Efficacy of the trial-based thought record, a new cognitive therapy strategy designed to change core beliefs, in social phobia

I. R. De Oliveira, Universidade Federal da Bahia
V. B. Powell, Universidade Federal da Bahia
A. Wenzel, University of Pennsylvania
M. Caldas, Universidade Federal da Bahia
C. Seixas, Universidade Federal da Bahia
C. Almeida, Universidade Federal da Bahia
T. Bonfim, Universidade Federal da Bahia
M. C. Grangeon, Universidade Federal da Bahia
M. Castro, Universidade Federal da Bahia
A. Galvão, Universidade Federal da Bahia
R. De Oliveira Moraes, Universidade Federal da Bahia
Donna M. Sudak, Department of Psychiatry, Drexel University College of Medicine, Philadelphia, PA


What is known and Background: Social anxiety disorder (SAD) often follows a chronic course and is associated with substantial impairment in functioning. Although results from clinical trials clearly establish evidence for efficacy of cognitive behavioural therapy in treating this disorder, up to 50% of patients with SAD show little or no improvement. Thus, new approaches that have promised in improving the efficacy of treatment for SAD are needed. One such approach is the trial-based thought record (TBTR), which targets the restructuring of patients' core beliefs. Objective: To determine whether patients receiving TBTR would report fewer symptoms of social anxiety and general psychiatric distress following treatment, relative to conventional cognitive therapy (CCT). Methods: A two-arm randomized trial comparing TBTR (n = 17) with a set of CCT techniques (n = 19), which included the standard seven-column dysfunctional thought record and the positive data log in SAD patients according to DSM-IV. Results: Scores on many outcome measures decreased significantly across the course of treatment in both groups (P < 0.001), including the Liebowitz Social Anxiety Scale, Fear of Negative Evaluation Scale (FNE), Social Avoidance and Distress Scale (SADS), Beck Anxiety Inventory, and Clinical Global Impression - Improvement. In addition, a one-way ancova, taking baseline values as covariates, showed that TBTR was significantly more efficacious than CCT in reducing the scores of FNE (P = 0.01 at mid-treatment and P = 0.004 at post-treatment), and SADS (P = 0.03 at post-treatment). What is new and Conclusion: This study provides preliminary evidence that TBTR is at least as efficacious as CCT in reducing symptoms of SAD, pointing to the need for additional studies of TBTR in SAD and other psychiatric disorders. © 2011 Blackwell Publishing Ltd.