Hostname: page-component-586b7cd67f-2plfb Total loading time: 0 Render date: 2024-11-24T03:36:52.690Z Has data issue: false hasContentIssue false
  • English
  • Français

Effectiveness of cognitive behavioural group therapy for social anxiety disorder: long-term benefits and aftercare

Published online by Cambridge University Press:  28 March 2019

Ciara Fogarty ,
David Hevey  and
Odhrán McCarthy
Ciara Fogarty*
Affiliation:
School of Psychology, Trinity College, University of Dublin, Dublin 2, Ireland
David Hevey
Affiliation:
School of Psychology, Trinity College, University of Dublin, Dublin 2, Ireland
Odhrán McCarthy
Affiliation:
Social Anxiety Ireland, Phibsborough, Dublin 7, Ireland
*
*Corresponding author. Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Empirical research demonstrates the short- to medium-term efficacy and effectiveness of cognitive behavioural group therapy (CBGT) for social anxiety disorder (SAD). Little is known about the durability of gains beyond 1 year following treatment in real-life clinical settings. Literature regarding the impact of aftercare programs as an adjunct to CBGT treatment on SAD is scarce.

Aims:

To evaluate the long-term effectiveness of CBGT for SAD in a community sample and to explore the relationship between long-term treatment outcomes and aftercare support group attendance.

Method:

A longitudinal cohort design evaluated changes in standardized psychological measures assessing aspects of SAD, anxiety and depression. Questionnaires were completed before the program (time 1, N = 457), after the program (time 2, n = 369) and at an average of 4.6 years follow-up (time 3, n = 138).

Results:

Large treatment effect sizes at post-intervention were maintained at long-term follow-up on measures of SAD, anxiety and depression. There was no statistically significant relationship between frequency of attendance at an aftercare support group and degree of improvement from post-treatment severity on any measure.

Conclusions:

CBGT is an effective intervention in the long-term in a routine clinical setting and should be considered a viable treatment option for SAD. Recommendations for future research, treatment implications and study limitations are considered.

