title: Baseline Patient Characteristics Predicting Outcome and Attrition in Cognitive Therapy for Social Phobia: Results from a Large Multicentre Trial.
abstract: We examined the role of baseline patient characteristics as predictors of outcome (end-state functioning, response and remission) and attrition for cognitive therapy (CT) in social anxiety disorder (SAD). Beyond socio-demographic and clinical variables such as symptom severity and comorbidity status, previously neglected patient characteristics (e.g., personality, self-esteem, shame, interpersonal problems and attachment style) were analysed.
  
  
  METHODS
  Data came from the CT arm of a multicentre RCT with n = 244 patients having DSM-IV SAD. CT was conducted according to the manual by Clark and Wells. Severity of SAD was assessed at baseline and end of treatment with the Liebowitz Social Anxiety Scale (LSAS). Multiple linear regression analyses and logistic regression analyses were applied.
  
  
  RESULTS
  Up to 37% of the post-treatment variance (LSAS) could be explained by all pre-treatment variables combined. Symptom severity (baseline LSAS) was consistently negatively associated with end-state functioning and remission, but not with response. Number of comorbid diagnoses was negatively associated with end-state functioning and response, but not with remission. Self-esteem was positively associated with higher end-state functioning and more shame with better response. Attrition could not be significantly predicted.
  
  
  CONCLUSIONS
  The results indicate that the initial probability for treatment success mainly depends on severity of disorder and comorbid conditions while other psychological variables are of minor importance, at least on a nomothetic level. This stands in contrast with efforts to arrive at an empirical-based foundation for differential indication and argues to search for more potent moderators of therapeutic change rather on the process level.
  
  
  CONCLUSIONS
  Personality, self-esteem, shame, attachment style and interpersonal problems do not or only marginally moderate the effects of interventions in CT of social phobia. Symptom severity and comorbid diagnoses might affect treatment outcome negatively. Beyond these two factors, most patients share a similar likelihood of treatment success when treated according to the manual by Clark and Wells. Copyright © 2014 John Wiley & Sons, Ltd.
authors.affiliation: Clinical Psychology and Psychotherapy, Technische Universitaet Dresden, Dresden, Germany.
authors.forename: Juergen
authors.initials: J
authors.lastname: Hoyer
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany.
authors.forename: Joerg
authors.initials: J
authors.lastname: Wiltink
authors.affiliation: Clinical Psychology and Psychotherapy, Johannes Gutenberg University Mainz, Mainz, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Hiller
authors.affiliation: Clinical Psychology and Psychotherapy, Technische Universitaet Dresden, Dresden, Germany.
authors.forename: Robert
authors.identifier: http://orcid.org/0000-0002-8665-5248
authors.initials: R
authors.lastname: Miller
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University Medicine, Georg-August University Goettingen, Goettingen, Germany.
authors.forename: Simone
authors.initials: S
authors.lastname: Salzer
authors.affiliation: Clinical Psychology and Psychotherapy, Technische Universitaet Dresden, Dresden, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Sarnowsky
authors.affiliation: Clinical Psychology and Psychotherapy, Goethe University Frankfurt, Frankfurt, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Stangier
authors.affiliation: Institute of Psychosocial Medicine and Psychotherapy, Jena University Hospital, Jena, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Strauss
authors.affiliation: Clinical Psychology and Psychotherapy, Ruhr University Bochum, Bochum, Germany.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Willutzki
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University Medicine, Georg-August University Goettingen, Goettingen, Germany.
authors.forename: Eric
authors.initials: E
authors.lastname: Leibing
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D010698:Phobic Disorders / Q000523:psychology* / Q000628:therapy*; D012649:Self Concept; D012720:Severity of Illness Index; D012752:Shame; D012959:Socioeconomic Factors; D016896:Treatment Outcome
keywords: CBT; Comorbidity; Interpersonal Problems; Predictors; Social Phobia; Treatment Outcome