title: Trajectories of change in emotion regulation and social anxiety during cognitive-behavioral therapy for social anxiety disorder.
abstract: Cognitive-behavioral therapy (CBT) for social anxiety disorder (SAD) may decrease social anxiety by training emotion regulation skills. This randomized controlled trial of CBT for SAD examined changes in weekly frequency and success of cognitive reappraisal and expressive suppression, as well as weekly intensity of social anxiety among patients receiving 16 weekly sessions of individual CBT. We expected these variables to (1) differ from pre-to-post-CBT vs. Waitlist, (2) have differential trajectories during CBT, and (3) covary during CBT. We also expected that weekly changes in emotion regulation would predict (4) subsequent weekly changes in social anxiety, and (5) changes in social anxiety both during and post-CBT. Compared to Waitlist, CBT increased cognitive reappraisal frequency and success, decreased social anxiety, but had no impact on expressive suppression. During CBT, weekly cognitive reappraisal frequency and success increased, whereas weekly expressive suppression frequency and social anxiety decreased. Weekly decreases in social anxiety were associated with concurrent increases in reappraisal success and decreases in suppression frequency. Granger causality analysis showed that only reappraisal success increases predicted decreases in subsequent social anxiety during CBT. Reappraisal success increases pre-to-post-CBT predicted reductions in social anxiety symptom severity post-CBT. The trajectory of weekly changes in emotion regulation strategies may help clinicians understand whether CBT is effective and predict decreases in social anxiety.
  
  
  BACKGROUND
  NCT00380731; http://www.clinicaltrials.gov/ct2/show/NCT00380731?term=social+anxiety+cognitive+behavioral+therapy+Stanford&rank=1.
authors.affiliation: Stanford University, Department of Psychology, Jordan Hall, Building 420, Stanford, CA 94305-2130, USA. Electronic address: pgoldin@stanford.edu.
authors.forename: Philippe R
authors.initials: PR
authors.lastname: Goldin
authors.affiliation: Stanford University, Department of Psychology, Jordan Hall, Building 420, Stanford, CA 94305-2130, USA.
authors.forename: Ihno
authors.initials: I
authors.lastname: Lee
authors.affiliation: Stanford University, Department of Psychology, Jordan Hall, Building 420, Stanford, CA 94305-2130, USA.
authors.forename: Michal
authors.initials: M
authors.lastname: Ziv
authors.affiliation: Stanford University, Department of Psychology, Jordan Hall, Building 420, Stanford, CA 94305-2130, USA.
authors.forename: Hooria
authors.initials: H
authors.lastname: Jazaieri
authors.affiliation: Temple University, Department of Psychology, Weiss Hall, 1701 North 13th Street, Philadelphia, PA 19122, USA.
authors.forename: Richard G
authors.initials: RG
authors.lastname: Heimberg
authors.affiliation: Stanford University, Department of Psychology, Jordan Hall, Building 420, Stanford, CA 94305-2130, USA.
authors.forename: James J
authors.initials: JJ
authors.lastname: Gross
mesh_terms: D001008:Anxiety Disorders / Q000523:psychology* / Q000628:therapy*; D003071:Cognition; D015928:Cognitive Behavioral Therapy; D004644:Emotions; D006801:Humans; D012094:Repression, Psychology; D063189:Symptom Assessment; D013997:Time Factors
keywords: CBT; Emotion regulation; Reappraisal; Social anxiety; Suppression; Trajectory of change