Randomized controlled trial of cognitive behavioral therapy and acceptance and commitment therapy for social phobia: Outcomes and moderators

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

Meuret et al. (2010) found that lower perceived control was associated with greater improvement in cognitive therapy for panic disorder.

“Meuret et al. (2010) found that lower perceived control was associated with greater improvement in cognitive therapy for panic disorder.”

• cites Meuret et al. (2010) sourceDisputed

  The Results (Effect of Baseline Perceived Control) report no significant association between perceived control and improvement within cognitive therapy (CT). The Discussion likewise says initial control did not predict CT outcome. Patients with low perceived control improved more in CT than in CART, but that is a comparison between treatments, not the claimed association within CT. (LLM, conf=0.88)

  Checked by a reasoning model — may be wrong.

  Experimental — accuracy not yet measured

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

In a panic disorder sample, lower perceived control was associated with poorer outcomes from a treatment aimed at changing respiration, whereas higher cognitive misappraisal of anxiety symptoms was related to poorer outcomes from cognitive therapy.

“In a panic disorder sample, Meuret et al. (2010) found that lower perceived control was associated with poorer outcomes from a treatment aimed at changing respiration, whereas higher cognitive misappraisal of anxiety symptoms (i.e., anxiety sensitivity) was related to poorer outcomes from cognitive therapy.”

• cites Meuret et al. (2010) sourceSupported

May combine two claims.

The sample in that first ACT-versus-CBT trial was composed of mixed anxiety disorders and was too small to evaluate the relative effects of CBT and ACT for specific anxiety disorders.

“However, the sample was comprised of mixed anxiety disorders and was too small to evaluate the relative effects of CBT and ACT for specific anxiety disorders.”

• cites Arch et al., 2012 sourceSupported

May combine two claims.

Gender was not a predictor of CBT outcomes in prior studies, including for social phobia, and it was neither a predictor nor a moderator of outcome in the previous study of a mixed anxiety disorder sample.

“Gender was not a predictor of CBT outcomes in prior studies, including for social phobia (Schuurmans et al., 2009; Watanabe et al., 2010), and it was neither a predictor nor a moderator of outcome in the previous study of a mixed anxiety disorder sample (Wolitzky-Taylor et al., 2012).”

• cites Schuurmans et al., 2009 sourceCould not verify

  The Predictor variables of treatment outcome section (p. 6) lists the factors tested for CBT outcome but does not include gender. Gender appears in Data analysis (p. 7) only as a variable used to impute missing data. Although the sample included people with social phobia (The treatment study, p. 3), our copy does not establish whether gender predicted CBT outcomes for them or for the sample overall. (LLM, conf=0.77)

  Experimental — accuracy not yet measured
• cites Watanabe et al., 2010 sourceSupported
• cites Wolitzky-Taylor et al., 2012 sourceNot checked — no full text of the source

May combine two claims.

The sample size was relatively small, which may have led to insufficient power to detect differences between two active treatments and failure to replicate all findings from the prior study.

“Most notably, the sample size was relatively small, which may have led to insufficient power to detect differences between two active treatments, and failure to replicate all findings from our prior study (Arch et al., 2012).”

• cites Arch et al., 2012 sourceSupported

May combine two claims.

In the current study, ACT and CBT produced similar rates of clinically significant improvement, comparable to published mean response rates for CBT for social phobia: 46% at post-treatment and 52.9% at follow-up.

“In the current study, ACT and CBT produced similar rates of clinically significant improvement, that were comparable to published mean response rates for CBT for social phobia: 46% at post-treatment (12 studies, 29 data points) and 52.9% at follow-up (3 studies, 10 data points)”

• cites Chen et al., 2007 sourcePartly supported

  The Discussion says the group CBT outcomes were comparable to Western reports, which supports the general comparison. But the Results report this study’s post-treatment response rates as 33.3% (intention-to-treat) and 38.0% (completers); our copy does not report published mean response rates of 46% at post-treatment or 52.9% at follow-up, or the stated study and data-point counts. The paper did not compare ACT with CBT; that comparison appears to be the citing authors’ own result. (LLM, conf=0.82)

  Experimental — accuracy not yet measured
• cites Davidson et al., 2004 sourceNot checked — no full text of the source
• cites Olivares et al., 2002Not matched

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

May combine two claims.

