The relationships among working alliance, group cohesion and homework engagement in group cognitive behaviour therapy for social anxiety disorder.

OBJECTIVE: Few studies have investigated the role of generic relational factors, such as group cohesion and working alliance, in group cognitive behaviour therapy (CBT) for social anxiety disorder (SAD). The aim of this study was to examine the temporal associations among working alliance, group cohesion, and an index of a CBT-specific factor, homework engagement, as correlates of fear of negative evaluation and symptoms of social anxiety in group CBT for SAD. METHOD: There were 105 participants with a diagnosis of social anxiety disorder who were randomly assigned to 12 sessions of group imagery-enhanced or standard CBT. Participants completed measures at various time points during the 12-session interventions, and the relationship among variables was examined through random-intercept cross-lagged panel models. RESULTS: Group cohesion was significantly associated with social anxiety symptoms at the end of treatment, however there was no significant relationship with working alliance. Greater homework engagement predicted lower social interaction anxiety, but only during mid-treatment. CONCLUSION: The results highlight the importance of supporting group cohesion and maximising homework engagement during core components of social anxiety treatment such as behavioural experiments.

Memory representation of aversive social experiences in Social Anxiety Disorder.

Aversive social experiences are proposed to be a risk factor for developing Social Anxiety Disorder (SAD). Many patients with SAD report associated daily life symptoms, such as intrusive re-experiencing (e.g., negatively distorted images of oneself), avoidance, alterations in cognitions and mood, as well as hyperarousal, resembling symptom dimensions of Posttraumatic Stress Disorder (PTSD). These PTSD-like symptoms may result from maladaptive processing and representation of the aversive social experiences in memory. Emotional hyperreactivity during memory retrieval of aversive social experiences is another feature of SAD which was found in previous studies. This study aimed to further investigate PTSD-like symptoms and emotional reactivity associated with etiologically relevant aversive social experiences and shed more light on a potential relationship between both. Eighty-five patients with SAD and 85 healthy controls (HC) participated in this cross-sectional study. It comprised an imagination task with self-report and physiological measures to assess emotional reactivity during the cued recall of the aversive social experience and clinical interviews to assess PTSD-like symptoms. We expected increased emotional reactivity and more severe PTSD-like symptoms in response to the aversive social experience in patients with SAD compared to HC, as well as a positive correlation between emotional reactivity and PTSD-like symptoms in patients with SAD. Indeed, patients with SAD showed emotional hyperreactivity (self-report, physiology) during the cued recall of the aversive social experiences, also when compared to two control memory conditions (neutral, negative non-social) and HC. Patients with SAD furthermore reported more severe PTSD-like symptoms compared to HC and intrusive re-experiencing symptoms were positively correlated with distress during imagery of the social aversive event in patients with SAD. These results might point toward a maladaptive representation of aversive social experiences in memory. Similar to PTSD, this maladaptive memory representation might promote the development of PTSD-like symptoms such as intrusive re-experiencing (e.g., in the form of intrusive self-images in patients with SAD), which might finally lead to and maintain symptoms of SAD.

Positive emotional reactivity to pleasant social and nonsocial stimuli in social anxiety disorder.

Prior research has shown that Social Anxiety Disorder (SAD) is associated with significantly diminished positive affect (PA). Few studies have examined PA reactivity to pleasant experimental stimuli in individuals with SAD and whether emotional responses might be moderated by social context. Here, we investigated repeated measures of PA reactivity among individuals with SAD (n = 46) and healthy controls (HC; n = 39) in response to standardized neutral images, pleasant music, and social versus nonsocial guided imagery. Primary analyses revealed that SAD and HC participants did not differ in their PA reactivity when PA was conceptualized as a unitary construct. Exploratory analyses examining discrete subfacets of PA revealed potential deficits for SAD participants in relaxed and content PA, but not activated PA. Although participants with SAD reported relatively lower levels of relaxed and content PA overall compared with controls, they exhibited normal increases in all PA subfacets in response to pleasant music as well as pleasant social and nonsocial stimuli. These findings support a more nuanced conclusion about PA deficits in SAD than is described in the extant literature, suggesting that detecting PA deficits in SAD may depend upon how PA is conceptualized, evoked, and measured. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The Use of Dynamic Cognitive Behavioural Therapy (DCBT) in Social Anxiety Disorder (SAD): A Theoretical Integration Initiative.

