-alone experienced LSAS improvements, similar to WCBT+VASU at later timepoints. Baseline psychological flexibility (beta=−.098 [−0.19–0.008]) and depression (beta=−0.18 [−0.34–0.009]) moderated change in social anxiety. Participants with lower psychological flexibility and higher depression responded more strongly to WCBT+VSAU than VSAU-alone over the duration of the study, suggesting that WCBT+VSAU may particularly benefit those with greater psychopathology. Results indicate that vocational centers are promising settings for treating SAD and employment-focused refinements are likely needed to improve work outcomes. © 2024 Elsevier Ltd

Integrity signals

Registry

Crossref · 10.1016/j.janxdis.2024.102875

Cites

64 of 64 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

24 of 50 cited sources checked · 9 supported · 1 flagged · accuracy not yet measured

  • Study design and conductcitation

    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).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Himle et al., 2014 source

      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 measured
  • Study design and conductcitation

    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).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Himle et al., 2014 source
  • Premisecitation

    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).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Himle et al., 2014 source
  • Premisecitation

    Socially anxious individuals often limit job searches to positions that do not require extended social interactions.

    “First, socially anxious individuals often limit job searches to positions that do not require extended social interactions”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Himle et al., 2020 source

      The Results (Avoidance; page unavailable) describe respondents avoiding interviews, networking, and follow-up during job searches; one preferred temporary-agency work because it bypassed an interview. They do not establish that socially anxious people often restrict their searches to jobs with little sustained social interaction. The study also concerns a specific low-income sample, rather than socially anxious individuals generally. (LLM, conf=0.83)

      Experimental — accuracy not yet measured
  • Premisecitation

    Longitudinal studies show higher unemployment among individuals with social anxiety disorder than among persons with other mental disorders.

    “Longitudinal studies of individuals with SAD show higher levels of unemployment compared to persons with other mental disorders (Keller, 2006; Moitra et al., 2011; Tolman et al., 2009).”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites Keller, 2006

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

    • cites Moitra et al., 2011 source

      The Results (Primary analyses, page unavailable) report that patients with SAD were more than twice as likely to be unemployed as the comparison patients. However, Methods (Procedures, page unavailable) says this paper analyzed only baseline data from a longitudinal project. It therefore supports the unemployment comparison, but not the characterization of this finding as longitudinal. (LLM, conf=0.90)

      Experimental — accuracy not yet measured
    • cites Tolman et al., 2009 source
  • May combine two claims. 46
  • Classified as probably not a substantial claim. 32

  • May combine two claims.

    Study design and conductcitation

    Measures assessing primary and secondary outcomes have adequate to excellent reliability and validity and have been widely used among diverse populations.

    “Measures assessing primary and secondary outcomes have adequate to excellent reliability and validity and have been widely used among diverse populations (Himle et al., 2019), and had acceptable reliability and test-retest reliability in this sample.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Himle et al., 2019 source

      The Method > Measures section (page unavailable) reports adequate to excellent reliability or validity for several measures, including the PHQ-9, BSI-18, LSAS and MINI. It does not establish that all primary and secondary outcome measures have those properties or that they have been widely used among diverse populations. (LLM, conf=0.83)

      Experimental — accuracy not yet measured

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

    Study design and conductcitation

    The PHQ-8, MMAS, and AAQ2 are widely used, with adequate reliability and validity.

    “The PHQ-8, MMAS, and the AAQ2 are widely used, with adequate reliability and validity (Bond et al., 2011; Moon et al., 2017; Villarreal-Zegarra et al., 2023).”
    Quote in the paperNot a substantial claim3 of 3 sources checked
    • cites Bond et al., 2011 source

      The General Discussion (page unavailable) reports promising evidence for the AAQ-II’s adequate reliability and validity. It describes the AAQ-II as a new measure whose psychometric properties need further study, however, and does not establish that the AAQ-II was widely used. The other instruments in the sentence have separate citations; this verdict addresses Bond et al.’s support for the AAQ-II. (LLM, conf=0.83)

      Experimental — accuracy not yet measured
    • cites Moon et al., 2017 source

      Moon et al. support the MMAS-8 portion of the sentence: the Background says it had been used in more than 200 studies, and the Discussion reports acceptable internal consistency in some patient groups. But the Discussion also says its criterion validity is insufficient for research requiring high sensitivity and specificity, so the unqualified claim of adequate validity overstates the source. This citation does not address the PHQ-8 or AAQ2. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites Villarreal-Zegarra et al., 2023 source

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

    Study design and conductcitation

    Independent evaluators rated 50 session recordings, 23%, to assess group leader competence and fidelity to the treatment protocol.