Keywords

aftercarecognitive behavioural group therapylong-term effectivenesssocial anxiety disorder
Type
Empirically Grounded Clinical Interventions
Information
Behavioural and Cognitive Psychotherapy , Volume 47 , Issue 5 , September 2019 , pp. 501 - 513
Copyright
© British Association for Behavioural and Cognitive Psychotherapies 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Acarturk, C., Cuijpers, P., van Straten, A. and de Graaf, R. (2009). Psychological treatment of social anxiety disorder: a meta-analysis. Psychological Medicine, 39, 241–254. doi: 10.1017/S0033291708003590 CrossRefGoogle ScholarPubMed
Acarturk, C., Smit, F., de Graaf, R., van Straten, A., ten Have, M. and Cuijpers, P. (2009). Economic costs of social phobia: a population-based study. Journal of Affective Disorders, 115, 421–429. doi: 10.1016/j.jad.2008.10.008 CrossRefGoogle ScholarPubMed
American Psychiatric Association (APA) (2000). Diagnostic and Statistical Manual of Mental Disorders (4th edn, text revision). Washington, DC: American Psychiatric Association.Google Scholar
Barkowski, S., Schwartze, D., Strauss, B., Burlingame, G. M., Barth, J. and Rosendahl, J. (2016). Efficacy of group psychotherapy for social anxiety disorder: a meta-analysis of randomized-controlled trials. Journal of Anxiety Disorders, 39, 44–64. doi: 10.1016/j.janxdis.2016.02.005 CrossRefGoogle ScholarPubMed
Beck, J. S. (1995). Cognitive Therapy: Basics and Beyond. New York, USA: Guilford Press.Google Scholar
Beck, A. T., Epstein, N., Brown, G. and Steer, R. A. (1988). An inventory for measuring clinical anxiety: psychometric properties. Journal of Consulting and Clinical Psychology, 56, 893–897. doi: 10.1037/0022-006X.56.6.893 CrossRefGoogle ScholarPubMed
Beck, A. T., Steer, R. A. and Brown, G. K. (1996). Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation.Google Scholar
Bjerkeset, O., Nordahl, H. M., Larsson, S., Dahl, A. A. and Linaker, O. (2008). A 4-year follow-up study of syndromal and sub-syndromal anxiety and depression symptoms in the general population: the HUNT study. Social Psychiatry and Psychiatric Epidemiology, 43, 192–199. doi: 10.1007/s00127-007-0289-6 CrossRefGoogle ScholarPubMed
Butler, A. C., Chapman, J. E., Forman, E. M. and Beck, A. T. (2006). The empirical status of cognitive-behavioural therapy: a review of meta-analyses. Clinical Psychology Review, 26, 17–31. doi: 10.1016/j.cpr.2005.07.003 CrossRefGoogle ScholarPubMed
Chambless, D. L. and Hope, D. A. (1996). Cognitive approaches to the psychopathology and treatment of social phobia. In Salkovskis, P. M. (ed), Frontiers of Cognitive Therapy. New York: Guilford Press.Google Scholar
Clark, D. M. and Wells, A. (1995). A cognitive model of social phobia. In Heimberg, R. G. and Liebowitz, M. R. (eds), Social Phobia: Diagnosis, Assessment and Treatment. New York: Guilford Press.Google Scholar
Coles, M. E., Turk, C. L., Jindra, L. and Heimberg, R. G. (2004). The path from initial inquiry to initiation of treatment for social anxiety disorder in an anxiety disorders clinic. Journal of Anxiety Disorders, 18, 371–383. doi: 10.1016/S0887-6185(02)00259-1 CrossRefGoogle Scholar
Curtin, R., Presser, S. and Singer, E. (2005). Changes in telephone survey non-response over the past quarter century. Public Opinion Quarterly, 69, 87–98. doi: 10.1093/poq/nfi002 CrossRefGoogle Scholar
Davidson, J. R., Foa, E. B., Huppert, J. D., Keefe, F. J., Franklin, M. E., Compton, J. S., et al. (2004). Fluoxetine, comprehensive cognitive behavioral therapy, and placebo in generalized social phobia. Archives of General Psychiatry, 61, 1005–1013. doi: 10.1001/archpsyc.61.10.1005 CrossRefGoogle ScholarPubMed
Delsignore, A., Rufer, M., Emmerich, J., Weidt, S., Brühl, A. B. and Moergeli, H. (2016). E-mail as an adjunct to cognitive-behavioural group therapy for social anxiety disorder: impact on dropout and outcome. Psychiatry Research, 244, 151–158. doi: 10.1016/j.psychres.2016.07.038 CrossRefGoogle Scholar
DiNardo, P. A., Brown, T. A. and Barlow, D. H. (1994). Anxiety Disorders Interview Schedule for DSM-IV: Lifetime Version (ADIS-IV-L). Albany, NY: Graywind Publications.Google Scholar