Psychotherapy theorists can often become fervent advocates of the schools they follow and place the doctrines of the theories they adopt above all else. This situation can sometimes turn into a war of theories between researchers as well. However, therapists should not aim to shape therapy sessions according to their methods but to use them in line with clients' needs. Although it is emphasised that the integration of both psychoanalytic and cognitive behavioural therapy techniques, which is going to be named dynamic cognitive behavioural therapy (DCBT) in this case report, will provide more effective and permanent treatment, a discernible gap exists regarding the integration of these theories and their use in psychotherapy. Taking into account this gap, it is considered important to use this approach with a client who has a social anxiety disorder (SAD). Therefore, this study aims to describe the almost forgotten DCBT approach step by step through a case report and reveal the effectiveness of this approach. As a result, DCBT seems to be effective in the treatment of SAD.

An Investigation of Cognitive and Affective Changes During Group Imagery Rescripting for Social Anxiety Disorder.

Recurrent, negative self-imagery is common in social anxiety disorder (SAD). Imagery rescripting (ImRs) is an effective therapeutic technique that aims to target past aversive memories to modify their associated meanings, and update the encapsulated negative schematic beliefs. The current study aimed to extend previous research by investigating the cognitive and affective shifts during each phase of ImRs delivered within a group cognitive behavioral therapy protocol. Participants (N = 32) retrieved an aversive memory associated with social anxiety and were guided through brief cognitive restructuring, prior to completing ImRs. Core beliefs associated with the memory (strength and valence) and fear of negative evaluation were assessed before and after ImRs and affect was assessed following each phase. Strength and affective valence of encapsulated core beliefs about the self, others, the world, and the image itself significantly reduced following ImRs, and core beliefs were updated to become more positive. Participants reported large affective shifts early in the process, with smaller shifts in the later stages. Fear of negative evaluation did not significantly reduce following ImRs. Outcomes provide some support for cognitive and affective changes during group ImRs for SAD and suggest future research directions to investigate longer-term impacts and to better understand the underlying mechanisms of the technique.

Impacts of imagery-enhanced versus verbally-based cognitive behavioral group therapy on psychophysiological parameters in social anxiety disorder: Results from a randomized-controlled trial.

Social anxiety disorder (SAD) is associated with marked physiological reactivity in social-evaluative situations. However, objective measurement of biomarkers is rarely evaluated in treatment trials, despite potential utility in clarifying disorder-specific physiological correlates. This randomized controlled trial sought to examine the differential impact of imagery-enhanced vs. verbal-based cognitive behavioral group therapy (IE-CBGT, n = 53; VB-CBGT, n = 54) on biomarkers of emotion regulation and arousal during social stress in people with SAD (pre- and post-treatment differences in heart rate variability (HRV) and skin conductance). We acquired psychophysiological data from randomized participants across four social stress test phases (baseline, speech preparation, speech, interaction) at pre-treatment, and 1- and 6-months post-treatment. Analyses revealed that IE-CBGT selectively attenuated heart rate as indexed by increases in median heart rate interval (median-RR) compared to VB-CBGT at post-treatment, whereas one HRV index showed a larger increase in the VB-CBGT condition before but not after controlling for median-RR. Other psychophysiological indices did not differ between conditions. Lower sympathetic arousal in the IE-CBGT condition may have obviated the need for parasympathetic downregulation, whereas the opposite was true for VB-CBGT. These findings provide preliminary insights into the impact of imagery-enhanced and verbally-based psychotherapy for SAD on emotion regulation biomarkers.