Very few studies have used reliable change index methods to compute treatment response rates, but the few that have evidence response rates comparable to those in the present study.

“Very few studies have used reliable change index methods to compute treatment response rates but the few that have (Stangier et al., 2003; Tillfors et al., 2008) evidence response rates comparable to those in the present study.”

• cites Stangier et al., 2003 sourceNot checked — no full text of the source
• cites Tillfors et al., 2008 sourceSupported

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

To our knowledge, only one other study examined extraversion as a predictor of behavioral treatment in a social phobia sample, with null results.

“To our knowledge, only one other study examined extraversion as a predictor of behavioral treatment in a social phobia sample, with null results (Chen et al., 2007).”

• cites Chen et al., 2007 sourceSupported

May combine two claims.

The current results contrast with the prior report in which moderate levels of anxiety sensitivity led to better outcomes from CBT whereas they did not affect ACT, and with the report by Meuret et al. (2010) where higher levels of anxiety sensitivity led to poorer response to cognitive therapy and greater response to capnometry assisted respiratory training.

“Thus, the current results contrast with the prior report in which moderate levels of anxiety sensitivity led to better outcomes from CBT whereas they did not affect ACT (Wolitzky-Taylor et al., 2012), and with the report by Meuret et al. (2010) where higher levels of anxiety sensitivity led to poorer response to cognitive therapy and greater response to capnometry assisted respiratory training.”

• cites Wolitzky-Taylor et al., 2012 sourceNot checked — no full text of the source
• cites Meuret et al. (2010) sourcePartly supported

  Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  Experimental — accuracy not yet measured

May combine two claims.

The results are generally consistent with a prior study (Arch et al., 2012), where few differences were found between the two treatments for a mixed anxiety disorder sample, excepting greater improvements from post to follow-up on clinical severity ratings for ACT than CBT.

“The results are generally consistent with a prior study (Arch et al., 2012), where few differences were found in outcomes between the two treatments for a mixed anxiety disorder sample, excepting greater improvements from post to follow-up on clinical severity ratings for ACT than CBT.”

• cites Arch et al., 2012 sourceSupported

May combine two claims.

These data suggest that changes in quality of life may take longer than symptom changes, consistent with prior evidence for changes in quality of life by the 12-month follow-up, albeit more so following CBT than ACT.

“These data suggest that changes in quality of life may take longer than symptom changes, which is consistent with prior evidence for changes in quality of life by the 12 month follow-up, albeit more so following CBT than ACT (Arch et al., 2012).”

• cites Arch et al., 2012 sourceSupported

Borderline on S3 (load-bearing), S4 (based): unclear from the text.

Treatment credibility ratings did not differ significantly between ACT and CBT.

“Treatment credibility ratings did not differ significantly between ACT (M=4.83, SD=2.5) and CBT (M=4.2, SD=2.4), t(60)=−1.02, p=.311.”

May combine two claims.

In all treatment conditions, greater perceived control and greater extraversion predicted more improvement.

“Across treatment groups, higher perceived control, and extraversion were associated with greater improvement”

May combine two claims.

Fear of negative evaluation, measured by self-report, was a significant moderator; both high and low scores tended to predict better results with CBT and worse results with ACT.

“Self-reported fear of negative evaluation significantly moderated outcomes as well, with trends for both extremes to be associated with superior outcomes from CBT and inferior outcomes from ACT.”

The quote only partly states this claim.

Having a comorbid depression diagnosis predicted worse outcomes in all treatment conditions.

“whereas comorbid depression was associated with poorer outcomes.”

May combine two claims.

In the current trial, both CBT and ACT outperformed waitlist on self-report, independent clinician, and public speaking outcomes; CBT and ACT did not differ.

“Both treatment groups outperformed WL, with no differences observed between CBT and ACT on self-report, independent clinician, or public speaking outcomes.”

May combine two claims.

The Time × Group interaction for quality of life was not significant for S1 or S2.

“The Time × Group interaction for quality of life was not significant for S1 (p=.539) or S2 (p=.427).”

May combine two claims.

Perceived control was a significant predictor of fear and avoidance ratings, with higher perceived control associated with lower fear and avoidance.

“Perceived control was a significant predictor of fear and avoidance ratings (z=2.00 p=.045), with patients higher in perceived control reporting lower fear and avoidance (b=−.73; CI=−.016 to −1.44), collapsed across group and follow-up assessments.”

