title: Public speaking avoidance as a treatment moderator for social anxiety disorder.
abstract: OBJECTIVE
  Cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT) have both garnered empirical support for the effective treatment of social anxiety disorder. However, not every patient benefits equally from either treatment. Identifying moderators of treatment outcome can help to better understand which treatment is best suited for a particular patient.
  
  
  METHODS
  Forty-nine individuals who met criteria for social anxiety disorder were assessed as part of a randomized controlled trial comparing 12 weeks of CBT and ACT. Pre-treatment avoidance of social situations (measured via a public speaking task and clinician rating) was investigated as a moderator of post-treatment, 6-month follow-up, and 12-month follow-up social anxiety symptoms, stress reactivity, and quality of life.
  
  
  RESULTS
  Public speaking avoidance was found to be a robust moderator of outcome measures, with more avoidant individuals generally benefitting more from CBT than ACT by 12-month follow-up. In contrast, clinician-rated social avoidance was not found to be a significant moderator of any outcome measure.
  
  
  CONCLUSIONS
  Results were found only at 12-month follow-up. More comprehensive measures of avoidance would be useful for the field moving forward.
  
  
  CONCLUSIONS
  Findings inform personalized medicine, suggesting that social avoidance measured behaviorally via a public speaking task may be a more robust factor in treatment prescription compared to clinician-rated social avoidance.
authors.affiliation: University of California, Los Angeles, Department of Psychology, 405 Hilgard Avenue, Los Angeles, 90095-1563, CA, United States. Electronic address: bmesri@ucla.edu.
authors.forename: Bita
authors.initials: B
authors.lastname: Mesri
authors.affiliation: University of California, Los Angeles, Department of Psychology, 405 Hilgard Avenue, Los Angeles, 90095-1563, CA, United States. Electronic address: aniles@ucla.edu.
authors.forename: Andrea N
authors.initials: AN
authors.lastname: Niles
authors.affiliation: Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Str. 46, Dresden, D-01187, Germany. Electronic address: andre.pittig@tu-dresden.de.
authors.forename: Andre
authors.initials: A
authors.lastname: Pittig
authors.affiliation: University of California, Los Angeles, Department of Psychology, 405 Hilgard Avenue, Los Angeles, 90095-1563, CA, United States. Electronic address: rlebeau@ucla.edu.
authors.forename: Richard T
authors.initials: RT
authors.lastname: LeBeau
authors.affiliation: University of California, Los Angeles, Department of Psychology, 405 Hilgard Avenue, Los Angeles, 90095-1563, CA, United States. Electronic address: ethanhaik@ucla.edu.
authors.forename: Ethan
authors.initials: E
authors.lastname: Haik
authors.affiliation: University of California, Los Angeles, Department of Psychology, 405 Hilgard Avenue, Los Angeles, 90095-1563, CA, United States. 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; D001362:Avoidance Learning / Q000502:physiology; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005239:Fear / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D000072861:Phobia, Social / Q000523:psychology / Q000534:rehabilitation*; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D013060:Speech; D016896:Treatment Outcome; D055815:Young Adult
keywords: Acceptance and commitment therapy; Cognitive behavioral therapy; Moderator; Social anxiety; Treatment outcome