    “Further, independent evaluators rated 50 session recordings of WCBT sessions (23%) to assess group leader competence and fidelity to the treatment protocol (see Himle et al., 2019 for details).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Himle et al., 2019 source

      The Method section, “Training independent evaluators” (page not available), says independent evaluators rated WCBT sessions for adherence and therapist competence. It does not report that they rated 50 recordings (23%); it says they were scoring approximately 37% of sessions. The cited protocol therefore supports the purpose of the ratings, but not the claimed count or percentage. (LLM, conf=0.89)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Fear and avoidance of job interviews is common in social anxiety disorder and is related to reduced job seeking behaviors.

    “Third, fear and avoidance of job interviews is common in this population and is related to reduced job seeking behaviors (Ruscio et al., 2008).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Ruscio et al., 2008 source

      The Results (Table 1; page unavailable) report that 67.5% of respondents with lifetime social phobia feared an important exam or interview, supporting the claim that interview-related fear is common. The paper does not distinguish job interviews from other interviews or link fear or avoidance of interviews to reduced job-seeking behavior; its Methods assess employment status and work impairment, not job seeking. (LLM, conf=0.84)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Study design and conductcitation

    All self-report measures had acceptable reliability and test-retest reliability in this sample and are widely used with strong prior evidence of reliability and validity.

    “All self-report measures had acceptable reliability and test-retest reliability in this sample and are widely used with strong prior evidence of reliability and validity (see Himle et al., 2019) with the exception of the WSAS, a scale developed for use in our prior WCBT trial (Himle et al., 2014).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Himle et al., 2019 source

      The Method > Measures section describes prior reliability or validity evidence for several self-report measures, including the PHQ-9, BSI-18 and Expectancy Rating. But this is a study protocol: the cited passages do not report reliability or test-retest results in the citing authors’ sample, and they do not establish those properties for all self-report measures. No page numbers are available in our copy. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • Classified as probably not a substantial claim.

    Premisecitation

    Lower psychological flexibility is associated with better cognitive-behavioral therapy response for social anxiety.

    “prior empirical demonstration of psychological flexibility as a moderator of CBT for social anxiety (lower levels associated with better CBT response - Craske et al., 2014)”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Craske et al., 2014 source

  • May combine two claims.

    Premisecitation

    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.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Himle et al., 2014 source

  • Classified as probably not a substantial claim.

    Premisecitation

    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).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Aderka et al., 2013 source

      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)

      Experimental — accuracy not yet measured

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

    Study design and conductcitation

    All interviews were conducted by reliably certified interviewers with consensus diagnoses overseen by experienced clinicians.

    “All interviews were conducted by reliably certified interviewers with consensus diagnoses overseen by experienced clinicians (see Himle et al., 2019 for more information on the certification process).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Himle et al., 2019 source

      The Method section (‘Training interviewers’; page unavailable) describes required agreement with gold-standard ratings, a mock interview with a licensed clinician, and ongoing clinical supervision. ‘Training independent evaluators’ describes review of possible misdiagnoses by the principal investigators, but does not say that diagnoses were reached by consensus under experienced clinicians’ oversight. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Interpretationown data

    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).”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites Himle et al., 2014 source
    • cites Colhoun et al., 2021 source

  • May combine two claims.

    Interpretationown data

    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.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Himle et al., 2014 source

  • May combine two claims.

    Findingown data

    The conditions did not differ on any variable at later time points or on secondary outcomes.

    “The conditions did not differ on any variable at later time points or on secondary outcomes.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Seven adverse events were reported; during baseline, six individuals reported acute suicide risk and one reported acute homicide risk.

