How much do sample characteristics affect the effect size?

Behaviour Research and Therapy, 1993

Patients with generalized social phobia (n = 73) were randomly allocated to two treatment modalities: (1) group or (2) individual treatment, and to three treatment packages: (1) two blocks of exposure in vivo (2) a block cognitive therapy followed by a block exposure in vivo, or (3) two blocks cognitive-behavioural treatment in which both strategies were integrated from the start. All treatments consisted of 16 sessions, given in two treatment blocks of 4 weeks each, separated by a no-treatment phase of 4 weeks. Self-report assessments were held before and after the treatment blocks and at 3-months follow-up. Significant differences were found between effects of the first treatment block vs those of the 4-weeks waiting-list period. Repeated measures MANOVA's demonstrated significant time effects after both treatment blocks and at follow-up, indicating improvement for the group as a whole. After the first treatment block the integrated treatment did significantly worse than either exposure in vivo or cognitive therapy in decreasing somatic complaints. On the other variables no differences among the treatments were found. At follow-up a significant interaction was found between treatment package and modality on the variable cognitions: largest progress was found in the group treatment with cognitive therapy followed by exposure in vivo; smallest progress was found in the integrated group treatment. Results are discussed and recommendations for further research are given.

Journal of Anxiety Disorders, 2006

The effects of intensive cognitive-behavioral group treatment (CBGT) for social phobia (DSM-IV) were studied in 26 patients randomly assigned either to a treatment group (TG) or to a 6-month waiting list control group (WG). Treatment involved 2 weeks of daily treatment sessions separated by 1 week of homework assignments. TG was superior to WG at all assessment points, i.e., at 3 weeks and at 3 and 6 months of post-treatment. After 6 months, significant treatment effects were found in the majority of social phobia measures indicating decreased levels of social anxiety and avoidance, safety-behaviors and symptoms influence on daily life. The WG received treatment following the waiting list period and was combined with the TG in order to evaluate the outcome in a larger sample. Treatment gains at 3 weeks were maintained or improved at 1-year follow-up. Average effect sizes of social phobia measures ranged from 0.56 at post-treatment, 0.68 at 3 months and 0.81 at 6 months and 1 year, respectively.

Journal of Anxiety Disorders, 2009

Journal of Consulting and Clinical Psychology, 2009

Recent theoretical models of social phobia suggest that targeting several specific cognitive factors in treatment should enhance treatment efficacy over that of more traditional skills-based treatment programs. In the current study, 195 people with social phobia were randomly allocated to 1 of 3 treatments: standard cognitive restructuring plus in vivo exposure, an "enhanced" treatment that augmented the standard program with several additional treatment techniques (e.g., performance feedback, attention retraining), and a nonspecific (stress management) treatment. The enhanced treatment demonstrated significantly greater effects on diagnoses, diagnostic severity, and anxiety during a speech. The specific treatments failed to differ significantly on self-report measures of social anxiety symptoms and life interference, although they were both significantly better than the nonspecific treatment. The enhanced treatment also showed significantly greater effects than standard treatment on 2 putative process measures: cost of negative evaluation and negative views of one's skills and appearance. Changes on these process variables mediated differences between the treatments on changes in diagnostic severity.

Psychotherapy and Psychosomatics, 2000

Background: The efficacy of cognitive behaviour therapy (CBT) in social phobia has been demonstrated in several controlled trials and meta-analyses, but no comparison of CBT with supportive therapy (ST) can be found in the literature. Method: The aim of the trial was to study the effectiveness of CBT versus ST carried out ‘as usual’. Sixty-seven DSM-4 social phobic patients (89% generalized subtype, most with avoidant personality) were randomly allocated into two groups. Group 1 (CBT) received 8 1-hour sessions of individual cognitive therapy (CT) for 6 weeks, followed by 6 2-hour sessions of social skills training (SST) in group weekly. Group 2 received ST for 12 weeks (6 half-hour sessions), then the patients were switched to CBT. All patients agreed not to take any medication during the whole trial. In group 1, 29 patients reached week 6, 27 reached week 12, and 24 weeks 36 and 60 (endpoint). In group 2, 29 patients reached week 6, 28 reached weeks 12 and 18, 26 week 24, and 23 r...