May combine two claims.

Neither comorbid anxiety nor neuroticism significantly predicted either composite symptoms or fear and avoidance ratings.

“and neither comorbid anxiety nor neuroticism significantly predicted either outcome (ps>.186).”

Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing), S4 (based). The quote only partly states this claim.

S1 change slopes indicated a significant reduction in subjective distress during public speaking in ACT.

“ACT (p<.001)”

May combine two claims.

At post-treatment, rates of clinically significant improvement were 52.3% for CBT, 40.9% for ACT, and 4.3% for WL.

“Rates at Post were as follows: CBT=52.3% (n=11/21), ACT=40.9% (n=9/22), and WL=4.3% (n=1/23); χ2 (N=66, df=2)=12.93, p=.001.”

May combine two claims.

The Time × Group interaction for fear and avoidance ratings was significant for S1 but not for S2.

“The Time × Group interaction for fear and avoidance ratings was significant for S1 (p=.003) but not for S2 (p=.366).”

The quote only partly states this claim.

S1 change slopes indicated significant fear and avoidance reduction in ACT.

“and ACT (p<.001)”

May combine two claims.

In the intent-to-treat analysis, clinically significant improvement rates at 12-month follow-up were 47.8% for CBT and 33.3% for ACT.

“and 47.8% and 33.3% for CBT and ACT, respectively, at 12MFU.”

May combine two claims.

Comorbid depression significantly predicted fear and avoidance ratings, with patients with comorbid depression rated as more fearful and avoidant.

“Comorbid depression significantly predicted fear and avoidance ratings (z=2.28, p=.023), with patients with comorbid depression rated as more fearful and avoidant (b=23.8; CI=3.33 to 44.33).”

May combine two claims.

At 12-month follow-up, clinically significant improvement rates were 40.0% for CBT and 41.2% for ACT.

“12MFU rates were CBT=40.0% (n=6/15) and ACT=41.2% (n=7/17) (p=.95).”

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

From post-treatment to 12-month follow-up, 8 participants stopped psychotropic medication (CBT=3, ACT=5) and 3 began medication (CBT=2, ACT=1).

“From Post to 12MFU, 8 stopped psychotropic medication (CBT=3, ACT=5) and 3 began medication (CBT=2, ACT=1).”

May combine two claims.

The Time × Group interaction for composite symptoms was significant for S1 but not for S2.

“The Time × Group interaction for composite symptoms was significant for S1 (p<.001) but not for S2 (p=.318).”

May combine two claims.

Neither age nor ethnicity was a significant predictor of composite symptoms or fear and avoidance ratings.

“Neither age nor ethnicity was a significant predictor of either outcome (ps>.230).”

May combine two claims.

Two participants completed one session and 14 completed between 2 and 11 sessions.

“Two completed one session and 14 completed between 2 and 11 sessions.”

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

One participant dropped from the wait-list condition.

“One participant dropped from WL.”

May combine two claims.

Neither comorbid depression nor perceived control predicted composite symptoms.

“Neither comorbid depression nor perceived control predicted composite symptoms (ps=.067)”

May combine two claims.

CBT and ACT both outperformed WL on clinically significant improvement.

“CBT and ACT both outperformed WL, χ2 (N=44, df=1)=12.77, p<.001 and χ2 (N=45, df=1)=8.70, p<.01, respectively”

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

Over the same interval, no participant ended psychotherapy and 4 began new psychotherapy (CBT=0, ACT=4), all between 6- and 12-month follow-up.

“Over the same interval, no participant ended psychotherapy and 4 began new psychotherapy (CBT=0, ACT=4) (all between 6MFU and 12MFU).”

May combine two claims.

The Time × Group interaction for clinical severity ratings was significant for S1 but not for S2.

“The Time × Group interaction for clinical severity ratings was significant for S1 (p<.001) but not for S2 (p=.629).”

May combine two claims.

Comorbid depression, extroversion, perceived control, comorbid anxiety, and neuroticism did not significantly moderate composite symptoms or fear and avoidance ratings.

“Comorbid depression, extroversion, perceived control, comorbid anxiety and neuroticism did not significantly moderate composite symptoms or fear and avoidance ratings (ps>.065).”

May combine two claims.