    “Seven adverse events were reported. During baseline assessment, six individuals reported acute suicide risk and one reported acute homicide risk.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The sample had substantial proportions chronically unemployed (≥1 year; 44%), homeless or transient housing (52%), current suicidality (40%), prior suicide attempt (16%), and diagnoses of alcohol use (24%), substance use (23%), or antisocial personality disorders (17%).

    “with substantial proportions chronically unemployed (≥1 year; 44%), homeless or with transient housing (52%), experiencing current suicidality (40%) or having a prior suicide attempt (16%), and having diagnoses of alcohol use (24%), substance use (23%), or antisocial personality disorders (17%).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Individuals with low psychological flexibility responded with a steeper reduction in social anxiety with WCBT+VSAU compared to VSAU-alone that sustained over the study, whereas those with high psychological flexibility did not respond differently across conditions.

    “First, individuals with low psychological flexibility responded with a steeper reduction in social anxiety with WCBT+VSAU compared to VSAU-alone that sustained over the course of the study, whereas those with high psychological flexibility did not respond differently across the two conditions.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Reported work hours and mental health were significantly correlated; higher LSAS total scores correlated with fewer reported work hours at 12 weeks (r=-.2, p=.012), 26 weeks (r=-.28, p=.001), and 52 weeks (r=-.27, p=.001).

    “Reported work hours and mental health were significantly correlated (e.g., higher LSAS total scores were correlated with fewer reported work hours at each time point (12-week r = −.2, p = .012; 26-week: r = −.28, p = .001; 52-week: r = −.27, p = .001)).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Average adherence was 97% and average competence was 4.48 among JVS counselors leading groups.

    “Average adherence was 97% and average competence was 4.48 (1–5 Likert-type scale) among JVS counselors leading groups.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Both groups continued to improve in social anxiety over the remainder of the study, but VSAU-alone showed a greater rate of decrease between 4 and 52 weeks compared to WCBT+VSAU.

    “Both groups continued to improve in social anxiety scores over the remainder of the study, but VSAU-alone showed a greater rate of decrease between the 4-week and 52-week assessments compared to WCBT+VSAU.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The sample was racially and ethnically diverse with high rates of poverty, housing instability, diagnostic comorbidity, and suicidality.

    “The sample was racially and ethnically diverse, with high rates of poverty, housing instability, diagnostic comorbidity, and suicidality, as shown by condition (Table 1) and by site (Table 2).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Fifty-three cohorts were randomized: 27 to WCBT+VSAU (n=120) and 26 to VSAU-alone (n=130).

    “Fifty-three cohorts were randomized: 27 to WCBT+VSAU (n = 120) and 26 to VSAU-alone (n = 130; see Fig. 1).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Those with higher depression at baseline responded with a steeper reduction in social anxiety following WCBT+VSAU than VSAU-alone, sustained over the course, whereas no difference was found among those with low depression.

    “Fig. 5 shows that those with higher depression at baseline responded with a steeper reduction in social anxiety following WCBT+VSAU than VSAU-alone, that sustained over the course of the study, whereas there was no difference between the two groups among those with low depression.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    VSAU-alone participants reported more hours of vocational service use (M=10.20, SD=18.03) compared to WCBT+VSAU (M=6.85, SD=10.62), though the difference was not significant (t(190)=1.71, p=.088).

    “VSAU-alone participants reported more hours of vocational service use (M=10.20, SD=18.03) compared to WCBT+VSAU (M=6.85, SD=10.62), though the difference was not significant (t(190) = 1.71, p = .088).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    College educated individuals showed stronger reductions in depressive symptoms with WCBT+VSAU compared to VSAU-alone, at least in the short-term, whereas depression among non-college educated individuals did not respond differently.

    “The third and final significant moderation finding was that college educated individuals showed stronger reductions in their depressive symptoms with WCBT+VSAU compared to VSAU-alone, at least in the short-term, whereas depression among non-college educated individuals did not respond differently to these two intervention conditions.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Individuals with higher depression showed a steeper reduction in social anxiety with WCBT+VSAU compared to VSAU-alone that sustained over the study, whereas those with low depression did not respond differently across conditions.