Behavior Therapy, 2014

Several authors have identified a disconnect between psychotherapy research, including research on cognitive behavioral therapy (CBT), and real-world psychotherapy practice. This disconnect has several negative consequences, potentially including less-than-optimal practice standards as well as a lack of input from practicing psychotherapists on how research can be improved and made more relevant in their day-to-day clinical work. As part of an ongoing effort to engage practicing psychotherapists in a feedback loop with psychotherapy researchers, this study reports the results of a survey of CBT therapists who have used CBT in the treatment of social phobia (SP). The survey was designed primarily to document how often certain potential problems, identified by expert researchers and CBT manuals, actually act as barriers to successful treatment when CBT is employed in nonresearch environments. The participants were 276 psychotherapists responding to email, online, and print advertisements completing the online survey. Participants varied considerably in psychotherapy experience, work environment, experience in using CBT for SP, and in some ways varied in their usual CBT techniques when treating SP. Among the most prominent barriers identified by many of the participants were patient motivation, comorbidity, logistical problems (especially with exposures), patient resistance, and severity and chronicity of SP symptoms. These findings may be useful for psychotherapy researchers as areas for potential study. The results may also suggest topics requiring clinical guidelines, innovations within CBT, and dissemination of successful techniques to address the barriers identified here.

International Journal of Cognitive Therapy, 2011

We examined cognitive behavior treatment (CBT) for social phobia (SP) in large groups (17-24 members) in a naturalistic setting. Individuals (n = 212) seeking treatment for SP in a large public clinic filled out self-report measures upon contacting the clinic (T1), at first session (T2, average 8.2 months after T1), immediately following treatment termination (T3), and 3 months after treatment termination (T4). The attrition rate was 5.7% from initial contact to treatment initiation, and an additional 30% during treatment. CBT for SP in large groups resulted in modest reductions in social anxiety (effect size = 0.55 for the entire sample, and 0.87 for completers). Clinically significant reductions in social anxiety during treatment were observed (30.0% during treatment vs. 10.2% during wait-list). Advantages and disadvantages of CBGT in large groups for social anxiety are discussed.

Acta Psychiatrica Scandinavica, 2007

A. Intensive group cognitive treatment and individual cognitive therapy vs. treatment as usual in social phobia: a randomized controlled trial. Objective: To compare the effects of an intensive group cognitive treatment (IGCT) to individual cognitive therapy (ICT) and treatment as usual (TAU) in social phobia (DSM-IV). Method: Hundred patients were randomized to: IGCT involving 16 group sessions spread over three weeks; ICT involving 16 shorter weekly sessions in 4 months and; TAU involving an indicated selective serotonin reuptake inhibitor (SSRI) with therapy sessions as required for 1 year. The main outcome measure was a Social Phobia Composite that combined several standardized self-report measures. Diagnostic assessment was repeated at 1-year follow-up. Results: Significant improvements were observed with all treatments. ICT was superior to IGCT and TAU, which did not differ in overall effectiveness. Conclusion: The study confirms and extends previously reported findings that ICT is more effective than group cognitive treatment and treatment with SSRIs. IGCT lasts only 3 weeks, and is as effective as more protracted TAU.

The Journal of Nervous and Mental Disease, 2009

Exposure is considered to be an essential ingredient of cognitivebehavioral therapy treatment of social phobia and of most anxiety disorders. To assess the impact of the amount of exposure on outcome, 30 social phobic patients were randomly allocated to 1 of 2 group treatments of 8 weekly sessions: Self-Focused Exposure Therapy which is based essentially on prolonged exposure to public speaking combined with positive feedback or a more standard cognitive and behavioral method encompassing psychoeducation, cognitive work, working through exposure hierarchies of feared situations for exposure within and outside the group. The results show that the 2 methods led to significant and equivalent symptomatic improvements which were maintained at 1-year follow-up. There was a more rapid and initially more pronounced decrease in negative cognitions with the Self-Focused Exposure Therapy, which included no formal cognitive work, than with the more standard approach in which approximately a third of the content was cognitive. In contrast, decrease in social avoidance was more persistent with standard cognitive-behavior therapy which involved less exposure. The results indicate that positive cognitive change can be achieved more rapidly with non cognitive methods while avoidance decreases more reliably with a standard approach rather than an approach with an exclusive focus on exposure. FIGURE 2. Evolution of the LSAS performance avoidance subscale and social avoidance subscale scores during the treatment and follow-up phases for both groups (SFET and SCBT).

2006