Imagery-enhanced v. verbally-based group cognitive behavior therapy for social anxiety disorder: a randomized clinical trial.

BACKGROUND: Cognitive behavior therapy (CBT) is effective for most patients with a social anxiety disorder (SAD) but a substantial proportion fails to remit. Experimental and clinical research suggests that enhancing CBT using imagery-based techniques could improve outcomes. It was hypothesized that imagery-enhanced CBT (IE-CBT) would be superior to verbally-based CBT (VB-CBT) on pre-registered outcomes. METHODS: A randomized controlled trial of IE-CBT v. VB-CBT for social anxiety was completed in a community mental health clinic setting. Participants were randomized to IE (n = 53) or VB (n = 54) CBT, with 1-month (primary end point) and 6-month follow-up assessments. Participants completed 12, 2-hour, weekly sessions of IE-CBT or VB-CBT plus 1-month follow-up. RESULTS: Intention to treat analyses showed very large within-treatment effect sizes on the social interaction anxiety at all time points (ds = 2.09-2.62), with no between-treatment differences on this outcome or clinician-rated severity [1-month OR = 1.45 (0.45, 4.62), p = 0.53; 6-month OR = 1.31 (0.42, 4.08), p = 0.65], SAD remission (1-month: IE = 61.04%, VB = 55.09%, p = 0.59); 6-month: IE = 58.73%, VB = 61.89%, p = 0.77), or secondary outcomes. Three adverse events were noted (substance abuse, n = 1 in IE-CBT; temporary increase in suicide risk, n = 1 in each condition, with one being withdrawn at 1-month follow-up). CONCLUSIONS: Group IE-CBT and VB-CBT were safe and there were no significant differences in outcomes. Both treatments were associated with very large within-group effect sizes and the majority of patients remitted following treatment.

Does treatment preference affect outcome in a randomized trial of a mindfulness intervention versus cognitive behaviour therapy for social anxiety disorder?

Research suggests that treatment preference may affect outcome of randomized clinical trials, but few studies have assessed treatment preference in trials comparing different types of psychosocial interventions. This study used secondary data analysis to evaluate the impact of treatment preference in a randomized trial of a mindfulness-based intervention adapted for social anxiety disorder (MBI-SAD) versus cognitive behaviour group therapy (CBGT). Ninety-seven participants who met DSM-5 criteria for SAD were randomized. Prior to randomization, twice as many participants expressed a preference for the MBI-SAD over CBGT. However, being allocated or not to one's preferred treatment had no impact on treatment response. Additionally, with the exception of perception of treatment credibility, treatment matching had no impact on treatment-related variables, including treatment initiation, session attendance, homework compliance, satisfaction with treatment and perception that treatment met expectations. In sum, despite the greater preference for the mindfulness intervention in this sample of participants with SAD, we found little evidence of preference effects on our study outcomes. Findings should be viewed as preliminary and require replication.

Beneficial Effects of Role Reversal in Comparison to role-playing on negative cognitions about Other's Judgments for Social Anxiety Disorder.

BACKGROUND AND OBJECTIVES: Negative beliefs about other's judgments play an important role in the development and maintenance of social anxiety disorder. The present experiment examined the effects of role-playing followed by role reversal compared to role-playing twice on altering these negative cognitions. METHODS: Thirty-six adult social anxiety patients were randomized into two conditions: a role-playing condition in which 18 participants role-played an anxiety-provoking social situation twice, or a role reversal condition in which 18 participants role-played an anxiety-provoking social situation followed by enacting the same situation using role reversal. Before the start of the experiment, patients were asked to report their negative cognitions about the other's judgments. Next, they were asked to rate the believability of these negative cognitions, as well as the probability and cost estimates of negative judgments by the other person, at three time-points: before the first block of role-playing, after the first block of role-playing, and after the second block of the experiment. RESULTS: Results demonstrated that role-playing followed by role reversal had a stronger effect on the most negative cognitions than role-playing twice. LIMITATIONS: The most important limitation of the present study is that there was no control group to assess the effects of role-playing alone. Moreover, the second block of the experiment was repetitive in role-playing, however, it was a new task in role reversal. CONCLUSIONS: The results support the hypothesis that role reversal is an effective technique that can be used to correct negative cognitions about other's judgments in SAD.