    “The second finding was that individuals with higher depression showed a steeper reduction in social anxiety with WCBT+VSAU compared to VSAU-alone, that sustained over the course of the study, whereas those with low depression did not respond differently across the two conditions.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S1 (asserted), S4 (based).

    Study design and conductnone given

    Evaluators were masked to condition allocation.

    “Evaluators were masked to condition allocation.”
    Quote in the paperNot a substantial claim

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

    Interpretationown data

    Employment-focused refinements are likely needed to improve work outcomes.

    “employment-focused refinements are likely needed to improve work outcomes.”
    Quote in the paperNot a substantial claim

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

    Study design and conductnone given

    The trial was overseen by a data and safety monitoring board.

    “The trial was overseen by a data and safety monitoring board”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Baseline data yielded Omega = .93, alpha = 0.92, for the LSAS anxiety subscale; Omega = .94, alpha = .93, for the avoidance subscale; and Omega = 0.96, alpha = 0.95, for the LSAS total.

    “Baseline data yielded Omega = .93 (alpha = 0.92) for the anxiety subscale, Omega = .94 (alpha =.93) for the avoidance subscale and Omega = 0.96 (alpha = 0.95) for the total Liebowitz Social Anxiety Scale.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premiseown data

    The pilot work is the only available study assessing the effect of vocational services as usual on mental health, and its results suggest that vocational services as usual have a limited impact on mental health symptoms.

    “Our pilot work is the only available study assessing the effect of VSAU on mental health, with results suggesting that VSAU has a limited impact on mental health symptoms.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    The two social anxiety scores were highly correlated and were also correlated with work-related social anxiety at 0.68-0.71.

    “The two social anxiety scores were highly correlated, and they were also correlated with work-related social anxiety at 0.68–0.71.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Social anxiety disorder negatively affects occupational functioning, including reduced productivity, job performance, income, and increased financial dependence.

    “Negative impacts on occupational functioning (Aderka et al., 2012; Bruch et al., 2003; Moitra et al., 2011) include reduced productivity, job performance (Hwang et al., 2020; Stein & Kean, 2000; Stuhldreher et al., 2014; Wittchen et al., 2000), and income (Magee et al., 1996; Patel et al., 2002), as well as increased financial dependence (Schneier et al., 1992).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Hwang et al., 2020 source
    • cites Stein & Kean, 2000 source
    • cites Stuhldreher et al., 2014 source

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

    Premisenone given

    Individuals with social anxiety disorder are at risk of employment problems.

    “Individuals with Social Anxiety Disorder (SAD) are at risk for employment problems.”
    Quote in the paperNot a substantial claim

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

    Study design and conductcitation

    The trial followed Consolidated Standards of Reporting Trials guidelines.

    “followed Consolidated Standards of Reporting Trials (CONSORT) guidelines (Boutron et al., 2017)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Boutron et al., 2017 source

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

    Study design and conductown data

    Test-retest reliability for the PHQ-8 ranged from 0.61 to 0.75 across the study.

    “Test-retest reliability ranged from 0.61 to 0.75 across the study.”
    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 conductnone given

    The trial was approved by Institutional Review Boards and NIH certificates of confidentiality were obtained.

    “was approved by Institutional Review Boards. NIH certificates of confidentiality were obtained.”
    Quote in the paperNot a substantial claim

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

    Study design and conductown data

    The trial was assessor-blinded.

    “This was a multi-site, assessor-blinded, parallel, 2-arm, cohort-randomized (1:1) clinical superiority trial, for socially anxious adults seeking vocational services.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Condition assignments were not accessible to study personnel supporting recruitment, assessment, or intervention delivery until the day of randomization for each cohort.

    “Condition assignments were not accessible to study personnel supporting recruitment, assessment, or intervention delivery until the day of randomization for each cohort.”
    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

    Omega total at baseline for the PHQ-8 was 0.942, alpha = 0.89.

