Aim: The present study aimed to examine the predictors of comorbid psychological symptoms in social anxiety disorder (SAD) after cognitive-behavioral therapy (CBT). Methods: One hundred fourteen SAD patients completed manualized group CBT. We examined associations between the personality dimensions of NEO Five Factor Index (NEO-FFI) and the subscales of Symptom Checklist-90 Revised (SCL-90-R) in SAD patients after CBT using multiple regression analysis. Results: High levels of conscientiousness at baseline predicted symptom reduction on 4 SCL-90-R scales, including somatization, obsessive-compulsive, anxiety and global severity index in patients with SAD after CBT. And high levels of agreeableness predicted symptom reduction on 2 SCL-90-R scales, including Hostility and Paranoid Ideation. High levels of openness predicted psychoticism. Conclusion: The present study suggested that high levels of three NEO-FFI dimensions (openness, agreeableness, conscientiousness) might predict comorbid psychological symptoms reduction in SAD patients after CBT. For the purpose of improving comorbid psychological symptoms with SAD patients, it might be useful to pay more attention to these dimensions of NEO-FFI at baseline.
Social anxiety disorder (SAD) is one of the most common psychiatric disorders with lifetime prevalence of 12% [
The efficacy of cognitive-behavioral therapy (CBT) encompassing exposure therapy and cognitive restructuring has been established for SAD [
Some studies suggest that personality mediates part of comorbidity [
The purpose of the present study is to examine the predictive personality characteristics of comorbid psychiatric symptoms in CBT for SAD.
One hundred forty-four SAD patients attended the group CBT program. All of the patients met the following entry criteria: 1) principal Axis I diagnosis of SAD according to the DSM-IV criteria, as assessed by the Structured Clinical Interview for DSM-IV(SCID) [
The group CBT for SAD at our department was originally based on the programme developed by Andrews et al. [
At pre- and post-treatment the Symptom Checklist-90 Revised (SCL-90-R) and the Liebowitz Social Anxiety Scale (LSAS) were assessed. The NEO Five Factor Index (NEO-FFI) was assessed at pre-treatment.
The SCL-90-R is a widely used and self-reported assessment tool for general psychopathology [
The NEO-FFI is a 60-item self-reported questionnaire designed to measure the five major personality dimensions of neuroticism, extraversion, conscientiousness, openness and agreeableness [
The LSAS is the most frequently used clinician-administered instrument for assessment of social anxiety disorder [
All the data were examined using SPSS 18.0 for Windows [
Thirty patients (26.3%) out of the 144 who started the treatment dropped out prematurely from the CBT program and 114 patients were included in the current analysis. The reasons for dropouts were mainly the increased anxiety and the difficulties in this therapy to pursue. In baseline demographic and clinical characteristics, no statistically significant differences were seen among the subgroups (
In regression analysis (
The present study suggests that high levels of three dimensions of NEO-FFI (openness, agreeableness, conscientiousness) at baseline may predict comorbid psychological symptoms reduction in patients with SAD after CBT. Especially high levels of conscientiousness may predict symptom reduction on somatization, obsessive-com- pulsive, anxiety and GSI at endpoint.
Although number of studies has examined the role of particular variables in predicting response to treatment for SAD, the results were inconsistent and inconclusive [
High openness patients are more likely benefit from group psychotherapy by being able to embrace the novel experience that psychotherapy offers [
Completer (N = 114) | Dropout (N = 30) | P value | |
---|---|---|---|
Mean age (SD) Sex (Male, %) Mean age of onset (SD) LSAS (SD) NEO-FFI Neuroticism (SD) NEO-FFI Extraversion (SD) NEO-FFI Openness (SD) NEO-FFI Agreeableness (SD) NEO-FFI Conscientiousness (SD) | 33.4 (10.5) 50% 18.9 (7.8) 75.3 (25.8) 31.6 (8.4) 21.5 (8.2) 28.8 (7.1) 30.9 (6.2) 25.3 (7.3) | 30.7 (10.8) 46.7% 16.7 (5.9) 77.1 (22.5) 29.6 (8.2) 22.3 (6.5) 28.7 (4.5) 29.9 (5.6) 22.1 (8.0) | 0.23 0.75 0.10 0.70 0.24 0.60 0.86 0.37 0.06 |
Note: LSAS, Liebowitz social anxiety scale; NEO-FFI, NEO five factor index ; SD, Standard deviation.
SOM | O-C | I-S | DEP | ANX | HOS | PHOB | PAR | PSY | GSI | |
---|---|---|---|---|---|---|---|---|---|---|
Baseline | 0.64** | 0.73** | 0.59** | 0.61** | 0.54** | 0.51** | 0.69** | 0.46** | 0.56** | 0.63** |
Sex | a | a | 0.17* | a | a | a | a | a | a | a |
Age | a | a | a | a | a | a | a | a | a | a |
Onset | a | a | a | a | a | a | a | a | a | a |
LSAS | a | a | a | a | a | a | a | a | a | a |
Neuroticism | a | a | a | a | a | a | a | a | a | a |
Extraversion | a | a | a | a | a | a | a | a | a | a |
Openness | a | a | a | a | a | a | a | a | −0.17* | a |
Agreeableness | a | a | a | a | a | −0.28** | a | −0.25** | a | a |
Conscientiousness | −0.15* | −0.16* | a | a | −0.16* | a | a | a | a | −0.15* |
Adjusted R-square | 0.41 | 0.57 | 0.40 | 0.36 | 0.31 | 0.42 | 0.47 | 0.32 | 0.31 | 0.42 |
Note:
patients are also more likely to benefit from psychotherapy because they work hard, tolerate discomfort, and delay gratification of impulses and desires [
For the purpose of improving comorbid symptoms with SAD patients, it might be useful to pay more attention to some dimensions of NEO-FFI, especially conscientiousness.
The present study has some limitations. First, we lacked follow-up data and could not refer to long-term effect of CBT for comorbid psychological symptoms. Second, this study did not include several predictors like expectancy regarding therapy or therapist [
The present study suggests that high levels of openness, agreeableness, and conscientiousness of NEO-FFI personality dimensions may predict some comorbid psychological symptoms reduction in SAD patients after CBT.
This study was supported by Grant-in-Aid from the Ministry of Health, Labour and Welfare, Japan.
The authors do not have any conflict of interest to report regarding this study.
SeiOgawa,RisaImai,MasakiKondo,Toshi A.Furukawa,TatsuoAkechi, (2016) Predictors of Comorbid Psychological Symptoms among Patients with Social Anxiety Disorder after Cognitive-Behavioral Therapy. Open Journal of Psychiatry,06,102-106. doi: 10.4236/ojpsych.2016.61012