Abnormal asymmetry of thalamic volume moderates stress from parents and anxiety symptoms in children and adolescents with social anxiety disorder.

Social anxiety disorder (SAD) usually onsets in childhood or adolescence and is associated with brain development and chronic family stress during this period. As an information hub, the thalamus plays a crucial role in the development of emotion processing and stress regulation. Its structural and functional lateralization have been related to mental disorders. This study examined the age-dependent asymmetry of the thalamic volume in children and adolescents with SAD. We further examined the role of the thalamic asymmetry in moderating the relationships between parental alienation, which is a main source of familial stress for children and adolescents, and anxiety symptoms in this population. Fifty-three medication-free children and adolescents with SAD and 53 typical developing controls (age: 8-17) were included. Anxiety severity was measured using the Screen for Child Anxiety-Related Emotional Disorders (SCARED). We estimated the bilateral thalamic volume and examined diagnosis effect and age-group difference on the thalamic asymmetry. We further examined the moderation of the thalamic asymmetry on the associations between scores on the parental alienation, social phobia, and total SCARED. Compared with controls, the SAD group exhibited significantly abnormal asymmetry in thalamic volume. This asymmetry became more evident in the older age group. Furthermore, this asymmetry significantly weakened the relationships between parental attachment and total SCARED score. The asymmetry of the thalamic volume and its age-group difference provide novel evidence to support brain developmental abnormalities in children and adolescents with SAD. The findings further revealed interactions between physiological and chronic stress in children and adolescents with SAD. This article is part of the special issue on 'Stress, Addiction and Plasticity'.

Interpretation Bias Modification Versus Progressive Muscle Relaxation for Social Anxiety Disorder: A Web-Based Controlled Trial.

Computerized interpretation bias modification (IBM) programs show promise for the treatment of anxiety disorders, though they have rarely been compared to active treatments. The goal of the present study was to compare the efficacy of IBM to progressive muscle relaxation (PMR) for the treatment of social anxiety disorder (SAD). Sixty-four participants with SAD were recruited from across the United States and randomly assigned to 8 internet-delivered twice-weekly sessions of IBM or PMR. Participants were administered assessments of primary symptom outcomes and interpersonal suicide risk factors at posttreatment and 3-month follow-up. IBM led to significantly lower negative interpretation bias than PMR at posttreatment but not follow-up. Both conditions experienced comparable reductions in social anxiety from pretreatment to follow-up (IBM d = 1.37, PMR d = 1.28). They also experienced significant reductions in depression and general anxiety that did not differ from one another. Additionally, IBM led to greater reductions in thwarted belongingness than PMR at posttreatment but not follow-up. Overall, these findings suggest IBM is not more effective than PMR for reducing social anxiety, though there was some evidence of its superiority in decreasing suicide risk. Limitations and directions for future research are discussed.

The effects of imagery rescripting on memory outcomes in social anxiety disorder.

