Fear of negative and positive evaluation as mediators and moderators of treatment outcome in social anxiety disorder.
Study Goal
The researchers aimed to examine the mediating and moderating effects of fear of negative evaluation (FNE) and fear of positive evaluation (FPE) on social anxiety treatment outcomes, comparing cognitive behavioral therapy (CBT) and mindfulness-based stress reduction (MBSR).
Results Summary
Both CBT and MBSR reduced FNE and FPE more than waitlist, with CBT being more effective than MBSR in reducing FPE. FNE and FPE mediated treatment outcomes for both therapies, though CBT and MBSR were not differentially mediated by FPE in the longitudinal model. Higher baseline FNE and FPE predicted greater reductions in social anxiety during CBT.
Population
210 individuals with social anxiety disorder (SAD) from three randomized controlled trials.
Effective Dosage
Not specified
Duration
Pre- and post-treatment/waitlist assessments, with follow-up at three months for treatment groups.
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
individual cognitive behavioral therapy (CBT) | decrease | fear of negative evaluation (FNE) | individuals with social anxiety disorder (SAD) | - | led to greater reductions | #1 |
individual cognitive behavioral therapy (CBT) | decrease | fear of positive evaluation (FPE) | individuals with social anxiety disorder (SAD) | - | led to greater reductions | #2 |
group cognitive behavioral therapy (CBT) | decrease | fear of negative evaluation (FNE) | individuals with social anxiety disorder (SAD) | - | led to greater reductions | #3 |
group cognitive behavioral therapy (CBT) | decrease | fear of positive evaluation (FPE) | individuals with social anxiety disorder (SAD) | - | led to greater reductions | #4 |
community mindfulness-based stress reduction (MBSR) | decrease | fear of negative evaluation (FNE) | individuals with social anxiety disorder (SAD) | - | led to greater reductions | #5 |
community mindfulness-based stress reduction (MBSR) | decrease | fear of positive evaluation (FPE) | individuals with social anxiety disorder (SAD) | - | led to greater reductions | #6 |
group mindfulness-based stress reduction (MBSR) | decrease | fear of negative evaluation (FNE) | individuals with social anxiety disorder (SAD) | - | led to greater reductions | #7 |
group mindfulness-based stress reduction (MBSR) | decrease | fear of positive evaluation (FPE) | individuals with social anxiety disorder (SAD) | - | led to greater reductions | #8 |
cognitive behavioral therapy (CBT) | decrease | fear of positive evaluation (FPE) | individuals with social anxiety disorder (SAD) | - | more efficacious in reducing | #9 |
cognitive behavioral therapy (CBT) | decrease | post-treatment social anxiety | individuals with social anxiety disorder (SAD) | - | significant indirect effects | #10 |
mindfulness-based stress reduction (MBSR) | decrease | post-treatment social anxiety | individuals with social anxiety disorder (SAD) | - | significant indirect effects | #11 |
cognitive behavioral therapy (CBT) | decrease | social anxiety | individuals with social anxiety disorder (SAD) with higher baseline fear of negative evaluation (FNE) | - | greater reductions | #12 |
cognitive behavioral therapy (CBT) | decrease | social anxiety | individuals with social anxiety disorder (SAD) with higher baseline fear of positive evaluation (FPE) | - | greater reductions | #13 |
INTRODUCTION: Elevated fear of negative evaluation (FNE) and fear of positive evaluation (FPE) are thought to play key roles in the maintenance of social anxiety disorder (SAD). Although efficacious therapies exist for SAD, the potential mediating and moderating effects of FNE and FPE on social anxiety treatment outcome have not been examined. METHODS: This sample comprised a secondary analysis of 210 individuals who participated in one of three randomized controlled trials for the treatment of SAD. Participants were randomized to: individual cognitive behavioral therapy (CBT), group CBT, community mindfulness-based stress reduction (MBSR), group MBSR, or they were randomized to waitlist and offered treatment after waitlist. Assessments were completed pre- and post-treatment/waitlist and, for the treatment groups, at three-month follow-up. RESULTS: CBT and MBSR led to greater reductions in FNE and FPE than waitlist, with CBT more efficacious in reducing FPE than MBSR. For both CBT (vs. waitlist) and MBSR (vs. waitlist), there were significant indirect effects on post-treatment social anxiety through both FNE and FPE, and the indirect effect through FPE was greater for CBT than MBSR. However, in the fully longitudinal model testing mediation, CBT and MBSR were not differentially mediated by FPE. Baseline FNE and FPE each moderated CBT treatment outcome compared to waitlist - higher baseline FNE and FPE were associated with higher baseline social anxiety and greater reductions in social anxiety during CBT. DISCUSSION: FNE and FPE contributed in sometimes similar and sometimes distinct ways to the mediation and moderation of psychosocial approaches for treating SAD. This supports the importance of distinguishing between fears of negative and positive evaluation in the assessment and treatment of SAD.