    “Omega total at baseline for the PHQ-8 was 0.942 (alpha = 0.89).”
    Quote in the paperNot a substantial claim

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

    Study design and conductown data

    Test-retest reliability for the LSAS total score ranged from 0.61 to 0.78 across the study.

    “The test-retest reliability for the LSAS total score ranged from 0.61 to 0.78 across the study.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Cohorts were randomized following a computer-generated randomization schedule.

    “Cohorts were randomized to WBCT+VSAU or to VSAU-alone, following a computer-generated randomization schedule.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Persons with social anxiety disorder often have limited social networks and are reluctant to ask for job leads.

    “Second, persons with SAD often have limited social networks and are reluctant to ask for job leads, although networking is among the most effective strategies for obtaining employment (Bolles & Hubbard, 2007).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Bolles & Hubbard, 2007

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

  • May combine two claims.

    Interpretationown data

    The slope effects reflect immediate improvement in LSAS in WCBT+VSAU and delayed improvement in VSAU-alone.

    “reflecting immediate improvement in LSAS in the WCBT+VSAU group and delayed improvement in LSAS in the VSAU-alone group.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Following intention-to-treat, 120 WCBT+VSAU and 130 VSAU-alone participants were analyzed in their assigned condition regardless of engagement.

    “Following an intention-to-treat approach, n = 120 in WCBT+VSAU and n = 130 in VSAU-alone were analyzed in their assigned treatment condition regardless of study engagement.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    Inter-rater reliability was excellent for the BPRS, ICC=0.94, and Kappa coefficients for MINI diagnoses ranged from 0.65-1.00.

    “Inter-rater reliability was excellent for the BPRS (ICC=0.94) and Kappa coefficients for MINI diagnoses ranged from 0.65–1.00.”
    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 conductnone given

    Randomization was managed by study statisticians and not accessible to study staff until time of assignment.

    “Randomization was managed by study statisticians and not accessible to study staff until time of assignment.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Findings indicate individuals with SAD can be identified and successfully treated in vocational service settings.

    “Findings indicate that individuals with SAD can be identified and successfully treated in vocational service settings.”
    Quote in the paperSubstantial claim

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

    Study design and conductown data

    Multiple imputation with 20 imputations via MCMC was used to account for missing data.

    “Multiple imputation, using single-chain MCMC estimation via SAS PROC MI with 20 imputations, was used to account for missing data.”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    Prior research indicates positive changes in mental health are associated with employment-related improvements.

    “This finding fits with prior research indicating that positive changes in mental health are associated with employment-related improvements (Cygan-Rehm et al., 2017).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Cygan-Rehm et al., 2017 source

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

    Interpretationown data

    The faster improvement in social anxiety symptoms observed in the WCBT+VSAU group is likely to benefit participants.

    “These similar long-term outcomes notwithstanding, the faster improvement in social anxiety symptoms observed in the WCBT+VSAU group is likely to benefit participants.”
    Quote in the paperNot a substantial claim

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

    Study design and conductreasoning

    Each analysis controlled for service use hours and average hours employed in the prior period to address group differences in JVS service utilization and employment.

    “To control for differences between groups in JVS service utilization and employment, each analysis also controlled for service use hours and average number of hours employed in the period prior to the assessment.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Despite challenges, retention rates in WCBT+VSAU were high, indicating the program was suitable for this highly complex sample.

    “Despite these challenges, retention rates in WCBT+VSAU were high, indicating that the program was suitable for this highly complex sample.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Given unexpected long-term improvement in VSAU-alone and the association between improvement in these symptoms and more hours worked, it is unsurprising that there were no differences in hours worked between groups over time.

    “Given the unexpected long-term improvement in social anxiety among VSAU-alone participants, and the association between improvement in these symptoms and more hours worked, it is unsurprising that there were no differences in hours worked between the groups over time.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    The outcome variables had approximately normal distributions and no concerning outliers.

    “Distributions were examined and found to be approximately normal with no concerning outliers detected for any of the outcome variables.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Even though WCBT+VSAU showed sustained improvement in social anxiety throughout 52 weeks, group differences overall largely dissipated by 26 weeks due to unexpected improvement in VSAU-alone.

