Changes in positive self-views mediate the effect of cognitive-behavioral therapy for social anxiety disorder

Social anxiety disorder is thought to be characterized by maladaptive self-views. This study investigated whether (a) patients with social anxiety disorder (n = 75) differ at baseline from healthy controls (n = 43) in negative and positive self-views, (b) cognitive-behavioral therapy (CBT) for social anxiety disorder versus wait-list control produces statistically and clinically significant changes in negative and positive self-views, (c) changes in self-views mediate the effect of CBT on social anxiety symptoms, and (d) changes in self-views during CBT related to social anxiety symptoms at 1-year post-CBT. As expected, patients endorsed more negative and fewer positive self-views than healthy controls at baseline. Compared to wait-list control, CBT yielded statistically and clinically significant changes, specifically, fewer negative and more positive self-views. Mediational analysis indicated that increased positive (but not reduced negative) self-views mediated the effect of CBT on social anxiety reduction. Correlational analyses determined that increased positive self-views were associated with social anxiety symptom reduction at 1-year post-CBT.