Behaviour Research and Therapy 45 (2007) 687–698 www.elsevier.com/locate/brat
Group cohesion in cognitive-behavioral group therapy for social phobia Marlene Taube-Schiffa, Michael K. Suvakb, Martin M. Antonyc,d,e,Ã, Peter J. Bielinge,f, Randi E. McCabed,e a
Psychosocial Oncology and Palliative Care Department, Princess Margaret Hospital, Toronto, ON, Canada b Department of Psychology, Boston University, Boston, MA, USA c Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, ON, Canada M5B 2K3 d Anxiety Treatment and Research Centre, St. Joseph’s Healthcare, Hamilton, ON, Canada e Department of Psychiatry and Behavioural Neurosciences, McMaster University f Mood Disorders Program, St. Joseph’s Healthcare, Hamilton Received 6 August 2005; received in revised form 11 June 2006; accepted 16 June 2006
Abstract Cognitive-behavior therapy (CBT) for Social Phobia is effective in both group and individual formats. However, the impact of group processes on treatment efﬁcacy remains relatively unexplored. In this study we examined group cohesion ratings made by individuals at the midpoint and endpoint of CBT groups for social phobia. Symptom measures were also completed at the beginning and end of treatment. We found that cohesion ratings signiﬁcantly increased over the course of the group and were associated with improvement over time in social anxiety symptoms, as well as improvement on measures of general anxiety, depression, and functional impairment. In conclusion, ﬁndings are consistent with the idea that changes in group cohesion are related to social anxiety symptom reduction and, therefore, speak to the importance of nonspeciﬁc therapeutic factors in treatment outcome. r 2006 Elsevier Ltd. All rights reserved. Keywords: Social phobia; Social anxiety disorder; Group cohesion; Cognitive-behavior therapy
Introduction Social phobia is characterized by an excessive fear of social or performance situations, during which a person may be scrutinized, judged, embarrassed, or humiliated by others. Evidence-based psychosocial treatments for social phobia have primarily come from a cognitive-behavioral orientation and include various combinations of four main components: (1) exposure-based strategies, (2) cognitive therapy, (3) social skills training, and (4) applied relaxation (for reviews, see Rodebaugh, Holaway, & Heimberg, 2004; Turk, Coles, & Heimberg, 2002). Cognitive-behavioral treatment for social phobia has been shown to be effective when ÃCorresponding author. Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, ON M5B 2K3, Canada. Tel.: +416 979 5000x2631; fax: +416 599 5660. E-mail address: firstname.lastname@example.org (M.M. Antony).
0005-7967/$ - see front matter r 2006 Elsevier Ltd. All rights reserved. doi:10.1016/j.brat.2006.06.004
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administered in either individual and group formats (e.g., Heimberg, Salzman, Holt, & Blendell, 1993; Turner, Beidel, Cooley, Woody, & Messer, 1994). However, the mechanisms of change, and effective ingredients of these treatments remain relatively understudied. Researchers have compared group and individual treatments for this condition, although evidence regarding the relative effectiveness of each approach has been inconsistent (see Scholing & Emmelkamp, 1993; Stangier, Heidenreich, Peitz, Lauterbach, & Clark, 2003; Wlazlo, Schroeder-Hartwig, Hand, Kaiser, & Munchau, 1990 for direct comparisons of individual and group cognitive-behavioral treatment for social ¨ phobia). However, for some patients, group treatment may offer a number of advantages over individual treatment. For example, group treatment provides an opportunity to marshal group processes (e.g., encouragement, support, and modeling from other group members) that may aid in teaching cognitive strategies and facilitating exposure exercises. Further, there may be...