Imagery rescripting (IR) is an effective intervention for social anxiety disorder (SAD) that targets negative autobiographical memories. IR has been theorized to work through various memory mechanisms, including modifying the content of negative memory representations, changing memory appraisals, and improving negative schema or core beliefs about self and others. However, no prior studies have investigated the unique effects of rescripting itself relative to other IR intervention components on these proposed mechanisms. In this preliminary study, 33 individuals with SAD were randomized to receive a single session of IR, imaginal exposure (IE), or supportive counselling (SC). Memory outcomes were assessed at 1- and 2-weeks post-intervention and at 3-months follow-up. Results demonstrated that the content of participants' autobiographical memory representations changed in distinct ways across the three conditions. Whereas IR facilitated increases only in positive/neutral memory details, IE facilitated increases in both positive/neutral and negative memory details and SC facilitated no changes in memory details. Although memory appraisals did not differ across conditions, participants who received IR were more likely to update their negative memory-derived core beliefs. These unique effects of rescripting on memory representations and core beliefs enhance our understanding of the memory-based mechanisms of IR within the context of exposure-based learning for people with SAD.

Prevalence and features of spontaneous recurrent images in social anxiety disorder: findings from a Korean community sample.

BACKGROUND: Previous studies have indicated that people with social anxiety disorder (SAD) often experience spontaneous, recurrent images (SRI). It was assumed that Koreans with interdependent self-views may contain more features related to social contexts in their self-images than those reported in Western cultures. AIMS: In the present study, we aimed to explore the prevalence and content of SRIs in individuals with SAD in Korea. Furthermore, we investigated the relationship between features of SRIs and variables of SAD. METHOD: Sixty-four individuals with SAD (27.00 ± 7.42 years, 64.1% female), diagnosed with SAD, completed self-report questionnaires related to social anxiety. Afterwards, a semi-structured interview was used to assess features and content of the individuals' SRI. RESULTS: Thirty (47%) of the participants reported experiencing SRIs in social situations. The content of the SRIs were classified under three themes: negative self-images, negative images of others, and abstract images. The distress level of SRIs was positively associated with social phobia scales (r = .385, p < .05) and physical anxiety symptoms (r = .478, p < .05). Frequency of SRIs was positively associated with avoidance scores (r = .402, p < .05). CONCLUSIONS: The results demonstrated differences in the prevalence and content of the SRIs between Western and non-Western cultures. Fewer individuals with SAD in Korea reported having SRIs, and the content of these SRIs involved people other than the self. Some features of SRIs were associated with variables of SAD.

Feasibility Study of Three-Phase Implementation of International Consortium for Health Outcomes Measurement Depression and Anxiety Standard Set in an Outpatient Consultation-Liaison Psychiatry Practice.

OBJECTIVE: We describe a three-phase implementation of the International Consortium for Health Outcomes Measurement Depression and Anxiety Standard Set in a Consultation-Liaison Psychiatry practice. METHODS: During the preintervention phase, we reviewed patient-reported outcome tools and engaged stakeholders and leadership. During phase 1, the standard set was converted into an electronic previsit intake assessment that was implemented in a physician champion's practice. Patients completed the intake on a tablet, and computer adaptive testing was used to reduce response burden. Physician-facing data display facilitated use during subsequent in-person visits. An electronic version of the follow-up standard set was used during follow-up visits. During phase 2, a second physician tested scalability and the intervention was disseminated department wide in phase 3. RESULTS: During phase 1, 186 intakes and 67 follow-up electronic patient-reported outcome sets were completed. Average patient age was 54 years, and 44% were male. On average, patients ranked the tool 4.4 out of 5 and spent 22 minutes completing the intake. Time-driven activity-based costing found the new process to be cost-effective. During phase 2, 386 patients completed electronic patient-reported outcome sets, with 315 follow-up visits. Patients ranked the tool as 4.0 out of 5 and spent 26 minutes completing the questions. During phase 3, 2166 patients completed intake electronic patient-reported outcome sets and 1249 follow-up visits. Patients ranked the tool 4.3 out of 5 and spent 26 minutes on it. Scores and completion time did not differ greatly between phases. CONCLUSIONS: Integration of the International Consortium for Health Outcomes Measurement Depression and Anxiety Standard Set is feasible. Future research comparing International Consortium for Health Outcomes Measurement set with other approaches and in different settings is needed.