Ebert, D., Tarnowski, T., Gollwitzer, M., Sieland, B. and Berking, M. (2013). A transdiagnostic internet-based maintenance treatment enhances the stability of outcome after inpatient cognitive behavioural therapy: a randomized controlled trial. Psychotherapy and Psychosomatics, 82, 246–256. doi: 10.1159/000345967 CrossRefGoogle ScholarPubMed
Egger, N., Konnopka, A., Beutel, M. E., Herpertz, S., Hiller, W., Hoyer, J., et al. (2015). Short-term cost-effectiveness of psychodynamic therapy and cognitive-behavioral therapy in social anxiety disorder: results from the SOPHO-NET trial. Journal of Affective Disorders, 180, 21–28. doi: 10.1016/j.jad.2015.03.037 CrossRefGoogle ScholarPubMed
Ekendahl, M. (2007). Aftercare and compulsory substance abuse treatment: a venture with potential. Contemporary Drug Problems, 34, 137–162. doi: 10.1177/009145090703400107 CrossRefGoogle Scholar
Eskildsen, A., Hougaard, E. and Rosenberg, N. K. (2010). Pre-treatment patient variables as predictors of drop-out and treatment outcome in cognitive behavioural therapy for social anxiety disorder: a systematic review. Nordic Journal of Psychiatry, 64, 94–105. doi: 10.3109/08039480903426929 CrossRefGoogle ScholarPubMed
Falk Dahl, C. A. and Dahl, A. A. (2010). Lifestyle and social network in individuals with high level of social phobia/anxiety symptoms: a community-based study. Social Psychiatry and Psychiatric Epidemiology, 45, 309–317. doi: 10.1007/s00127-009-0069-6 CrossRefGoogle ScholarPubMed
Fedoroff, I. C. and Taylor, S. (2001). Psychological and pharmacological treatments of social phobia: a meta-analysis. Journal of Clinical Psychopharmacology, 21, 311–324.CrossRefGoogle ScholarPubMed
Feske, U. and Chambless, D. L. (1995). Cognitive behavioural versus exposure only treatment for social phobia: a meta-analysis. Behavior Therapy, 26, 695–720. doi: 10.1016/S0005-7894(05)80040-1 CrossRefGoogle Scholar
Furmark, T. (2002). Social phobia: overview of community surveys. Acta Psychiatrica Scandinavica, 105, 84–93. doi: 10.1034/j.1600-0447.2002.1r103.x CrossRefGoogle ScholarPubMed
Gaston, J. E., Abbott, M. J., Rapee, R. M. and Neary, S. (2006). Do empirically supported treatments generalise to private practice? A benchmark study of a cognitive-behavioural group treatment program for social phobia. British Journal of Clinical Psychology, 45, 33–48. doi: 10.1348/014466505X35146 CrossRefGoogle Scholar
Gould, R. A., Buckminster, S., Pollack, M. H., Otto, M. W. and Yap, L. (1997). Cognitive-behavioral and pharmacological treatment for social phobia: a meta-analysis. Clinical Psychology: Science and Practice, 4, 291–306. doi: 10.1111/j.1468-2850.1997.tb00123.x Google Scholar
Grant, B., Hasin, D., Blanco, C., Stinson, F., Chou, S. and Goldstein, R. B. (2005). The epidemiology of social anxiety disorder in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry, 11, 1351–1361.CrossRefGoogle Scholar
Gysin-Maillart, A., Schwab, S., Soravia, L., Megert, M. and Michel, K. (2016). A novel brief therapy for patients who attempt suicide: a 24-months follow-up randomized controlled study of the attempted suicide short intervention program (ASSIP). PLoS Medicine, 13, e1001968; available at: http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001968 CrossRefGoogle Scholar
Heimberg, R. G., Mueller, G. P., Holt, C. S., Hope, D. A. and Liebowitz, M. R. (1992). Assessment of anxiety in social interaction and being observed by others: the Social Interaction Anxiety Scale and the Social Phobia Scale. Behavior Therapy, 23, 53–73. doi: 10.1016/S0005-7894(05)80308-9 CrossRefGoogle Scholar
Heimberg, R. G., Salzman, D., Holt, C. S. and Blendell, K. (1993). Cognitive behavioral group treatment of social phobia: effectiveness at 5-year follow-up. Cognitive Therapy Research, 17, 325–339. doi: 10.1007/BF01177658 CrossRefGoogle Scholar
Hofmann, S. G. and Scepowski, L. A. (2006). Social self-reappraisal therapy for social phobia: preliminary findings. Journal of Cognitive Psychology, 20, 45–57.Google ScholarPubMed