    “Even though WCBT+VSAU showed sustained improvement in social anxiety throughout 52 weeks, group differences overall largely dissipated by 26 weeks due to unexpected improvement in VSAU-alone.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    Although 295 participants completed baseline assessments, 45 were excluded from data analyses because they did not attend the randomization meeting and were never randomized.

    “Although 295 participants completed baseline assessments, 45 participants were excluded from data analyses since they did not attend the randomization meeting and thus were never randomized.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    Retention at later assessments was 84% at 4 weeks, 76% at 12 weeks, 70% at 26 weeks, and 66% at 52 weeks.

    “The sample sizes and percent retention for later assessments were as follows: 4 weeks n = 211 (84%), 12 weeks n = 189 (76%), 26 weeks, n = 174 (70%) and 52 weeks, n = 166 (66%).”
    Quote in the paperNot a substantial claim

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

    Study design and conductown data

    Participants were cohort randomized 1:1 to WCBT+VSAU versus VSAU-alone via centralized, computer-generated allocation sequences with variable-sized permuted block sizes, using a SAS data step.

    “Participants were cohort randomized 1:1 to WCBT+VSAU vs VSAU-alone via centralized, computer-generated allocation sequences with variable-sized permuted block sizes, using a SAS data step.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Analyses controlled for baseline values of dependent variables as proposed in the data analysis plan.

    “As proposed in the data analysis plan, analyses controlled for baseline values of dependent variables.”
    Quote in the paperSubstantial claim

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

    Study design and conductnone given

    All participants provided written informed consent.

    “All participants provided written informed consent.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Among this diverse sample, WCBT+VSAU was more effective than VSAU-alone for reducing social anxiety symptoms in the short-term, particularly social anxiety-related avoidance.

    “Among this racially, ethnically, and socioeconomically diverse sample of unemployed/underemployed individuals seeking vocational services, WCBT+VSAU was more effective than VSAU-alone for reducing social anxiety symptoms in the short-term, particularly with respect to social anxiety-related avoidance.”
    Quote in the paperSubstantial claim

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

    Study design and conductcitation

    Two extreme outliers in JVS service use hours were Winsorized to the 95th percentile value.

    “For JVS service use hours, two extreme outliers were Winsorized (Salkind, 2010).”
    • Also stated in: § Statistical Methods · plain
      “two outliers above the 95th percentile were set to the value of the 95th percentile.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Salkind, 2010

      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 conductcitation

    Multiple imputation with fully conditional specification accounted for the multilevel nature of the data.

    “To account for missing data, we used multiple imputation with fully conditional specification, which takes into account the multilevel nature of the data (Enders et al., 2020).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Enders et al., 2020 source

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

    Study design and conductcitation

    The Brief Symptom Inventory-18 is a commonly used inventory with well-established reliability and validity.

    “The Brief Symptom Inventory-18 (BSI-18) is a commonly used inventory with well-established reliability and validity (Andreu et al., 2008).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Andreu et al., 2008

  • May combine two claims.

    Interpretationown data

    WCBT+VSAU benefits did not extend to depression or employment-related outcomes.

    “However, WCBT+VSAU benefits did not extend to depression or employment-related outcomes.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    Strengths include a highly diverse sample resembling persons seeking vocational services in under-resourced urban areas, a scalable intervention relying on vocational service professionals, and absence of adverse events following baseline despite lack of direct mental health specialist providers.

    “Strengths include: a highly diverse sample that resembles persons seeking vocational services in under-resourced, urban areas; a scalable intervention that relies on vocational service professionals delivering the intervention; and the absence of adverse events following baseline despite the lack of direct involvement by mental health specialist providers.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Prior evidence from mixed anxiety disorders found lower levels of depression associated with superior outcomes from CBT compared to comparison conditions.

    “This finding contrasts with prior evidence from samples of mixed anxiety disorders where lower levels of depression were associated with superior outcomes from CBT compared to comparison conditions (e.g., acceptance and commitment therapy - Wolitzky-Taylor et al., 2012) and mindfulness (Arch & Ayers, 2013).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Wolitzky-Taylor et al., 2012 source
    • cites Arch & Ayers, 2013 source

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

    Study design and conductnone given

    Initial power calculations were conducted for 300 participants, but only 250 participants were randomized.

