Efficacy of transdiagnostic cognitive-behavioral therapy for assertiveness: A randomized controlled trial

Area of Science:

• Psychology
• Clinical Psychology
• Behavioral Therapy

Background:

• Assertiveness training is a key component of cognitive-behavioral therapy (CBT), used in treating social anxiety and dialectical behavioral therapy.
• The construct of assertiveness has received limited attention in recent clinical research.
• Internet-based interventions offer scalable solutions for mental health treatment.

Purpose of the Study:

• To investigate the efficacy of an eight-week, transdiagnostic, internet-based CBT intervention designed to enhance assertive behavior.
• To compare therapist-guided self-help, unguided self-help, and wait-list control conditions.
• To assess outcomes at post-treatment and one-year follow-up.

Main Methods:

• Randomized 210 participants into therapist-guided, unguided, and wait-list control groups.
• Utilized a linear mixed model for analysis of primary (assertiveness) and secondary (anxiety, depression, well-being) outcomes.
• Assessed reliable clinical change at post-test and one-year follow-up.

Main Results:

• Both internet-based CBT groups showed significant improvements in adaptive assertiveness compared to the wait-list control (ES = 0.95–1.73).
• Participants experienced reductions in social anxiety (ES = 0.67–0.93) and improvements in well-being (ES = 0.70–1.05).
• A medium effect on depression was observed one year post-treatment; no effects on generalized anxiety were found.

Conclusions:

• Assertiveness training via internet-based CBT is effective in increasing assertive behavior and reducing psychological symptoms.
• The intervention demonstrates potential as a transdiagnostic approach for improving mental health and daily functioning.
• Both therapist-guided and unguided self-help formats yielded comparable positive outcomes.