title: Randomized controlled trial of cognitive behavioral therapy and acceptance and commitment therapy for social phobia: outcomes and moderators.
abstract: OBJECTIVE
  Cognitive behavioral therapy (CBT) is an empirically supported treatment for social phobia. However, not all individuals respond to treatment and many who show improvement do not maintain their gains over the long-term. Thus, alternative treatments are needed.
  
  
  METHODS
  The current study (N = 87) was a 3-arm randomized clinical trial comparing CBT, acceptance and commitment therapy (ACT), and a wait-list control group (WL) in participants with a diagnosis of social phobia based on criteria of the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994). Participants completed 12 sessions of CBT or ACT or a 12-week waiting period. All participants completed assessments at baseline and posttreatment, and participants assigned to CBT and ACT also completed assessments 6 and 12 months following baseline. Assessments consisted of self-report measures, a public-speaking task, and clinician ratings.
  
  
  RESULTS
  Multilevel modeling was used to examine between-group differences on outcomes measures. Both treatment groups outperformed WL, with no differences observed between CBT and ACT on self-report, independent clinician, or public-speaking outcomes. Lower self-reported psychological flexibility at baseline was associated with greater improvement by the 12-month follow-up in CBT compared with ACT. Self-reported fear of negative evaluation significantly moderated outcomes as well, with trends for both extremes to be associated with superior outcomes from CBT and inferior outcomes from ACT. Across treatment groups, higher perceived control and extraversion were associated with greater improvement, whereas comorbid depression was associated with poorer outcomes.
  
  
  CONCLUSIONS
  Implications for clinical practice and future research are discussed.
authors.affiliation: Department of Psychology.
authors.forename: Michelle G
authors.initials: MG
authors.lastname: Craske
authors.affiliation: Department of Psychology.
authors.forename: Andrea N
authors.initials: AN
authors.lastname: Niles
authors.affiliation: Department of Psychology.
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Burklund
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Southern California.
authors.forename: Kate B
authors.initials: KB
authors.lastname: Wolitzky-Taylor
authors.affiliation: Veterans Affairs Puget Sound Health Care System-Seattle Division.
authors.forename: Jennifer C Plumb
authors.initials: JC
authors.lastname: Vilardaga
authors.affiliation: Department of Psychology, University of Colorado at Boulder.
authors.forename: Joanna J
authors.initials: JJ
authors.lastname: Arch
authors.affiliation: Department of Psychology, University of Southern California.
authors.forename: Darby E
authors.initials: DE
authors.lastname: Saxbe
authors.affiliation: Department of Psychology.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Lieberman
mesh_terms: D064869:Acceptance and Commitment Therapy; D000328:Adult; D015928:Cognitive Behavioral Therapy; D015897:Comorbidity; D003863:Depression / Q000150:complications / Q000628:therapy; D004522:Educational Status; D005239:Fear; D005260:Female; D006801:Humans; D008297:Male; D017533:Marital Status; D010551:Personality; D010698:Phobic Disorders / Q000150:complications / Q000523:psychology / Q000628:therapy*; D011788:Quality of Life; D057566:Self Report; D012720:Severity of Illness Index; D013060:Speech; D016896:Treatment Outcome; D014850:Waiting Lists