Self-related constructs in cognitive behavioural treatment for social anxiety disorder

Despite the efficacy of cognitive-behavioural therapy (CBT) for social anxiety disorder (SAD), many patients remain symptomatic following treatment. More research is therefore needed to uncover active change mechanisms that govern anxiety reduction to help optimise CBT outcomes. The program of research undertaken in this thesis addresses whether self-related constructs change during and/or following CBT for SAD and how change in these variables relate to treatment outcome. The first two papers employ a review methodology and investigate the current state of the theoretical (Paper One) and empirical (Paper Two) literature in this area. Overall, these papers underscore the importance of self-related constructs (e.g., maladaptive self-beliefs, self-focused attention) in cognitive models and CBT for SAD, and indicate that these constructs change during and following treatment intervention. Change in these variables also predict and/or mediate treatment response; however, relatively few studies have examined this in the literature. The empirical papers build on the findings and future research suggestions generated from the review papers. Paper Three finds that while self-esteem is the strongest unique statistical predictor of depression scores in a non-clinical sample, maladaptive self-beliefs are the strongest unique statistical predictor of social anxiety scores. Paper Four permits inferences about the temporal sequence of change processes in therapy, and suggests that change in maladaptive self-beliefs predicts later change in social anxiety (but not vice versa). Paper Five indicates that while both the implicit and explicit anxiety self-concept change from pre- to post-CBT, they may function independently in treatment. Finally, Paper Six shows that pre- to post-treatment change in self-structure, as measured by self-concept clarity, is associated with both treatment outcome and change in self-related content. Taken together, these findings underscore the importance of modifying a negative self in CBT for SAD and extend the broader fields of the self, psychopathology, and CBT literature.