ACT may be recommended as atreatment for social anxiety disorderbecause it targets key maintaining factors, such as experiential avoidance and self-critical thoughts, while promoting behavior change in alignment with personal values.
By cultivatingmindfulness, self-compassion, and committed action, ACT can help individuals with social anxiety disorder cope with their fears, reduce avoidance, and improve their quality of life.
Key Points
Rationale
Social anxiety disorder is a common and debilitating condition affecting approximately 13% of the population (Kessler et al., 2012). It can lead to social isolation, impaired functioning, and economic burden (Teo et al., 2013; Hofmann & Otto, 2008; Dams et al., 2017).
While cognitive-behavioral therapy has shown efficacy, some patients do not respond or symptoms remain (Dalrymple & Herbert, 2007).
Recent studies have explored the effectiveness ofACT for anxiety disorders(Twohig et al., 2006; Eifert et al., 2009; Roemer et al., 2008).
However, more research is needed to determine ACT’s efficacy for social anxiety disorder, especially in different cultures and for emotion regulation variables (Azadeh et al., 2016; Dalrymple & Herbert, 2007).
Method
This semi-experimental clinical trial randomly divided twenty-four students with social anxiety disorder into an experimental group (n=12) receiving 12 ACT sessions and a control group (n=12) on the waiting list.
Participants were assessed at pre-test, post-test, and two-month follow-up using the following measures:
Measures
Procedure
Students with social anxiety symptoms underwent a diagnostic interview. Those meeting inclusion criteria were randomly assigned to the experimental or control group.
The experimental group received twelve 90-minute ACT sessions tailored to their needs, while the control group was put on a waiting list and received treatment after final evaluations.
Sample
Twenty-two students (15 women, 7 men) with a mean age of 22.12±1.08 completed the study.
Statistical Analysis
Multivariate analysis of covariance was used to compare the experimental and control groups on the target variables. Data normality was verified using the Kolmogorov-Smirnov test.
Equality of covariance matrices and error variances were checked using Box’s M and Leven’s tests, respectively.
Results
ACT significantly reduced external shame, social anxiety, difficulty in emotion regulation, and increased psychological flexibility and self-compassion in the experimental group compared to the control group at post-test and follow-up (p < 0.05).
The largest effect size was for increasing psychological flexibility (43-67%). The smallest effect sizes were for “difficulty in impulse control” and “limited access to emotional strategies” components.
Insight
This study demonstrates ACT’s effectiveness in improving psychological symptoms in students with social anxiety disorder.
By targeting acceptance, committed action, and psychological flexibility, ACT helped reduce shame, anxiety, and emotion dysregulation while increasing self-compassion.
The robust effects on psychological flexibility align with ACT’s theoretical model. Notably, ACT impacted emotion regulation, suggesting it changes emotional experience in addition to one’s relationship with emotions.
Future research could explore ACT’s mechanisms of change and long-term effects in larger, more diverse samples. Integrating self-compassion training into ACT may enhance outcomes.
Strengths
The study had several methodological strengths:
Limitations
Some limitations should be noted:
Implications
ACT appears to be an effective treatment for social anxiety disorder, reducing symptoms and improving psychological flexibility and emotion regulation.
Clinicians may consider using ACT with socially anxious clients, emphasizing acceptance and action aligned with values.
The findings support ACT’s transdiagnostic applicability, as it impacted both disorder-specific and broader outcomes. Policymakers may promote access to ACT as an evidence-based option.
However, further research in real-world settings with larger and more diverse samples is warranted to confirm and extend the findings.
References
Primary reference
Khoramnia, S., Bavafa, A., Jaberghaderi, N., Parvizifard, A., Foroughi, A., Ahmadi, M., & Amiri, S. (2020). The effectiveness of acceptance and commitment therapy for social anxiety disorder: a randomized clinical trial.Trends in psychiatry and psychotherapy,42, 30-38.https://doi.org/10.1590/2237-6089-2019-0003
Other references
Azadeh, S. M., Kazemi-Zahrani, H., & Besharat, M. A. (2016). Effectiveness of acceptance and commitment therapy on interpersonal problemsand psychological flexibility in female high school students with social anxiety disorder.Global journal of health science,8(3), 131.
Dams, J., König, H. H., Bleibler, F., Hoyer, J., Wiltink, J., Beutel, M. E., … & Konnopka, A. (2017). Excess costs of social anxiety disorder in Germany.Journal of Affective Disorders,213, 23-29.https://doi.org/10.1016/j.jad.2017.01.041
Dalrymple, K. L., & Herbert, J. D. (2007). Acceptance and commitment therapy for generalized social anxiety disorder: A pilot study.Behavior modification,31(5), 543-568.https://doi.org/10.1177/0145445507302037
Eifert, G. H., Forsyth, J. P., Arch, J., Espejo, E., Keller, M., & Langer, D. (2009). Acceptance and commitment therapy for anxiety disorders: Three case studies exemplifying a unified treatment protocol.Cognitive and behavioral practice,16(4), 368-385.https://doi.org/10.1016/j.cbpra.2009.06.001
Hofmann, S. G., & Otto, M. W. (2008).Cognitive behavioral therapy for social anxiety disorder: Evidence-based and disorder-specific treatment techniques. Routledge.https://doi.org/10.4324/9780203927526
Kessler, R. C., Petukhova, M., Sampson, N. A., Zaslavsky, A. M., & Wittchen, H. U. (2012). Twelve‐month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States.International journal of methods in psychiatric research,21(3), 169-184.https://doi.org/10.1002/mpr.1359
Roemer, L., Orsillo, S. M., & Salters-Pedneault, K. (2008). Efficacy of an acceptance-based behavior therapy for generalized anxiety disorder: evaluation in a randomized controlled trial.Journal of consulting and clinical psychology,76(6), 1083.https://doi.org/10.1037/a0012720
Teo, A. R., Lerrigo, R., & Rogers, M. A. (2013). The role of social isolation in social anxiety disorder: A systematic review and meta-analysis.Journal of anxiety disorders,27(4), 353-364.https://doi.org/10.1016/j.janxdis.2013.03.010
Twohig, M. P., Hayes, S. C., & Masuda, A. (2006). Increasing willingness to experience obsessions: Acceptance and commitment therapy as a treatment for obsessive-compulsive disorder.Behavior therapy,37(1), 3-13.https://doi.org/10.1016/j.beth.2005.02.001
Keep Learning
Here are some questions for a college class to discuss this paper:
Saul McLeod, PhD
BSc (Hons) Psychology, MRes, PhD, University of Manchester
Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.
Olivia Guy-Evans, MSc
BSc (Hons) Psychology, MSc Psychology of Education
Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.
