title: Cognitive mediators of treatment for social anxiety disorder: comparing acceptance and commitment therapy and cognitive-behavioral therapy.
abstract: OBJECTIVE
  To assess the relationship between session-by-session mediators and treatment outcomes in traditional cognitive-behavioral therapy (CBT) and acceptance and commitment therapy (ACT) for social anxiety disorder.
  
  
  METHODS
  Session-by-session changes in negative cognitions (a theorized mediator of CBT) and experiential avoidance (a theorized mediator of ACT) were assessed in 50 adult outpatients randomized to CBT (n=25) or ACT (n=25) for DSM-IV social anxiety disorder.
  
  
  RESULTS
  Multilevel modeling analyses revealed significant nonlinear decreases in the proposed mediators in both treatments, with ACT showing steeper decline than CBT at the beginning of treatment and CBT showing steeper decline than ACT at the end of treatment. Curvature (or the nonlinear effect) of experiential avoidance during treatment significantly mediated posttreatment social anxiety symptoms and anhedonic depression in ACT, but not in CBT, with steeper decline of the Acceptance and Action Questionnaire at the beginning of treatment predicting fewer symptoms in ACT only. Curvature of negative cognitions during both treatments predicted outcome, with steeper decline of negative cognitions at the beginning of treatment predicting lower posttreatment social anxiety and depressive symptoms.
  
  
  CONCLUSIONS
  Rate of change in negative cognitions at the beginning of treatment is an important predictor of change across both ACT and CBT, whereas rate of change in experiential avoidance at the beginning of treatment is a mechanism specific to ACT.
authors.affiliation: University of California, Los Angeles.
authors.forename: Andrea N
authors.initials: AN
authors.lastname: Niles
authors.affiliation: University of California, Los Angeles.
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Burklund
authors.affiliation: University of California, Los Angeles.
authors.forename: Joanna J
authors.initials: JJ
authors.lastname: Arch
authors.affiliation: University of California, Los Angeles.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Lieberman
authors.affiliation: University of California, Los Angeles.
authors.forename: Darby
authors.initials: D
authors.lastname: Saxbe
authors.affiliation: University of California, Los Angeles. Electronic address: craske@psych.ucla.edu.
authors.forename: Michelle G
authors.initials: MG
authors.lastname: Craske
mesh_terms: D064869:Acceptance and Commitment Therapy / Q000379:methods*; D000293:Adolescent; D000328:Adult; D001007:Anxiety / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D003071:Cognition / Q000502:physiology*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011788:Quality of Life; D012918:Social Alienation / Q000523:psychology*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult
keywords: acceptance and commitment therapy; cognitive-behavioral therapy; social anxiety disorder; treatment mechanism; treatment mediator