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# Efficacy of cognitive behavioral therapy for social anxiety disorder

## Problem

Social anxiety disorder is a mental illness characterized by excessive fear or anxiety about one or more social situations. Individuals with social Anxiety Disorder are irrationally afraid of exposure to negative evaluation or scrutiny from others in social situations, and often avoid social interaction all together. For those with social anxiety disorder, socializing with others is endured, not enjoyed. This causes significant disturbances in daily functioning, and impairments are typically chronic and pervasive.
Cognitive Behavioral Therapy (CBT) seeks to actively change irrational thoughts and behaviors. A top CBT researcher decides to evaluate the potential of a manual-based CBT intervention to treat symptoms of social anxiety disorder, and change irrational thoughts and behaviors related to social situations. To do this, he recruits 50 clinical psychologists with advanced training in CBT. Each therapist is given a manual to use as a guide for therapy sessions, with enough content for 22 individual sessions. The manual includes a variety of CBT exercises, including role-play based behavioral exercises, challenges designed to restructure irrational or dysfunctional thoughts, biofeedback exercises, and goal setting tasks.
To participate, individuals must have a primary diagnosis of Social Anxiety Disorder, and must not have any severe medical conditions, history of self-harm, or current diagnosis of a substance-use disorder. Of the 500 individuals who respond to an internet-based advertisement, 420 meet the eligibility criteria. They are then randomized the active (CBT; n = 210) or control (waitlist; n = 210) condition. Each participant completes questionnaires related to social anxiety, social phobia or anxiety symptoms, and depression at baseline and after 22 weeks. There are no significant demographic differences between the groups; there are equal numbers of men and women enrolled in the study and all participants are between the ages of 18 and 60, with a mean age of 38, point, 8 (SD = 12, point, 09).
Table 1 contains means of the outcome variables. Scores on the social anxiety questionnaire range from 0 to 100, scores on the social phobia and anxiety questionnaire range from 0 to 100, and scores on the depression questionnaire range from 0 to 30. Higher scores on any of the measures indicate greater pathology.
Table 1CBTWaitlist
Social AnxietyPre72, point, 0473, point, 04
Post21, point, 0770, point, 13
Social Phobia and Anxiety Pre90, point, 1989, point, 91
Post40, point, 2888, point, 70
DepressionPre15, point, 2815, point, 34
Post6, point, 4015, point, 20
Some experts believe that anxiety is a learned response acquired through classical conditioning. A patient in the study recalls that she used to be able to go out with friends without feeling anxious. One night, she was attacked while out at a bar with friends. She now avoids socializing with friends, going out to bars, and remains very anxious about social situations in general. What is the neutral stimulus (NS) and conditioned response (CR) in this scenario?