Cognitive Therapy for Social Anxiety Disorder in clinical practice: the importance of adherence, competence, therapeutic relationship and common factors

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The primary goal of the present study is to identify dimensions of therapists` behavior that contribute to a positive outcome of cognitive therapy for social anxiety disorder in clinical practice. Research has shown that adherence to a manual and therapeutic competences (flexible adjustment of the manual to the actual context of treatment) are central therapist factors. Besides, it is assumed that therapeutic alliance and common factors are of major importance for the outcome. Although there is some evidence for these assumptions from trials in a controlled research setting, there are currently no data on the role of therapists`factors in the treatment of social anxiety disorder in clinical practice settings. The planned analyses are based on data available from a study which refers to the effectiveness of a manual-based treatment approach, cognitive therapy for social anxiety disorder. In this study, 49 psychological psychotherapists were randomised to a training in manual-based cognitive therapy of a control condition (no specific training). A total of 166 patients were quasi-randomized to a treatment within one of both therapist conditions. Treatment outcome was assessed using the Liebowitz Social Anxiety Scale (LSAS). 116 treatments have been completed, and the results are currently analysed. Within the proposed add-on study, adherence, competence, common factors and therapeutic alliance of trained vs. non-trained therapists will be analyzed on the basis of audiotapes from treatments. In addition, the contribution of these factors to the prediction of treatment outcome will be analysed. Therapists` behaviour will be assessed by raters who are already trained in some of the rating scales selected for the study. The results may contribute to the improvement of training methods and treatment manuals, in order to optimize training of therapists and treatment of patients with social anxiety disorder in clinical practice.