Hofmann, S. G. and Suvak, M. (2006). Treatment attrition during group therapy for social phobia. Journal of Anxiety Disorders, 20, 961–972. doi: 10.1016/j.janxdis.2006.03.005 CrossRefGoogle ScholarPubMed
Jacobson, N. S. and Truax, P. (1991). Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12–19. doi: 00224)06X/91/$3O0 CrossRefGoogle ScholarPubMed
Kessler, R. C., Berglund, P., Demler, O., Jin, R. and Walters, E. E. (2005). Lifetime prevalence and the age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 593–602. doi: 10.1001/archpsyc.62.6.593 CrossRefGoogle ScholarPubMed
Kessler, R. C., Stang, P., Wittchen, H. U., Stein, M. B. and Walters, E. E. (1999). Lifetime co-morbidities between social phobia and mood disorders in the US National Comorbidity Survey. Psychological Medicine, 29, 555–567.CrossRefGoogle ScholarPubMed
Lamers, F., Hoogendoorn, A. W., Smit, J. H., van Dyck, R., Zitman, F. G., Nolen, W. A. and Penninx, B. (2012). Sociodemographic and psychiatric determinants of attrition in the Netherlands Study of Depression and Anxiety (NESDA). Comprehensive Psychiatry, 53, 63–70. doi: 10.1016/j.comppsych.2011.01.011 CrossRefGoogle Scholar
Ledley, D. R., Huppert, J. D., Foa, E. B., Davidson, J. R., Keefe, F. J. and Potts, N. L. (2005). Impact of depressive symptoms on the treatment of generalized social anxiety disorder. Depression and Anxiety, 22, 161–167. doi: 10.1002/da.20121 CrossRefGoogle ScholarPubMed
Lincoln, T. M., Rief, W., Hahlweg, K., Frank, M., von Witzleben, I., Schroeder, B. and Fiegenbaum, W. (2003). Effectiveness of an empirically supported treatment for social phobia in the field. Behaviour Research and Therapy, 41, 1251–1269.CrossRefGoogle ScholarPubMed
Lipsitz, J. D. and Schneier, F. R. (2000). Social phobia: epidemiology and cost of illness. Pharmaeconomics, 18, 23–32. doi: 10.2165/00019053-200018010-00003 CrossRefGoogle ScholarPubMed
Marom, S., Gilboa-Schechtman, E., Aderka, I. M., Weizman, A. and Hermesh, H. (2009). Impact of depression on treatment effectiveness and gains maintenance in social phobia: a naturalistic study of cognitive behaviour group therapy. Depression and Anxiety, 26, 289–300. doi: 10.1002/da.20390 CrossRefGoogle Scholar
Mattick, R. P. and Clarke, J. C. (1998). Development and validation of measures of social phobia scrutiny fear and social interaction anxiety. Behaviour Research and Therapy, 36, 455–470.CrossRefGoogle ScholarPubMed
Mavranezouli, I., Mayo-Wilson, E., Dias, S., Kew, K., Clark, D. M., Ades, A. E. and Pilling, S. (2015). The cost effectiveness of psychological and pharmacological interventions for social anxiety disorder: a model-based economic analysis. PloS One, 10, e0140704; available at: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0140704 CrossRefGoogle ScholarPubMed
Mayo-Wilson, E., Dias, S., Mavranezouli, I., Kew, K., Clark, D. M., Ades, A. E. and Pilling, S. (2014). Psychological and pharmacological interventions for social anxiety disorder in adults: a systematic review and network meta-analysis. Lancet Psychiatry, 1, 368–376. doi: 10.1016/S2215-0366(14)70329-3 CrossRefGoogle ScholarPubMed
McCarthy, O., Hevey, D., Brogan, A. and Kelly, B. (2013). Effectiveness of a cognitive behavioural group therapy (CBGT) for social anxiety disorder: immediate and long-term benefits. The Cognitive Behaviour Therapist, 6, 1–13. doi: 10.1017/S1754470X13000111 CrossRefGoogle Scholar
McEvoy, P. M. (2007). Effectiveness of cognitive behavioural group therapy for social phobia in a community clinic: a benchmarking study. Behaviour Research and Therapy, 45, 30–40. doi: 10.1016/j.brat.2007.08.002 CrossRefGoogle Scholar
McEvoy, P. M., Erceg-Hurn, D. M., Saulsman, L. M. and Thibodeau, M. A. (2015). Imagery enhancements increase the effectiveness of cognitive behavioural group therapy for social anxiety disorder: a benchmarking study. Behaviour Research and Therapy, 65, 42–51. doi: 10.1016/j.brat.2014.12.011 CrossRefGoogle ScholarPubMed
McEvoy, P. M., Nathan, P., Rapee, R. M. and Campbell, B. C. (2012). Cognitive behavioural group therapy for social phobia: evidence of transportability to community clinics. Behaviour Research and Therapy, 50, 258–265. doi: 10.1016/j.brat.2012.01.009 CrossRefGoogle ScholarPubMed
