Changes in Positive Self-Views Mediate the Effect of Cognitive-Behavioral Therapy for Social Anxiety Disorder

Social Anxiety Disorder (SAD) is thought to be characterized by maladaptive self-views. This study investigated whether (1) patients with SAD (n=75) differ at baseline from healthy controls (HC; n=43) in negative and positive self-views, (2) Cognitive-Behavioral Therapy (CBT) for SAD vs. waitlist control (WL) produces statistically and clinically significant changes in negative and positive self-views, (3) changes in self-views mediate the effect of CBT on social anxiety symptoms, and (4) changes in self-views during CBT related to social anxiety symptoms at 1-year post-CBT. As expected, patients endorsed more negative and fewer positive self-views than HC at baseline. Compared to WL, CBT yielded statistically and clinically significant changes, specifically, fewer negative and more positive self-views. Mediational analysis indicated that increased positive (but not reduced negative) self-views mediated the effect of CBT on social anxiety reduction. Correlational analyses determined that increased positive self-views were associated with social anxiety symptom reduction at 1-year-post-CBT.