(PS5-A6) Cognitive Reappraisal, Acceptance and Self-compassion as Predictors of Treatment Outcome in Cognitive Behavioral Group Therapy for Social Anxiety Disorder

Cognitive reappraisal (CR) is considered to be a central mechanism through which cognitive-behavioral therapy leads to reductions in social anxiety. However, findings from studies examining this association are inconsistent. Some studies indicate that greater engagement in CR is not always associated with lower levels of social anxiety. Furthermore, CR may prove to be a challenging treatment target for socially anxious individuals, particularly for those with low self-efficacy. Given this, the current study evaluated CR, as well as two additional forms of emotion regulation – self-compassion and acceptance – as predictors of treatment outcome (i.e., improvements in social anxiety).

The final sample comprised 78 individuals with social anxiety disorder, who completed pre- and post-treatment assessments of social anxiety symptoms (Liebowitz Social Anxiety Scale-Self Report), CR (Emotion Regulation Questionnaire), acceptance (Acceptance and Action Questionnaire), and self-compassion (Self-Compassion Scale-Short Form). All participants completed 12 weekly sessions of Cognitive Behavioral Group Therapy, which involved psychoeducation, cognitive restructuring and in-session exposure exercises.

Residualized change scores were calculated for pre- and post-treatment social anxiety symptom severity, CR, self-compassion and acceptance. A hierarchical linear regression was conducted to test the hypothesis that changes in endorsed levels of acceptance and self-compassion predict improvements in social anxiety, while controlling for changes in CR. Change in CR was entered at stage one, and acceptance and self-compassion were entered at stage two of the regression model.

At stage one, CR significantly predicted improvements in social anxiety (p = .015). The addition of acceptance and self-compassion both contributed significantly to the prediction of improvements in social anxiety, while controlling for CR. At stage two, CR failed to significantly predict improvements in social anxiety (p = .621), while acceptance (p = .012) and self-compassion (p = .034) emerged as significant predictors.

The current results provide further insight into the inconsistent findings in literature exploring the utility of CR as a treatment target for social anxiety. Our findings provide preliminary support for alternate emotion regulation skills (acceptance and self-compassion) that contribute to symptom change in CBT. It may be that changing one’s relation to thoughts, rather than reappraising thoughts, is more effective in promoting symptom change. Thus, our findings also supports the integration of therapeutic strategies that specifically target self-compassion and acceptance in cognitive-behavioral therapies.