Recent Research Findings of Cognitive-Behavioural Therapy (CBT) for Social Anxiety Disorder

Social anxiety disorder is one of the most common anxiety disorders individuals experience, and it is associated with severe psychosocial impairment and high socio-economic costs. This disorder is frequently chronic, and is characterized by an unwarranted fear of being humiliated or embarrassed in social situations. There are both psychological and pharmacological treatment options that are effective in treating social anxiety disorder.

“[CBT] is proposed to reduce social anxiety by addressing and reconstructing distorted cognitions, teaching adaptive coping skills, anticipatory processing, and emotion management.”

One of the most well-known psychological treatments for anxiety disorders is cognitive-behavioural therapy. This form of therapy is proposed to reduce social anxiety by addressing and reconstructing distorted cognitions, teaching adaptive coping skills, anticipatory processing, and emotion management. Evidence generally suggests that cognitive-behavioural therapy is an effective treatment method for social anxiety disorder when sessions occur 1-2 times per week over a 4-12 week period (Herbert et al., 2009). To date, this form of treatment for social anxiety disorder has the strongest research support (Leichsenring et al., 2015).

Strengths of CBT for Social Anxiety

Evidence has shown that cognitive-behavioural therapy is effective in reducing symptoms of social anxiety disorder (Gingnell et al., 2016; Gregory & Peters, 2017).

The results of one study revealed significant reductions in social anxiety, perfectionism, and rumination in the cognitive-behavioural therapy group compared to the waitlist control group. However, the participants in this study were individuals with social anxiety who were seeking treatment, therefore the results may not be generalizable to those not seeking treatment (Abdollahi et al., 2019). Individuals not seeking treatment could be potentially less receptive to the treatment, and therefore experience less reductions in the symptoms investigated in this study. Future research should investigate the effect of cognitive-behavioural therapy on social anxiety, perfectionism, rumination, and other symptoms in individuals with social anxiety disorder who are not seeking treatment.

Cognitive-behavioural therapy has also shown to be effective in reducing dysfunctional interpersonal emotion regulation and avoidance behaviours associated with social anxiety disorder (Schmidt et al., 2012).

The results of another study provided further support; levels of interpersonal problems decreased significantly over the course of treatment. More specifically, improvements were evident in the cold/distant, vindictive/self-centered, socially inhibited, overly accommodating, and non-assertive domains of dysfunctional interpersonal patterns from pre-treatment to post-treatment. However, no differences were observed in the domineering/controlling, self-sacrificing, or intrusive/needy domains (Swee et al., 2021). This suggests that cognitive-behavioural therapy is efficacious in reducing most dysfunctional interpersonal patterns associated with social anxiety disorder, but not all.

Cognitive-behavioural therapy has also proven to be effective at maintaining large effect sizes for an average of 4.6 years following the termination of treatment. This study demonstrated that the maintenance of large effect sizes was also evident on measures of depression and anxiety. Furthermore, no relationship between length of time to follow-up and scores recorded at follow-up was found (Fogarty et al., 2019). This suggests that the beneficial effects of cognitive-behavioural therapy do not dissipate after the termination of treatment, but rather persist for several years. On the other hand, this study also found that less participants fell within the functional range at the follow-up assessment compared to the initial assessment. It is possible that this was due to other participant-related factors, for instance pre-treatment symptom severity (Fogarty et al., 2019).

Weaknesses of CBT for Social Anxiety

Despite the evidence in support of cognitive-behavioural therapy as an efficacious treatment for social anxiety disorder, evidence has also shown that up to 40% of patients do not report clinically significant improvements following treatment (Mortberg et al., 2007). This finding could be due to participant-related factors such as comorbid diagnoses, or treatment-related factors such as failure to complete homework assigned during therapy. Further research is needed to determine why some patients with social anxiety disorder do not experience significant improvements following cognitive-behavioural interventions, and how these factors can be addressed to improve treatment efficacy.

One primary weakness of cognitive-behavioural therapy is that it tends to result in a significantly worse treatment response in adolescents with social anxiety disorder (Hudson et al., 2015; Waters et al., 2018). This is has been hypothesized to be attributable to causal and maintaining factors of social anxiety disorder such as maladaptive thoughts about the self, attention biases, hypervigilance towards social threat, anticipatory anxiety, post-event rumination, and poor social skills and competence that are unaddressed in generic cognitive-behavioural therapy (Spence & Rapee, 2016). This suggests that it may be valuable to adapt a version of cognitive-behavioural therapy that is tailored to youth with social anxiety disorder, as this could result in an improved treatment response.

The results of one study provided support for this conclusion; youth participants reported high treatment satisfaction, and 42.9% no longer met diagnostic criteria for social anxiety disorder six months after completing a disorder-specific cognitive-behavioural intervention for adolescents. Furthermore, there was a significant decrease in diagnostic severity following treatment, which persisted at the follow-up assessment (O’Shannessy et al., 2021). Considering this, adapted versions of cognitive-behavioural therapy should be implemented in youth with social anxiety disorder, in order to avoid the inferior treatment response associated with generic cognitive-behavioural therapy.

When exploring treatment for social anxiety disorder, cognitive-behavioural therapy is a common suggestion as a place to start in therapy because the research shows generally favourable results: research shows reductions in social anxiety, perfectionism, and rumination, as well as a reduction in dysfunctional interpersonal emotion regulation and avoidance behaviours. Interpersonal problems can decrease significantly, and the effect size can last for over 4 years after treatment. However not all clients report experiencing these changes, and the approach needs to be adapted appropriately for adolescent clients in order to be effective.

If you or someone you love is looking for support with social anxiety, we’re happy to help connect you with a practitioner who can help. Please contact our team to set up a free consultation with one or more of our team members who practice CBT.

About the Author

Kendra is an MSW Intern competing her practicum at The Growth and Wellness Therapy Centre. She supports youth and adults around issues of anxiety, depression, self-esteem, communication, and life transitions.