    “Sixth, although our initial power calculations were conducted for 300 participants, only 250 participants were randomized.”
    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 conductnone given

    WCBT was initially developed and tested among a group of job seekers who identified as racial minority group members, and no additional specific cultural adaptations were included for this study.

    “Fifth, as WCBT was initially developed and tested among a group of job seekers who identified as racial minority group members, we did not include additional specific cultural adaptations for this study.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Although concurrent use of CBT for social anxiety was restricted during the four-week active treatment phase, outside mental health services were utilized at greater rates than expected.

    “Fourth, although concurrent use of CBT for social anxiety was restricted during the four-week active treatment phase, outside mental health services were utilized at greater rates than expected.”
    Quote in the paperNot a substantial claim
69 of 69

  • The paper relies on this without support.

    Research-supported psychosocial treatments are currently not provided for most unemployed people with social anxiety disorder.

    “because research-supported psychosocial treatments are currently not provided for most unemployed people with SAD.”

  • The paper relies on this without support.

    Group-based treatment aligns well with the majority of programming typically offered at JVS sites.

    “it aligns well with the majority of programming typically offered at JVS sites.”
2 of 2

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.

  • Not confirmedt(48) = 1.5reported p = .127 · recomputed p = .140

    “t(48) = 1.5, p = .127”

  • Consistentt(48) = 6.3reported p < .001 · recomputed p < .001

    “t(48) = 6.3, p < .001”

  • Consistentt(190) = 1.71reported p = .088 · recomputed p = .089

    “t(190) = 1.71, p = .088”

3 of 3

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.

  • Different cohort totals are given for randomization

    Minor

    The Randomization section says 20 groups were randomized at JVS-D and 34 at JVS-SoCal, but the Participant Flow section says 53 cohorts were randomized in total. That is a direct mismatch in the number of randomized cohorts.

  • Abstract overlooks a later difference on an exploratory outcome

    Minor

    The abstract says the conditions did not differ on any variable at later time points, but the results report a significant between-condition SPIN difference at 12 weeks.

2 of 2

Cites

Flagged first, then by citations

6 of the 70 references couldn’t be matched to a known paper.

Research works printed but not linked: 2

  1. Austin, 2019, Vocational rehabilitation outcomes for individuals with intellectual disabilities and со-occurring psychiatric disorders, Journal of Rehabilitation, 85, 14
  2. Salkind, 2010, Vol. 1

Cited by

Sorted by citations

Related

Authors
Himle, J. A., LeBeau, R. T., Jester, J. M., Kilbourne, A. M., Weaver, A., Brydon, D. M., Tucker, K. M., Hamameh, N., Castriotta, N., & Craske, M. G.
Affiliations
  • University of Michigan (US)
  • University of California, Los Angeles (US)
  • United States Department of Veterans Affairs (US)
  • University of California San Diego (US)
Corresponding author
Himle, Joseph A.
ORCID
Venue
Journal of Anxiety Disorders
Publisher
Elsevier BV
Published
2024-06
Volume
104
Pages
102875
ISSN
0887-6185 (ISSN-L)
DOI
10.1016/j.janxdis.2024.102875
PMC
PMC11639394
OpenAlex
W4396952018
Semantic Scholar
897199e591c3fb1cbc1e82284f1680f6bf070806
Cited by
4
References
70
Citations by year
2026: 1 · 2025: 2 · 2024: 1
FWCI
1.63
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Anxiety Disorders (acceptedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
NIMH (RO1MH102263, R01MH102274)
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
  • Health Sciences › Health Professions › General Health Professions › Employment and Welfare Studies
Keywords
social anxiety disorder, vocational services, employment effects, unemployment, psychological flexibility, depression, treatment moderators, vocational rehabilitation
MeSH terms
Phobia, Social, Adult, Depression, Female, Humans, Male, Middle Aged, Rehabilitation, Vocational, Unemployment, 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 by deepseek-v4.1-flash 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.

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