Social well-being moderates behavioral therapy response for generalized anxiety disorder

Identifying moderators of treatment outcome for depression and anxiety offers promise for personalizing treatment or providing novel intervention targets. Indices of social well-being have emerged as candidate moderators due to their robust impact on mental health and quality of life. Here, we examine whether measures of social support, isolation, and loneliness moderate outcomes to behavioral activation (BA) and exposure-based therapy (EXP) for individuals with GAD.

This secondary analysis of a randomized clinical trial included 69 participants (31 EXP, 38 BA). Participants completed the GAD-7, along with NIH PROMIS (Depression; Social Isolation; and Emotional, Instrumental, and Informational Support) and NIH Toolbox (Friendship; Loneliness) scales. Regularized factor analysis identified two factors: social support and isolation/loneliness.

Social support (p < .001, η² = 0.19) and isolation/loneliness (p < .001, η² = 0.33) improved over time, regardless of treatment condition. Lower baseline social support related to more GAD-7 improvement to BA and less improvement to EXP (p = 0.030, d = 0.17). Greater baseline isolation/loneliness related to more PROMIS Depression improvement to BA and less improvement to EXP (p = 0.025, d = 0.17). Individuals reporting baseline isolation/loneliness ≥ 0.22 standard deviations above the sample mean exhibited no significant depression symptom reduction with EXP.

Measures of social well-being moderate treatment outcome to behavioral therapy for GAD, providing valuable information for personalized treatment. Results suggest, for individuals reporting low social support and/or high isolation and loneliness, exposure-based treatment outcomes may benefit from early or adjunctive intervention strategies targeting social well-being.