Change Processes in Cognitive Therapy for Social Anxiety Disorder Delivered in Routine Clinical Practice

Authors

  • Graham R. Thew Orcid
    Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom; Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom; Oxford Health NHS Foundation Trust, Oxford, United Kingdom
  • Anke Ehlers
    Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom; Oxford Health NHS Foundation Trust, Oxford, United Kingdom; Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom; National Institute for Health Research Mental Health Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, United Kingdom
  • Nick Grey
    Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom; National Institute for Health Research Mental Health Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, United Kingdom; Sussex Partnership NHS Foundation Trust, Worthing, United Kingdom
  • Jennifer Wild
    Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom; Oxford Health NHS Foundation Trust, Oxford, United Kingdom
  • Emma Warnock-Parkes
    Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom; Oxford Health NHS Foundation Trust, Oxford, United Kingdom; Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom; National Institute for Health Research Mental Health Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, United Kingdom
  • Rachelle L. Dawson
    Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
  • David M. Clark
    Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom; Oxford Health NHS Foundation Trust, Oxford, United Kingdom; Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom; National Institute for Health Research Mental Health Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, United Kingdom

Abstract

Background: Most studies examining processes of change in psychological therapy for social anxiety disorder (SAD) have analysed data from randomised controlled trials in research settings.
Method: To assess whether these findings are representative of routine clinical practice, we analysed audit data from two samples of patients who received Cognitive Therapy for SAD (total N = 271). Three process variables (self-focused attention, negative social cognitions, and depressed mood) were examined using multilevel structural equation models.
Results: Significant indirect effects were observed for all three variables in both samples, with negative social cognitions showing the strongest percent mediation effect. ‘Reversed’ relationships, where social anxiety predicted subsequent process variable scores, were also supported.
Conclusion: The findings suggest the processes of change in this treatment may be similar between research trials and routine care.