Fear of Negative Evaluation and Rapid Response to Treatment During Cognitive Behaviour Therapy for Social Anxiety Disorder

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Cognitive behavioural therapy (CBT) for Social Anxiety Disorder (SAD) is an effective intervention for SAD, however, many individuals with SAD remain symptomatic at the end of CBT. Therefore, it is important to understand variables that influence patients’ responses to treatment. The present study investigated temporal changes in SAD symptoms as related to fear of negative evaluation (FNE) in a clinical sample of individuals with SAD who completed CBT. Participants with SAD (N = 175) completed self-report measures of SAD symptoms and FNE weekly across 12 weeks of group CBT. We used latent difference score dynamic modelling to explore the relationship between SAD symptom scores and FNE during CBT. Reductions in FNE were associated with subsequent reductions in SAD symptoms for individuals who showed a rapid response to treatment. The coupling of FNE and subsequent reductions in SAD symptoms was not seen in individuals not showing a rapid response. This study provides further support for the phenomenon of rapid response in CBT for SAD and suggests that mechanisms of change may be different for rapid responders as compared to non-rapid responders. The results of the current study may have implications for understanding the mechanisms underlying treatment response during CBT for SAD and for whom particular mechanisms are relevant.

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Fig. 1


  1. 1.

    Each variable was evaluated for longitudinal measurement invariance. A confirmatory factor analysis (CFA) was first conducted for each measure. Measurement invariance was evaluated using the items retained in the CFAs. Weak longitudinal measurement invariance (i.e., equal factor loadings over time) was demonstrated for all measures before proceeding with the LDS analyses.


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Correspondence to Karen Auyeung.

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Karen Auyeung, Lance L. Hawley, Kevin Grimm, Randi McCabe, and Karen Rowa declares that there are no potential conflicts of interest

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Auyeung, K., Hawley, L.L., Grimm, K. et al. Fear of Negative Evaluation and Rapid Response to Treatment During Cognitive Behaviour Therapy for Social Anxiety Disorder. Cogn Ther Res (2020) doi:10.1007/s10608-020-10077-5

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  • Social anxiety
  • Cognitive behavior therapy
  • Fear of negative evaluation
  • Rapid response