46 of 62 participants (74%) completed all 12 treatment sessions; completion was 67% in CBT and 83% in ACT.

“46 of 62 participants (74%) completed all 12-treatment sessions: CBT=67% (22/33), ACT=83% (24/29).”

May combine two claims.

The Time × Group interaction for subjective distress during public speaking was not significant for S1 or S2.

“The Time × Group interaction was not significant for subjective distress during public speaking for S1 (p=.469) or for S2 (p=.051).”

May combine two claims.

Individuals assigned to ACT or CBT did not differ in their rate of attrition or perceived credibility in the treatment.

“Nor did they differ in their rate of attrition or their perceived credibility in the treatment.”

May combine two claims.

Four participants in ACT added a new psychotherapy, and none did so in CBT; none of the four achieved clinically reliable change despite additional therapy.

“Notably, whereas four participants in ACT added a new psychotherapy (although none achieved clinically reliable change despite additional therapy), none did so in CBT.”

May combine two claims.

Some participants in ACT received additional treatment during the follow-up period, and the study did not assess what type of treatment or the number of sessions they received.

“Finally, some participants in ACT received additional treatment during the follow-up period, and we did not assess what type of treatment or the number of sessions they received.”

May combine two claims.

Over and above symptom severity, the SSPS significantly moderated clinician-rated outcome, although interpretation is tempered by lack of significant simple effects.

“Over and above symptom severity, our measure of fear of negative evaluation, the SSPS, significantly moderated clinician-rated outcome, although interpretation is tempered by lack of significant simple effects.”

May combine two claims.

Visual inspection revealed inverse curvilinear relationships, with individuals scoring either the highest or the lowest on fears of negative evaluation tending to fare better with CBT and worse with ACT.

“Visual inspection revealed inverse curvilinear relationships, with individuals scoring either the highest or the lowest on fears of negative evaluation tending to fare better with CBT and worse with ACT.”

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

Social phobia is one of the most common anxiety disorders, with lifetime prevalence rates of 16.6%.

“We focused on social phobia to decrease heterogeneity in this first comparison study and because social phobia is one of the most common anxiety disorders, with lifetime prevalence rates of 16.6% (Kessler, Chiu, Demler, Merikangas, & Walters, 2005).”

• cites Kessler, Chiu, Demler, Merikangas, & Walters, 2005 sourceNot checked — no full text of the source

May combine two claims. The quote only partly states this claim.

In that mixed anxiety disorder sample, there were trends for CBT to outperform ACT at higher levels of experiential avoidance, and ACT outperformed CBT among those with a comorbid mood disorder, with trends to outperform CBT at lower levels of experiential avoidance.

“Also, there were trends for CBT to outperform ACT at higher levels of experiential avoidance. ACT outperformed CBT among those with a comorbid mood disorder, and there were trends to outperform CBT at lower levels of experiential avoidance.”

• cites Wolitzky-Taylor, Arch, Rosenfield, & Craske, 2012 sourceNot checked — no full text of the source

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

ACT cultivates mindfulness, acceptance, and cognitive defusion to increase psychological flexibility and promote behavior change consistent with personal values.

“ACT cultivates mindfulness, acceptance, and cognitive defusion (flexible distancing from the literal meaning of cognitions) to increase psychological flexibility and promote behavior change consistent with personal values.”

• cites Hayes, Strosahl, & Wilson, 1999Not matched

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

May combine two claims.

Instructions for emotional acceptance lower distress and increase tolerance for experimentally induced anxiety symptoms.

“Instructions for emotional acceptance have been shown to lower distress and increase tolerance for experimentally-induced symptoms of anxiety (Campbell-Sills, Barlow, Brown, & Hofmann, 2006; Levitt, Brown, Orsillo, & Barlow, 2004).”

• cites Campbell-Sills, Barlow, Brown, & Hofmann, 2006 sourceNot checked — no full text of the source
• cites Levitt, Brown, Orsillo, & Barlow, 2004 sourceNot checked — no full text of the source

The quote only partly states this claim.

Neuroticism was a predictor of poorer outcomes regardless of treatment condition in the mixed anxiety disorder sample.

“Also, neuroticism was a predictor of poorer outcomes, regardless of treatment condition.”

