Abstract
The goal in (Heimberg, R. G. (1991). A manual for conducting Cognitive Behavior Group Therapy for social phobia (2nd ed), Unpublished manuscript) cognitive behavioral group therapy (CBGT) for social anxiety disorder (social phobia) is to challenge irrational automatic thoughts and create exposures to provide disconfirming evidence for these irrational thoughts as well as habituation to fearful stimuli. Yet little is know about the types of thoughts reported by socially anxious individuals in therapy or which thoughts therapists select for cognitive restructuring in CBGT sessions. The present study analyzed the semantic content of automatic thoughts reported in CBGT and found that the most common thoughts related to poor social performance, negative labels by others, and the anticipation of negative outcomes in feared situations. Principle components analyses indicated the automatic thoughts reflected three underlying themes: Experiencing Anxiety, Negative Self-Evaluation, and Fear of Negative Evaluation. The paper also describes exploratory analyses of which thoughts became the focus of cognitive restructuring exercises and their relationship to treatment outcome. Implications for cognitive therapy are also discussed.
Similar content being viewed by others
Notes
Ethnicity is not assessed on the ADIS-R. Unfortunately, ethnicity is not available for these clients
Although portions of this study were conducted before the publication of DSM-IV (American Psychiatric Association, 1994), these participants would have met diagnostic criteria for social phobia under DSM-IV.
References
American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (4th ed). Washington, DC: Author.
Beck, A. T. (1976). Cognitive therapy and the emotional disorders. New York: International Universities Press.
Beck, A. T., & Emery, G. (1985). Anxiety disorders and phobias: A cognitive perspective. New York: Basic Books.
DiNardo, P. A., Barlow, D. H., Cerny, J., Vermilyea, B. B., Vermilyea, J. A., Himadi, W., & Waddell, M. (1985). Anxiety disorders interview schedule - revised (ADIS - R). Albany, NY: Phobia and Anxiety Disorders Clinic, State University of New York at Albany.
Heimberg, R. G., & Becker, R. E. (2002). Nature and treatment of social fears and phobias. New York: Guilford Press.
Heimberg, R. G., Dodge, C. S., Hope, D. A., Kennedy, C. R., Zollo, L., & Becker, R. E. (1990). Cognitive-behavioral group treatment for social phobia: Comparison to a credible placebo control. Cognitive Therapy and Research, 14, 1–23.
Heimberg, R. G., Salzman, D. G., Holt, C. S., Blendell, K. A. (1993). Cognitive behavioral group treatment for social phobia: Effectiveness at five-year follow-up. Cognitive Therapy and Research, 17, 325–339.
Heimberg, R. G., Liebowitz, M. R., Hope, D. A., Schneier, F. R., Holt, C. S., Welkowitz, L. A., Juster, H. R., Campeas, R., Bruch, M. A., Cloitre, M., Fallon, B., & Klein, D. F. (1998). Cognitive behavioral group therapy vs. phenelzine therapy for social phobia. Archives of General Psychiatry, 55, 1133–1141.
Hofmann S., & DiBartolo, P. (2000). From social anxiety to social phobia: multiple perspectives. Boston: Allyn & Bacon.
Hope, D. A., Herbert, J. D., & White, C. (1995). Diagnostic subtype, avoidant personality disorder, and efficacy of cognitive behavioral group therapy for social phobia. Cognitive Therapy and Research, 19, 285–303.
Hope, D. A., Heimberg, R. G., & Bruch, M. A. (1995). Dismantling cognitive-behavioral group therapy for social phobia. Behaviour Research and Therapy, 33, 1–14.
Liebowitz, M. R., Gorman, J. M., Fyer, A. J., & Klein, D. F. (1985). Social phobia: Review of a neglected anxiety disorder. Archives of General Psychiatry, 42, 729–736.
Liebowitz, M. R., Heimberg, R. G., Schneier, F. R., Hope, D. A., Davies, S., Holt, C. S., Goetz, D., Juster, H. R., Lin, S. H., Bruch, M. A., Marshall, R. D., & Klein, D. F. (1999). Cognitive-behavioral group therapy versus phenelzine in social phobia: Long-term outcome. Depression and Anxiety 10, 89–98.
Lucas, R. A. & Telch, M. J. (1993, November). Group versus individual treatment of social phobia. Paper presented at the annual meeting of the Association for the Advancement of Behavior Therapy, Atlanta, GA.
Mathews, A., & MacLeod, C. (1985). Selective processing of threat cues in anxiety states. Behaviour Therapy and Research, 18, 249–258.
Persons, J. B. (1989). Cognitive-behavioral therapy: A case formulation approach. New York: Norton.
Spitzer, R. L., Williams, J. B. W., Gibbon, M., & First, M. B. (1992). The structured clinical interview for DSM III-R (SCID): I. History, rationale, and description. Archives of General Psychiatry, 49, 624–629.
Stopa, L., & Clark, D. M. (1993). Cognitive processes in social phobia. Behaviour Research and Therapy, 31, 255–267.
Weilage, M. E., & Hope, D. A. (1999). Self-discrepant cognitions in social phobia and dysthymia. Cognitive Therapy and Research, 23, 637–650.
Zuercher-White, E. (1997). Treating panic disorder and agoraphobia: A step by step clinicalguide. Oakland: New Harbinger Publications, Inc.
Acknowledgements
The authors would like to thank Robin L. Treptow, Eileen Wade, and various research assistants for their assistance with coding and Alan Bellack for providing research assistant support. This study was supported in part by grant # MH48751 from the National Institute of Mental Health to the first author. Portions of this paper were presented at the presented at the 1995 annual meeting of the Association for the Advancement of Behavior Therapy, Washington DC.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hope, D.A., Burns, J.A., Hayes, S.A. et al. Automatic Thoughts and Cognitive Restructuring in Cognitive Behavioral Group Therapy for Social Anxiety Disorder. Cogn Ther Res 34, 1–12 (2010). https://doi.org/10.1007/s10608-007-9147-9
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10608-007-9147-9