Treatment of Severe Social Phobia: Effects of Guided Exposure With and Without Cognitive Restructuring

Fifty-one social phobics with severe scrutiny fears were randomly assigned to treatment in an experiment designed to assess the effectiveness of therapist-guided exposure and to determine the extent to which cognitive restructuring alone increases the effects of this exposure. Additionally, the ability of treatment-induced changes in locus of control, of irrational attitudes, and of within-session habituation to predict level of functioning at follow-up was assessed. Treatment integrity assessment showed compliance with instructions that was consistent with the respective treatments. The combined condition proved to be significantly more effective than guided exposure alone in endstate functioning, in increasing behavioral approach, and in decreasing self-rated avoidance. Regression analysis showed that treatment-induced changes in fear of negative evaluation (FNE), irrational beliefs, locus of control, and exposure-practice habituation were significantly predictive of endstate functioning at follow-up; the change in FNE accounted for virtually all the explained variance.