TY - JOUR
T1 - The role of expressive suppression and cognitive reappraisal in cognitive behavioral therapy for social anxiety disorder
T2 - A study of self-report, subjective, and electrocortical measures
AU - Kivity, Yogev
AU - Cohen, Lior
AU - Weiss, Michal
AU - Elizur, Jonathan
AU - Huppert, Jonathan D.
N1 - Funding Information:
The authors would like to thank Roni Pener-Tessler, Ariela Friedman, Asher Strauss, Yael Milgram, Shai Avishay, Michal Kovacs, and Maayan Langmass for their help in data collection and Jason Moser and members of the clinical psychophysiology lab for their help in analyses of the ERP data. Preparation of this manuscript was supported by a grant from the Israel Science Foundation (grant #332/09) to the last author, the Sam and Helen Beber Chair of Clinical Psychology at The Hebrew University. The funding sources did not have any involvement in conducting the study and preparing the manuscript.
Publisher Copyright:
© 2020
PY - 2021/1/15
Y1 - 2021/1/15
N2 - Background: Contemporary models of cognitive behavioral therapy (CBT) for social anxiety disorder (SAD) emphasize emotion dysregulation as a core impairment whose reduction may play a causal role in psychotherapy. The current study examined changes in use of emotion regulation strategies as possible mechanisms of change in CBT for SAD. Specifically, we examined changes in expressive suppression and cognitive reappraisal during CBT and whether these changes predict treatment outcome. Methods: Patients (n = 34; 13 females; Mean age = 28.36 (6.97)) were allocated to 16-20 sessions of CBT. An electrocortical measure of emotion regulation and a clinician-rated measure of SAD were administered monthly. Self-report measures of emotion regulation and social anxiety were administered weekly. Multilevel models were used to examine changes in emotion regulation during treatment and cross-lagged associations between emotion regulation and anxiety. Results: CBT led to decreased suppression frequency, increased reappraisal self-efficacy, and decreased unpleasantness for SAD-related pictures (ps < .05). At post-treatment, patients were equivalent to healthy controls in terms of suppression frequency and subjective reactivity to SAD-related stimuli. Gains were maintained at 3-months follow-up. Decreases in suppression frequency and electrocortical reactivity to SAD-related pictures predicted lower subsequent anxiety but not the other way around (ps < .05). Lower anxiety predicted greater subsequent increases in reappraisal self-efficacy. Limitations: The lack of a control group precludes conclusions regarding mechanisms specificity. Conclusions: Decreased frequency of suppression is a potential mechanism of change in CBT for SAD.
AB - Background: Contemporary models of cognitive behavioral therapy (CBT) for social anxiety disorder (SAD) emphasize emotion dysregulation as a core impairment whose reduction may play a causal role in psychotherapy. The current study examined changes in use of emotion regulation strategies as possible mechanisms of change in CBT for SAD. Specifically, we examined changes in expressive suppression and cognitive reappraisal during CBT and whether these changes predict treatment outcome. Methods: Patients (n = 34; 13 females; Mean age = 28.36 (6.97)) were allocated to 16-20 sessions of CBT. An electrocortical measure of emotion regulation and a clinician-rated measure of SAD were administered monthly. Self-report measures of emotion regulation and social anxiety were administered weekly. Multilevel models were used to examine changes in emotion regulation during treatment and cross-lagged associations between emotion regulation and anxiety. Results: CBT led to decreased suppression frequency, increased reappraisal self-efficacy, and decreased unpleasantness for SAD-related pictures (ps < .05). At post-treatment, patients were equivalent to healthy controls in terms of suppression frequency and subjective reactivity to SAD-related stimuli. Gains were maintained at 3-months follow-up. Decreases in suppression frequency and electrocortical reactivity to SAD-related pictures predicted lower subsequent anxiety but not the other way around (ps < .05). Lower anxiety predicted greater subsequent increases in reappraisal self-efficacy. Limitations: The lack of a control group precludes conclusions regarding mechanisms specificity. Conclusions: Decreased frequency of suppression is a potential mechanism of change in CBT for SAD.
UR - http://www.scopus.com/inward/record.url?scp=85092918498&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85092918498&partnerID=8YFLogxK
U2 - 10.1016/j.jad.2020.10.021
DO - 10.1016/j.jad.2020.10.021
M3 - Review article
C2 - 33096332
AN - SCOPUS:85092918498
VL - 279
SP - 334
EP - 342
JO - Journal of Affective Disorders
JF - Journal of Affective Disorders
SN - 0165-0327
ER -