The effectiveness of cognitive-behavioral therapy on fear of negative evaluation, interpretation bias and self-focused attention in women with generalized anxiety disorder

Document Type : Research Paper

Authors

1 Master of Clinical Psychology, Department of Clinical Psychology, Faculty of Humanities, Ashtian Branch, Islamic Azad University, Ashtian, Iran.

2 Assistant Professor of Clinical Psychology, Department of Clinical Psychology, Faculty of Humanities, Ashtian Branch, Islamic Azad University, Ashtian, Iran.

Abstract

Introduction: The aim of this study was the effectiveness of cognitive-behavioral therapy on fear of negative evaluation, interpretation bias and self-focused attention in women with generalized anxiety disorder.
Methods: The research method was quasi-experimental with pre-test-post-test design and quarterly follow-up with the control group. The statistical population included women who referred to counseling centers in Qom in 1400. Based on a diagnostic interview and a 7-item scale scale of general anxiety, 24 women were selected by convenience sampling method and randomly divided into two groups of 12 experiments. And controls were divided. The experimental group underwent 9 sessions of 90-60 minutes of cognitive-behavioral therapy based on group protocol (Wildermott, 2008) and the control group did not receive any intervention. Research tools include: Fear of Negative Evaluation Questionnaires (Watson and Friend; 1969), Interpretation Bias of Amir et al. (1998) and Woody, Chambels, & Glass (1997). Data were analyzed using SPSS statistical software and descriptive and inferential tests including multivariate and univariate analysis of covariance.
Results: The findings showed that cognitive-behavioral therapy could reduce the symptoms of generalized anxiety compared to the control group.
Conclusion: Conclusion, cognitive-behavioral therapy can be considered as an effective intervention for women with generalized anxiety disorder.

