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Background  Cognitions play an important role in the development and maintenance of social anxiety disorder (SAD).    Methods  To investigate whether changes in cognitions during the first six sessions of exposure therapy are associated with treatment outcome, we assessed reported self-focused attention, self-efficacy in social situations, and estimated social costs in 60 participants ( M  age  = 36.9 years) diagnosed with SAD who received in vivo or virtual reality exposure therapy.    Results  Patients demonstrating a greater decrease in estimated social costs during treatment reported greater improvement of their social anxiety symptoms following both forms of exposure therapy. While changes in self-focused attention and social self-efficacy during treatment were significantly associated with treatment outcome when examined individually, these changes did not significantly predict symptom improvement beyond social costs.    Conclusions  Changes in estimated social costs during treatment are associated with improvement of social anxiety symptoms after exposure therapy. Future research needs to further investigate estimated social costs as a predictor in relation to other cognitive variables.    Trial registration   NCT01746667 ; www.clinicaltrials.gov, November 2012, retrospectively registered.

bmc psychiatry

Cognitive predictors of treatment outcome for exposure therapy: do changes in self-efficacy, self-focused attention, and estimated social costs predict symptom improvement in social anxiety disorder?