• cites Wolitzky-Taylor, Arch, Rosenfield, & Craske, 2012 sourceNot checked — no full text of the source

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

The treatment credibility questionnaire had a Cronbach's alpha of .95.

“Prior to the second therapy session, after treatment rationales, participants completed a 6-item treatment credibility questionnaire adapted from Borkovec and Nau (1972) (α=.95).”

May combine two claims.

There were trends for superior outcomes from CBT and inferior outcomes from ACT at the extreme ends of fear of negative evaluation.

“there were trends for superior outcomes from CBT and inferior outcomes from ACT at the extreme ends of fear of negative evaluation.”

May combine two claims.

The modified intent-to-treat analysis omitted 10 people who dropped out before starting treatment and before learning their randomization; these dropouts were comparable to non-attriters on sociodemographic variables, clinical severity, and treatment assignment.

“We used a modified intent-to-treat approach in that we did not analyze 10 of the original 100 participants who dropped prior to treatment initiation before they were aware of their randomization to ACT or CBT: they did not differ from non-attriters on sociodemographic variables (ps>.12), clinical severity ratings (p=.85), or assignment to ACT (n=4) vs. CBT (n=5) vs. WL (n=1; p=.48).”

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

Moderator analyses were restricted to composite symptoms and fear and avoidance outcomes; clinical severity ratings were excluded because of limited range, and public-speaking anxiety was excluded because of non-normal distribution.

“Moderator analyses were limited to composite symptoms and fear and avoidance outcomes; CSR was excluded due to limited range in the data, and anxiety during public speaking was excluded due to a non-normal distribution that produced inaccurate parameter estimates in the model.”

Probably not a substantial claim: may not pass S3 (load-bearing). The quote only partly states this claim.

The self-report social anxiety measures (LSAS-SR, SIAS, SPS) had high internal consistency in this sample, with Cronbach's alphas ranging from .90 to .97.

“In the current sample, Cronbach’s αs=.97 (Pre) and .94 (Post).”

• Also stated in: § Outcome Measures · plain

  “Cronbach’s αs=.96 (Pre) and .95 (Post).”

• Also stated in: § Outcome Measures · plain

  “In the current sample, αs=.93 (Pre) and .90 (Post).”

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

The Self Statements During Public Speaking questionnaire had Cronbach's alphas of .88 at pre-treatment and .90 at post-treatment.

“Mean ratings for negative thoughts are analyzed in the current sample: αs were .88 (Pre) and .90 (Post).”

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

Moderator analyses used a multilevel model with a repeated-measures ANCOVA-like design, pre-treatment values as a covariate, and Post, 6-month, and 12-month follow-up as repeated measures.

“Consistent with prior studies of moderators (Wolitzky-Taylor et al., 2012), we chose a MLM, repeated measures analysis of covariance (ANCOVA)-like design, implemented using the xtmixed command in Stata 12.0. Pre values of the dependent measures were included as a covariate, and Post, 6MFU, and 12MFU were levels of the repeated measures independent variable (Time).”

• cites Wolitzky-Taylor et al., 2012 sourceNot checked — no full text of the source

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

Longitudinal data were analyzed with multilevel modeling, which accounts for nesting of time-points within subjects and includes participants with missing data.

“Longitudinal data were analyzed with multi-level modeling (MLM) in Stata 12.0 using the xtmixed command. MLM accounts for nesting of time-points within subjects, allowing examination of within and between subject change across Time (Pre, Post, 6MFU, 12MFU) and by group (ACT, CBT and WL). MLM includes participants with missing data and uses all available data to estimate the models.”

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

The residuals were normally distributed in every model.

“Residuals were normally distributed across all models.”

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

The Quality of Life Inventory had Cronbach's alphas of .85 at pre-treatment and .84 at post-treatment.

“In the current sample, Cronbach’s αs=.85 (Pre) and .84 (Post).”

May combine two claims.

Therapist competence scores indicated good therapist skills in both CBT and ACT and did not differ significantly between treatments.

“Therapist competence scores indicated “good” therapist skills in CBT (M=3.06, SD=.67) and ACT (M=3.21, SD=.57) that did not significantly differ, t(42)=−.76, p=.449.”

May combine two claims.

Inter-rater reliability on the principal diagnosis was 100%, and on dimensional CSR ratings for social phobia was ICC = 1.00 (100% agreement).

