Abstract

Objectives

In cognitive behavioral therapy (CBT) for social anxiety disorder (SAD), avoidance behavior (AB) and cognitions (COG) are two important targets of intervention, but so far no studies have directly examined their relative importance. By means of cross-lagged panel models (CLPM), we examined their temporal associations and impacts on outcome in clients with symptoms of SAD while addressing typical methodological challenges.

Method

We used data from the first six therapy sessions in a sample of 428 primary care clients (mean [SD] age = 34.6 [12.2], 34.3% men), participating in the Prompt Mental Health Care trial. Session-by-session data was collected on AB, COG, depression and general anxiety. Competing multiple indicator CLPMs were tested.

Results

The Random Intercept-CLPM provided best fit, and indicated that AB predicted COG at subsequent time points (.39 ≤ β ≤ .42 for T2–T5, p < .05), but not vice versa. In addition, AB, but not COG, predicted clients’ general anxiety score at subsequent time points. Results were both robust to the inclusion of depressive symptoms as a within-level covariate, and sensitivity tests for stationarity and missing data assumptions.

Conclusion

Targeting avoidance behavior for primary care clients with symptoms of SAD may be more vital for the optimal effect of CBT than targeting cognitions. Methodological considerations and limitations of the study are discussed.

Trial registration: ClinicalTrials.gov identifier: NCT03238872.

中文翻译：

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探讨社交焦虑症患者在认知行为治疗过程中回避行为与认知之间的时间关联

摘要

目标

在社交焦虑症（SAD）的认知行为疗法（CBT）中，回避行为（AB）和认知（COG）是干预的两个重要目标，但迄今为止还没有研究直接检验它们的相对重要性。通过交叉滞后面板模型 (CLPM)，我们检查了它们的时间关联以及对具有 SAD 症状的客户的结果的影响，同时解决了典型的方法学挑战。

方法

我们使用了 428 名初级保健客户（平均 [SD] 年龄 = 34.6 [12.2]，34.3% 的男性）样本中前六次治疗的数据，这些客户参与了即时心理保健试验。逐次收集关于 AB、COG、抑郁和一般焦虑的数据。测试了多个竞争指标 CLPM。

结果

随机截距-CLPM 提供了最佳拟合，并表明 AB 在随后的时间点预测 COG（T2-T5 的 0.39 ≤  β ≤ .42，p < .05），但反之则不然。此外，AB 而非 COG 预测了客户在随后时间点的一般焦虑评分。结果对于将抑郁症状作为水平内协变量包括在内，以及对平稳性和缺失数据假设的敏感性测试都是稳健的。

结论

针对有 SAD 症状的初级保健客户的回避行为，对于 CBT 的最佳效果可能比针对认知更为重要。讨论了研究的方法学考虑和局限性。

试用注册： ClinicalTrials.gov 标识符：NCT03238872。