Keywords


  1. American Psychiatric Association. DSM-5-TR Diagnostic and Statistical Manual of Mental Disorders (First Edition).2022, Translated by Mehdi Ganji. (2022). Tehran: Savalan Publishing.
  2. Patterson TJ, Spritch S, Wilhelm S New Cognitive-Behavioral Therapy (CBT) Strategy (First Edition).2016, Translated by Simin Jafari, Roghayeh Kiani, Amin Rafieipour. (2020). Tehran: New Generation of Thought.
  3. Ganji M. Psychopathology based on DSM-5 (ninth edition). 2021. Tehran: Savalan Publishing.
  4. Saduk JB, Saduk VA, Ruiz P. Summary of Kaplan and Zadok Psychiatry (First Edition). 2015. Translated by Farzin Rezaei. (2015). Tehran: Arjmand Publications, Volume One.
  5. Clark D, Beck A. Worry and Anxiety Workbook (Third Edition). 2012. Translated by Farzin Rezaei. (2019). Tehran: Arjmand Book.
  6. Puklek M. Development of the two forms of social anxiety in adolescence. Horizon of psychology 2008; 13(3),27-40.
  7. Button K, Kounali D. Fear of Negative Evaluation Biases Social Evaluation Inference: Evidence from a Probabilistic Learning Task. PLoS One. 2015; 10(4): PMC4390305.
  8. Masoumi N. Comparison of fear of negative evaluation, fear of body image and eating styles in overweight and normal women. Master Thesis. Islamic Azad University, Shahroud Branch. 2017.
  9. Beadel J. R, Smyth FL, Teachman BA. Change processes during cognitive bias modification for obsessive compulsive beliefs. Journal of Cognitive Therapy Research, 2014; 38:103-119.
  10. Butler G, Mathews A. Cognitive processes in anxiety. Journal Advances in Behavior Research and Therapy, 1983; 5(2): 51-62.
  11. Burack JA, Enns JT, Fox, NA. Cognitive neuroscience, development, and psychology: Typical and atypical developmental trajectories of attention. New York: Oxford University Press. 2012.
  12. Woody SR. Effects of focus of attention on anxiety levels and social performance of individuals with social phobia. Journal of Abnormal Psychology, 1996; 105, 61-69.
  13. Pineles S, & Mineka S. Attentional biases to internal and external sources of potential threat in social anxiety. Journal of Abnormal Psychology, 2005; 114, 314-318.
  14. Hofmann SG, Barlow, DH. Social phobia (social anxiety disorder). In D. H. Barlow (Ed). Anxiety and Its Disorder: The Nature and Treatment of Anxiety and Panic (2nd. Ed., pp. 454-477). New York: The Guilford Press. 2002.
  15. Halgin RP, Whitburn SC. Psychopathology DSM-5 (Eighteenth Edition). 2014. Translated by Yahya Seyed Mohammadi. (2016). Tehran; Psychic Publishing, Volume One.
  16. GhamkharFard Z, Bakhtiari, M, HajiHeidari Z, Puravari M, Tahmassian K. Evaluation of the effectiveness of cognitive-behavioral group therapy on anxiety and fatigue in girls with generalized anxiety disorder. Knowledge and Research in Applied Psychology of the Twentieth Year, No.2019; 3, (77), 132-122.
  17. Beheshtian E, TozandeJohnny H, Saffarian Tusi, M. Comparison of the effectiveness of unit cognitive-behavioral therapy and behavioral activation on fear of negative evaluation in patients with generalized anxiety disorder, Journal of Applied Psychological Research, 2019, 10(4), 106.
  18. Butler, R. Cognitive Behavioral Therapy for Social Anxiety Disorder: Predictors of Treatment Outcome in a Quasi-Naturalistic Setting, Behavior Therapy, 2021; 52(2), 465-477.
  19. Daitch C. Cognitive Behavioral Therapy, Mindfulness, and Hypnosis as Treatment Methods for Generalized Anxiety Disorder, Original Articles, 2018; 17(1), 57-1069.
  20. Spitzer RL, Kroenke K, Williams, JB, Löwe B. A brief measure for assessing, 2006.
  21. Mohammadpanah Ardakan A, Shams Esfandabad S. The role of pervasive anxiety, cognitive bias and resilience in predicting depression in infertile people. Dawn of Health. 2020; 19 (3): 32-42.
  22. Nainian MR, Sha'iri MR, Sharifi M, Hadian M. Assessing the reliability and validity of the short scale of pervasive anxiety disorder. Clinical Psychology and Personality (Behavior Scholar): 2011, 50-41.
  23. Watson D, Friend R. Measurement of social-evaluative anxiety. Journal of Consulting and Clinical Psychology. 1969; 2(3), 448-457.
  24. Sohrabi Z. The effectiveness of self-encouragement and mindfulness training on their thoughts, fear of negative evaluation and cognitive slippage of female students. Master Thesis of Allameh Tabatabai University. 2018.
  25. Amir N, Foa E.B, Coles ME. Negative interpretation bias in social phobia. Behavior Research and Therapy, 1998; 36, 945-957.
  26. Khayer M, Ostvar S, Latifian M, Taqawi MR, Samani, S. The mediating effect of self-focused attention and social self-efficacy on the relationship between social anxiety and arbitrary biases. Iranian Journal of Psychiatry and Clinical Psychology. 2008; Year 14(1).
  27. Gholami Hyderabadi Z, Ebrahimipour S. The effectiveness of cognitive-behavioral therapy techniques on fear of negative evaluation and self-esteem in 11 to 12 year old students in Tehran. Applied Research in Counseling, 2018; 1(2), 18-17.
  28. Hashemi Nosratabad T, Mahmoud Alilou M, Gholizadeh, AThe effectiveness of Hoffman's cognitive-behavioral therapy on reducing fear of negative evaluation and self-focused attention in social anxiety disorder. Journal of Clinical Psychology, 2017; 9 (33), 108.
  29. Dadashzadeh H, Yazdandoost R, Gharaei B, Asgharnejad F. The effectiveness of group cognitive-behavioral therapy and exposure therapy on the rate of interpretation bias and fear of negative evaluation in social anxiety disorder. Iranian Journal of Psychiatry and Clinical Psychology, 2012; 18(1),
  30. Cho Ch, Self-Focused Attention and Social Anxietyļ¼šThe Role of fear of negative evaluation and Interdependent self-construction, Psychological Science, 2018; 5(1), 1261-1267.
  31. Kodal A. Long-term effectiveness of cognitive behavioral therapy for youth with anxiety disorders, Journal of Anxiety Disorders, 2018; 1(53). 58-67.
  32. Arouti Aziz M, Mehri Nejad, SA, Hashemian K, Peyvastegar, M. The effectiveness of cognitive-behavioral therapy on my strength and anxiety in people with generalized anxiety disorder. Psychological Studies, 2020; 16(3), 51-50.
  33. Shahriari H, Zare H, Ali Akbari Dehkordi M, Sarami Foroushani, Gh. The effectiveness of cognitive-behavioral interventions in the treatment of generalized anxiety disorder; A review study with a meta-analysis approach. Journal of Rafsanjan University of Medical Sciences, 2018; 1(17), 473.
  34. Carl J. Efficacy of digital cognitive behavioral therapy for moderate-to-severe symptoms of generalized anxiety disorder: A randomized controlled trial. First published, 2020; 29(1), 14-28.
  35. Dehshiri Gh, The effectiveness of cognitive-behavioral therapy on anxiety and worry in people with generalized anxiety disorder. Journal of Clinical Psychology, 2012; 4(2), 25.
  36. Stefan S, Cristea L, Tatar A, David D. Cognitive-behavioral therapy (CBT) for generalized anxiety disorder: Contrasting various (CBT) approaches in a randomized clinical trial. INTERVENTION RESEARCH, 2019; 20(1), 1-10.
  37. Hofart SR, Chambless DL, Glass CR.  Self-focused attention in the treatment of social phobia. Behaviour Research and Therapy.2008; 35(2): 117-29.
  38. Borkovec TD., Alcaine O, & Behar, EW. Avoidance theory of worry and generalized anxiety disorder. Generalized anxiety disorder: Advances in research and practice, 2004; 20-04.
  39. Davidson JR, Foa EB, Huppert, JD, Keefe, FJ, Franklin ME, Compton, JS, Gadde KM. Fluoxetine, comprehensive cognitive behavioral therapy, and placeboin generalized social phobia. Archives of General Psychiatry. 2004; 61(10), 1005-13
  40. Clark D, Wells A. A cognitive model of social phobia. In R. G. Heimberg & M. R. Liebowitz, Social phobia: Diagnosis, assessment, and treatment (69-93). NewYork: Guilford. 1995.
  41. Hirsch CR, Clark DM. Information-processing bias in social phobia. Clinical Psychology Review, 2004; 24, 799–825.
  42. Herbert JD, Foa EB, Franklin ME, Perry, KJ. Cognitive biases in generalized social phobia. Journal of Abnormal Psychology, 2003; 105, 433-439.
  43. Spurr, JM, Stopa L. Self-focused attention in social phobia and social anxiety. Clinical Psychology Review, 2002; 22, 947-975.