McEvoy, P. M. and Saulsman, L. M. (2014). Imagery-enhanced cognitive behavioural group therapy for social anxiety disorder: a pilot study. Behaviour Research and Therapy, 55, 1–6. doi: 10.1016/j.brat.2014.01.006 CrossRefGoogle ScholarPubMed
Mein, G., Johal, S., Grant, R., Seale, C., Ashcroft, R. and Tinker, A. (2012). Predictors of two forms of attrition in a longitudinal health study involving ageing participants: an analysis based on the Whitehall II study. BMC Medical Research Methodology, 12, 164. doi: 10.1186/1471-2288-12-164 CrossRefGoogle Scholar
National Institute for Health and Care Excellence (NICE) (2013). Social anxiety disorder: recognition, assessment and treatment, NICE Clinical Guideline [CG159]; available at: https://www.nice.org.uk/Guidance/CG159 Google Scholar
Oei, T. S. and Boschen, M. J. (2009). Clinical effectiveness of a group treatment for anxiety disorders: a benchmarking study. Journal of Anxiety Disorders, 23, 950–957. doi: 10.1016/j.janxdis.2009.06.004.CrossRefGoogle ScholarPubMed
Patel, A., Knapp, M., Henderson, J. and Baldwin, D. (2002). The economic consequences of social phobia. Journal of Affective Disorders, 68, 221–233.CrossRefGoogle ScholarPubMed
Powers, M. B., Sigmarsson, S. and Emmelkamp, P. G. (2008). A meta-analytic review of psychological treatments for social anxiety disorder. International Journal of Cognitive Therapy, 12, 94–113. doi: 10.1521/ijct.2008.1.2.94 CrossRefGoogle Scholar
Sato, H. and Kawahara, J. (2011). Selective bias in retrospective self-reports of negative mood states. Anxiety Stress and Coping, 24, 359–367. doi: 10.1080/10615806.2010543132 See comment in PubMed Commons belowCrossRefGoogle Scholar
Shingleton, R. M., Richards, L. K. and Thompson-Brenner, H. (2013). Using technology within the treatment of eating disorders: a clinical practice review. Psychotherapy (Chic), 50, 576–582. doi: 10.1037/a0031815 CrossRefGoogle ScholarPubMed
Smits, J. J., Minhajuddin, A. and Jarrett, R. B. (2009). Cognitive therapy for depressed adults with comorbid social phobia. Journal of Affective Disorders, 114, 271–278. doi: 10.1016/j.jad.2008.08.008 CrossRefGoogle ScholarPubMed
Stein, M. D. and Kean, Y. M. (2000). Disability and quality of life in social phobia: epidemiologic findings. American Journal of Psychiatry, 157, 1606–1613. doi: 10.1176/appi.ajp.157.10.1606 CrossRefGoogle ScholarPubMed
Taylor, S. (1996). Meta-analysis of cognitive-behavioral treatments for social phobia. Journal of Behavior Therapy and Experimental Psychiatry, 27, 1–9.CrossRefGoogle ScholarPubMed
Watanabe, N., Furukawa, T. A., Chen, J., Kinoshita, Y., Nakano, Y. Ogawa, S., et al. (2010). Change in quality of life and their predictors in the long-term follow-up after group cognitive behavioral therapy for social anxiety disorder: a prospective cohort study. BioMed Central Psychiatry, 10, 81. doi: 10.1186/1471-244X-10-81 CrossRefGoogle ScholarPubMed
Wersebe, H., Sijbrandij, M. and Cuijpers, P. (2013). Psychological group-treatments of social anxiety disorder: a meta-analysis. PLoS One, 8, e79034; available at: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0079034 CrossRefGoogle ScholarPubMed
Wittchen, H. U. and Fehm, L. (2003). Epidemiology and natural course of social fears and social phobia. Acta Psychiatrica Scandinavica, 108, 4–18. doi: 10.1034/j.1600-0447.108.s417.1.x CrossRefGoogle Scholar
Worrall, H., Schweizer, R., Marks, E., Yuan, L., Lloyd, C. and Ramjan, R. (2018). The effectiveness of support groups: a literature review. Mental Health and Social Inclusion, 22, 85–93. doi: 10.1108/MHSI-12-2017-0055 CrossRefGoogle Scholar
Wunderlich, U., Bronisch, T. and Wittchen, H. U. (1998). Comorbidity patterns in adolescents and young adults with suicide attempts. European Archives of Psychiatry and Clinical Neuroscience, 248, 87–95. doi: 10.1007/s004060050023 CrossRefGoogle Scholar
Yalom, I. D. (1995). The Theory and Practice of Group Psychotherapy, 5th edn. New York, USA: Basic Books.Google Scholar
Submit a response

Comments

No Comments have been published for this article.