Changes in Empathy Mediate the Effects of Cognitive-Behavioral Group Therapy but Not Mindfulness-Based Stress Reduction for Social Anxiety Disorder.

Social anxiety disorder (SAD) has been shown to be associated with difficulty in the ability to vicariously share others' positive emotions (positive affective empathy). Mixed evidence also suggests potentially impaired recognition of the positive and negative emotions of others (cognitive empathy) and impaired or enhanced sharing of the negative emotions of others (negative affective empathy). Therefore, we examined whether two efficacious treatments for SAD, cognitive-behavioral group therapy (CBGT) and mindfulness-based stress reduction (MBSR), improve empathy in SAD relative to a wait-list condition and whether improvements in empathy mediate improvements in social anxiety. In the context of a randomized controlled trial, participants with SAD completed an empathy task at baseline, posttreatment/wait-list (N = 81), and 1-year follow-up (N = 37). Relative to both MBSR and wait-list, CBGT resulted in significant improvements in positive affective empathy. CBGT-related changes in positive affective empathy also mediated improvements in social anxiety at both posttreatment/wait-list and at 1-year follow-up. Other indices of empathy did not change differentially across the three conditions. Therefore, one way in which CBGT may specifically confer benefits to individuals with SAD is through increasing their ability or willingness to share in the positive emotions of others.

Do sudden gains predict treatment outcome in social anxiety disorder? Findings from two randomized controlled trials.

OBJECTIVE: Sudden gains (SGs) have been found to occur during randomized controlled trials (RCTs) for social anxiety disorder (SAD). Evidence is mixed whether SGs relate to treatment outcome in SAD. We examined SGs in two RCTs for SAD. METHOD: Study 1 (N = 68) examined SGs in individual cognitive-behavioral therapy (CBT), and Study 2 (N = 100) compared SGs in group CBT and Mindfulness-Based Stress Reduction (MBSR). Weekly ratings of social anxiety were used to calculate SGs. The Liebowitz Social Anxiety Scale-Self-Report and the Social Interaction Anxiety Scale were completed at pretreatment, posttreatment, and follow-up to assess outcome. RESULTS: In Study 1, 17.6% of participants experienced a SG. Participants with SGs started and ended treatment with lower social anxiety. SGs were not associated with greater decreases in social anxiety from pre-to posttreatment or 12-month follow-up. In Study 2, SGs occurred in 27% of participants and at comparable rates in MBSR and group CBT. SGs were not associated with changes in social anxiety during treatment in either condition. CONCLUSION: SGs occurred during treatment for SAD. In both RCTs, participants improved regardless of experiencing a SG, suggesting that SGs are not predictive of greater improvement during treatment for SAD.

Intrusive social images in individuals with high and low social anxiety: a multi-method analysis.

BACKGROUND: Models of social anxiety suggest that intrusive images/memories are common in social anxiety and contribute to the maintenance of social anxiety. AIMS: We examined the context and phenomenological features of intrusive social images using quantitative and qualitative measures across various levels of social anxiety. METHOD: Undergraduate students (n = 191) completed measures of social anxiety (i.e. Social Interaction Anxiety Scale and Social Phobia Scale) and wrote a description of an intrusive social image. Individuals who reported an intrusive social image (n = 77) rated the frequency, interference and phenomenological (e.g. vividness, emotional intensity) characteristics of the image. A content analysis of the intrusive image narratives was completed by independent raters. RESULTS: High social anxiety (HSA) increased the likelihood and frequency of experiencing intrusive images, and to some extent the interference caused by these images. However, the characteristics of these images with regard to their content and quality were similar across levels of social anxiety. Among participants who provided narratives, HSA individuals (n = 34) did not differ from low socially anxious (LSA) individuals (n = 28) in themes that reflect concerns about their own thoughts, actions and behaviours. However, HSA individuals reported greater concerns about how other individuals would react, and their intrusive images were often from an observer perspective when compared with LSA individuals. CONCLUSIONS: These results are interpreted in relation to cognitive models of emotion, memory and cognitive behavioural models of social anxiety.