“Inter-rater reliability on the principal diagnosis (n=22) was 100%, and on dimensional CSR ratings for social phobia (n=10) was ICC=1.00 (100% agreement).”

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

The two active treatments had the same number of exposure sessions, but the stated purpose of exposure differed between them.

“ACT and CBT were matched on number of sessions devoted to exposure but differed in framing of the intent of exposure.”

May combine two claims.

Models with and without dropout as a predictor produced the same results, which supports a missing-at-random assumption.

“Results did not differ between models that included dropout as a predictor and those that did not.”

May combine two claims.

Individuals without comorbid depression, or who were higher in extraversion or perceived control, fared better than their counterparts with either treatment approach.

“Also, individuals without comorbid depression or who were higher in extraversion or perceived control fared better than their counterparts with either treatment approach.”

May combine two claims.

Broadly, CBT and ACT did not differ from each other on self-report, independent clinician, or public speaking outcomes, and each was superior to wait-list on the majority of measures.

“Broadly speaking, the two treatments did not differ from each other in terms of self-report, independent clinician, or public speaking outcomes, with each treatment superior to the wait-list control on the majority of measures.”

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

The majority of participants completed therapy within 12 to 16 weeks (range 11-18 weeks).

“The majority completed therapy within 12 to 16 weeks (range 11 – 18 weeks).”

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

The Anxiety Control Questionnaire had Cronbach's alphas of .89 at pre-treatment and .90 at post-treatment.

“Current αs were .89 (Pre) and .90 (Post).”

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

The Acceptance and Action Questionnaire-16 had Cronbach's alphas of .83 at pre-treatment and .88 at post-treatment.

“Herein, a one-factor scale was used, with higher scores indicating greater psychological flexibility: αs were .83 (Pre) and .88 (Post).”

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

Only participants with Post scores were included in the moderator analysis.

“Therefore, only participants with Post scores were included in the moderator analysis.10”

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

Participants were stratified by age and gender across CBT, ACT, and waitlist.

“Participants were stratified by age and gender in CBT, ACT and WL.”

May combine two claims.

Treatment adherence and therapist competence ratings had excellent inter-rater reliability (ICCs .78-.97) and intra-rater reliability (ICCs .98-1.0).

“Inter-rater reliability on 35 sessions was excellent (ICCs for scales ranged from .78 to .97).”

• Also stated in: § Treatment Adherence and Therapist competence · plain

  “Intra-rater reliability of the primary rater, which was assessed on 18 sessions, was excellent (ICCs for scales ranged from .98 to 1.0).”

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

Therapists delivering CBT, ACT, or both did not differ in gender, age, or years since starting graduate school (p's > .39).

“There were no differences among therapists who provided CBT, ACT or both in terms of gender, age or years since entering graduate school (p’s>.39).”

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

The Eysenck Personality Questionnaire neuroticism and extraversion scales had high internal consistency in this sample, with alphas ranging from .84 to .90.

“Current αs for neuroticism were .86 (Pre) and .84 (Post) and for extroversion were .90 (Pre) and .85 (Post).”

May combine two claims.

The study had a high level of treatment attrition (nearly 50% by 12-month follow-up), which may have reduced power and affected the ability to observe continued change over the follow-up period.

“Also, we had a high level of treatment attrition (nearly 50% by 12 month follow-up), which may have reduced power and affected our ability to observe continued change over the follow-up period.”

May combine two claims.

Superior CBT outcomes as a function of higher experiential avoidance mirrors trends in the prior study.

“Superior CBT outcomes as a function of higher experiential avoidance mirrors trends in the prior study (Wolitzky-Taylor et al., 2012).”

• cites Wolitzky-Taylor et al., 2012 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

The role of predictors of exposure-based treatment, whether cognitively based or acceptance based, is in need of further replication.

“Thus, in all cases, the role of predictors of exposure-based treatment, whether cognitively based or acceptance based, is in need of further replication.”

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

It was previously found that comorbid depression led to greater improvement in ACT and for CBT, depression either led to poorer outcome or had no association with outcome.

“It was previously found that comorbid depression led to greater improvement in ACT (Wolitzky-Taylor et al., 2012) and for CBT, depression either led to poorer outcome (Chambless, Tran, & Glass, 1997; Steketee, Chambless, & Tran, 2001) or had no association with outcome (Kampman, Keijsers, Hoogduin, & Hendriks, 2008; Schuurmans et al., 2009).”

