(PS7-57) Relative Efficacy of Cognitive Restructuring vs. Cognitive Defusion When Treating Adolescents with Social Anxiety

Social anxiety negatively impacts the daily functioning of nearly 15% of youth in the U.S. When left untreated, social anxiety can result in poor academic performance, social withdrawal, depression, and low self-esteem, all of which can have significantly negative impacts on development and functioning into adulthood. Several evidence-based interventions have been suggested in literature as effective treatments for adolescents suffering from social anxiety, including CBT and ACT. Research is lacking on the mechanisms of action and relative efficacy of these two interventions when used with adolescents. Few studies critically examine the specific strategies, such as cognitive restructuring (CR) and cognitive defusion (CD), used respectively within CBT and ACT to understand why one treatment may be preferable for use with adolescents. The current study aimed to fill this gap in the literature by comparing two cognitive therapy strategies.

This study examined how various symptom domains of social anxiety are affected by a brief treatment dose of CR or CD delivered in group format. Ten participants were recruited (ages 13-17) to participate in a pre-treatment behavioral task, receive three sessions of either CR or CD, followed by a post-treatment behavioral task. Intervention sessions in both conditions followed pre-existing treatment protocols derived from manuals written by the original authors of each intervention, which have been approved by experts in the respective areas of intervention. Intervention sessions acted as the independent variable, and the study measured their effects on the following dependent variables: self-reported psychological flexibility, anxiety sensitivity, present-moment anxiety, and perceived accuracy of maladaptive thoughts, as measured by responses on the Avoidance and Fusion Questionnaire for Youth, Anxiety Sensitivity Index, State-Trait Anxiety Inventory, and Self-Efficacy Questionnaire respectively. Researchers hypothesized the following regarding changes from pre- to post- treatment: Greater decreases in perceived accuracy of negative automatic thoughts in the CR group; greater increases in psychological flexibility in the CD group; greater decreases in anxiety sensitivity in the CD group; greater decreases in current moment anxiety in the CR group.

Data collection will be complete by April 1, 2024. Preliminary visual inspection suggests meaningful decrease in participants’ perceived accuracy of maladaptive thoughts and anxiety sensitivity in both groups, with some evidence suggesting increase in psychological flexibility in the CD group. Initial examination also indicates greater decreases in anxiety symptoms, and a higher likelihood to continue using learned skills, in the CR group as compared to CD. Qualitative data collected in exit-interviews suggest that participants found the treatment to be useful in managing anxiety, and 80% of participants thus far have reported they will continue to use skills learned in the treatment; 66% of which were in the CR group. Post-treatment data will be collected 2- and 4-weeks post-treatment to assess changes over time.