Effects of Self-Image on Anxiety, Judgement Bias and Emotion Regulation in Social Anxiety Disorder.

BACKGROUND: Research to date has focused on the detrimental effects of negative self-images for individuals with social anxiety disorder (SAD), but the benefits of positive self-images have been neglected. AIMS: The present study examined the effect of holding a positive versus negative self-image in mind on anxiety, judgement bias and emotion regulation (ER) in individuals with SAD. METHOD: Forty-two individuals who met the diagnostic criteria for SAD were randomly assigned to either a positive or a negative self-image group. Participants were assessed twice with a week's interval in between using the Reactivity and Regulation Situation Task, which measures social anxiety, discomfort, judgement bias and ER, prior to and after the inducement of a positive or negative self-image. RESULTS: Individuals in the positive self-image group reported less social anxiety, discomfort and distress from social cost when compared with their pre-induction state. They also used more adaptive ER strategies and experienced less anxiety and discomfort after using ER. In contrast, individuals in the negative self-image group showed no significant differences in anxiety, judgement bias or ER strategies before and after the induction. CONCLUSIONS: This study highlights the beneficial effects of positive self-images on social anxiety and ER.

Enhancing the Efficacy of Cognitive Bias Modification for Social Anxiety.

Cognitive bias modification for interpretation (CBM-I) is a promising treatment modality for social anxiety disorder, but effect sizes are relatively small across investigations (Hallion & Ruscio, 2011). Additionally, the extent to which CBM-I impacts other cognitive, emotional, and behavioral outcomes is unclear. This study investigated whether two empirically supported treatment components for anxiety disorders, imaginal exposure (IE) and relaxation, augment the effects of CBM-I and increase the extent to which the effects of CBM-I generalize to behavioral and affective outcomes. We randomly assigned 111 undergraduate students with social anxiety to undergo IE, relaxation, or neutral thinking prior to CBM-I, then measured their interpretation biases, as well as their speaking time, anxiety, and subjective evaluations of performance during a speech task. Results indicated that individuals who received IE prior to CBM-I evidenced more adaptive interpretation biases and less behavioral avoidance during the speech task than did individuals who engaged in relaxation or neutral thinking. However, they did not report differential anxiety, habituation, or evaluations of their performance on the speech task. These findings suggest that the combination of CBM-I with adjunct components that target behavioral, rather than cognitive, mechanisms can facilitate transfer of the effects of CBM-I to reducing behavioral avoidance.

Autobiographical memory retrieval and appraisal in social anxiety disorder.

Individuals with social anxiety disorder (SADs; n = 41) and healthy controls (HCs; n = 40) were administered the Waterloo Images and Memories Interview, in which they described mental images that they tend to experience in both anxiety-provoking and non-anxiety-provoking social situations. Participants then recalled, in as much detail as possible, specific autobiographical memories of salient aversive and non-aversive social experiences that they believed led to the formation of these images. Audio-recorded memory narratives were transcribed and coded based on the procedure of the Autobiographical Interview, which provides a precise measure of the degree of episodic detail contained within each memory. Participants also rated the subjective properties of their recalled memories. Results revealed that participants across the two groups retrieved equivalent rates of both aversive and non-aversive social memories. However, SAD participants' memories of aversive events contained significantly more episodic detail than those of HCs, suggesting that they may be more highly accessible. Moreover, participants with SAD appraised their memories of aversive experiences as more distressing and intrusive than HCs, and perceived them as having a significantly greater influence on their self-perception. In contrast, no group differences were observed for memories of non-aversive events. Findings have the potential to shed new light on autobiographical memory in SAD, with implications for psychotherapeutic intervention.