The link between social anxiety disorder, treatment outcome, and sleep difficulties among patients receiving cognitive behavioral group therapy.
OBJECTIVE
The aim of our study was to examine the association between sleep disturbances and social anxiety disorder (SAD). Another aim was to explore the impact of cognitive behavioral group therapy (CBGT) for SAD on co-occurring sleep difficulties.


METHODS
Data were obtained retrospectively from patient files receiving CBGT for SAD. The sample included 63 patients with SAD (mean age, 30.42 years [standard deviation, 6.92 years]). There were 41 men and 22 women, of whom 41 participants completed the treatment protocol. Before treatment onset participants completed the Liebowitz Social Anxiety Scale (LSAS), the Beck Depression Inventory (BDI), the Pittsburgh Sleep Quality Index, and several sociodemographic questions. On completion of the treatment protocol, the same measures were completed, with the addition of the Sheehan Disabilities Scale (SDS).


RESULTS
The results of our study suggest that: (1) subjective insomnia is associated with SAD severity even after controlling for depression severity and additional variables; (2) participants with SAD with co-occurring clinical levels of subjective insomnia present a more severe clinical picture both at treatment onset and termination; and (3) although CBGT lead to reduction in SAD and depression symptoms severity, it had no significant impact on co-occurring sleep difficulties.


CONCLUSIONS
Sleep difficulties predict SAD severity regardless of depressive symptoms and may be linked to a more severe clinical picture. Clinicians should be aware of these sleep difficulties co-occurring with SAD and consider implementing specific sleep interventions. Future studies should incorporate larger samples sizes from clinical populations outside of Israel.
The Child Psychiatry Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel. Electronic address: yonikushnir@gmail.com.
Jonathan
J
Kushnir
Anxiety Disorders and Behavior Therapy Unit, Outpatient Department, Geha Mental Health Center, Tel-Aviv University, Tel-Aviv, Israel.
Sofi
S
Marom
Anxiety Disorders and Behavior Therapy Unit, Outpatient Department, Geha Mental Health Center, Tel-Aviv University, Tel-Aviv, Israel.
Mika
M
Mazar
The School of Psychological Sciences, Tel-Aviv University, Israel.
Avi
A
Sadeh
Anxiety Disorders and Behavior Therapy Unit, Outpatient Department, Geha Mental Health Center, Tel-Aviv University, Tel-Aviv, Israel.
Haggai
H
Hermesh
D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods; D003863:Depression / Q000150:complications; D005260:Female; D006801:Humans; D008297:Male; D010698:Phobic Disorders / Q000150:complications / Q000628:therapy*; D011569:Psychiatric Status Rating Scales; D011615:Psychotherapy, Group / Q000379:methods; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012893:Sleep Wake Disorders / Q000150:complications*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
Cognitive behavioral therapy; Depression; Insomnia; Sleep difficulties; Social anxiety disorder; Treatment outcome