Fear, avoidance and physiological symptoms during cognitive-behavioral therapy for social anxiety disorder

Idan M. Aderka*, Carmen P. McLean, Jonathan D. Huppert, Jonathan R.T. Davidson, Edna B. Foa

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

30 Scopus citations

Abstract

We examined fear, avoidance and physiological symptoms during cognitive-behavioral therapy (CBT) for social anxiety disorder (SAD). Participants were 177 individuals with generalized SAD who underwent a 14-week group CBT as part of a randomized controlled treatment trial. Participants filled out self-report measures of SAD symptoms at pre-treatment, week 4 of treatment, week 8 of treatment, and week 14 of treatment (post-treatment). Cross-lagged Structural Equation Modeling indicated that during the first 8 weeks of treatment avoidance predicted subsequent fear above and beyond previous fear, but fear did not predict subsequent avoidance beyond previous avoidance. However, during the last 6 weeks of treatment both fear and avoidance predicted changes in each other. In addition, changes in physiological symptoms occurred independently of changes in fear and avoidance. Our findings suggest that changes in avoidance spark the cycle of change in treatment of SAD, but the cycle may continue to maintain itself through reciprocal relationships between avoidance and fear. In addition, physiological symptoms may change through distinct processes that are independent from those involved in changes of fear and avoidance.

Original languageAmerican English
Pages (from-to)352-358
Number of pages7
JournalBehaviour Research and Therapy
Volume51
Issue number7
DOIs
StatePublished - Jul 2013

Keywords

  • Avoidance
  • Cognitive-behavior therapy
  • Expectancy
  • Fear
  • Physiological symptoms
  • Social anxiety disorder

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