• cites Wolitzky-Taylor et al., 2012 sourceNot checked — no full text of the source
• cites Chambless, Tran, & Glass, 1997 sourceNot checked — no full text of the source
• cites Steketee, Chambless, & Tran, 2001 sourceNot checked — no full text of the source

May combine two claims.

Although involvement in alternative psychotherapy clouds the group comparison, the results indicate that individuals with social phobia will, on average, respond as well to ACT as they do to CBT.

“Although involvement in alternative psychotherapy clouds the group comparison, the results indicate that individuals with social phobia will, on average, respond as well to ACT as they do to CBT.”

May combine two claims.

The lack of differences between CBT and ACT is not due to lack of effectiveness, since the two treatment conditions yielded superior outcomes to a wait-list comparison on most outcomes.

“The lack of differences between CBT and ACT is not due to lack of effectiveness, since the two treatment conditions yielded superior outcomes to a wait-list comparison on most outcomes.”

May combine two claims.

None of the four ACT participants who received additional treatment achieved reliable change criteria by the 12-month follow-up, suggesting that the findings were unlikely to be influenced by the additional treatment.

“However, none of these four participants achieved reliable change criteria by the 12-month follow-up, suggesting that the findings were unlikely to be influenced by the additional treatment.”

May combine two claims.

These data suggest that repetition of the public speaking task was alone sufficient to yield significant improvements in anxiety, although improvements did not generalize to other measures of social anxiety severity.

“These data suggest that repetition of the public speaking task was alone sufficient to yield significant improvements in anxiety, although improvements that did not generalize to other measures of social”

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

Although expert supervision was provided, the findings may have differed with more experienced clinicians.

“Although this is common to many clinical trials and expert supervision was provided, the findings may have differed with more experienced clinicians.”

May combine two claims.

Given the sample size, the study had sufficient power (80%) to detect only large effects for treatment group effects and moderator analyses; power to detect moderate and small effects was 40% and 20%, respectively.

“Given our sample size, we had sufficient power (80%) to detect only large effects for the treatment group effects (Cohen’s d = .85) and moderator analyses (Cohen’s f2 = .45). Power to detect moderate and small effects for both analyses was 40% and 20%, respectively.”

May combine two claims.

In sum, this study adds to the small but growing body of evidence indicating that CBT and ACT perform equally well for the treatment of social phobia, and significantly outperform waitlist controls.

“In sum, this study adds to the small but growing body of evidence indicating that CBT and ACT perform equally well for the treatment of social phobia, and significantly outperform waitlist controls.”

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

Treatment was delivered by relatively inexperienced graduate students.

“Second, treatment was delivered by relatively inexperienced graduate students.”

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

Although multilevel modeling can produce less biased estimates when data are missing, it is unknown whether lower attrition would have influenced findings for the follow-up time points.

“Although multi-level modeling can produce less biased estimates when data are missing, we do not know whether lower attrition would have influenced findings for the follow-up time points.”

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

Similarities between ACT and CBT are discussed elsewhere, including exposure to rather than suppression of anxious thoughts, active effort to deal with anxious thoughts, and attainment of strategic control over emotions via different paths.

“Similarities between ACT and CBT are discussed elsewhere (Arch & Craske, 2008). These include exposure to, rather than suppression of, anxious thoughts; active effort to deal with anxious thoughts; and attainment of strategic control over emotions albeit via different paths.”

• cites Arch & Craske, 2008 sourceNot checked — no full text of the source

Classified as probably not a substantial claim.

Given the potency of exposure for anxiety disorders, it is conceivable that the shared component of exposure overrode other differences between the two treatments and thereby equated their effects.

“Given the potency of exposure for anxiety disorders (e.g. Norton & Price, 2007), it is conceivable that the shared component of exposure overrode other differences between the two treatments, and thereby equated their effects.”

• cites Norton & Price, 2007 sourceNot checked — no full text of the source

May combine two claims.

This study replicated a moderator finding from a previous comparison of CBT and ACT, showing that individuals with lower psychological flexibility respond more favorably to CBT.

“This study also replicated a moderator finding from a previous comparison of CBT and ACT, showing that individuals with lower psychological flexibility respond more favorably to CBT.”