Network changes in psychopathological symptoms following cognitive behavioral therapy for social anxiety disorder: evidence from 29 university outpatient clinics

While network theory posits that interactions between social anxiety symptoms perpetuate social anxiety disorder (SAD), findings on how these networks change following treatment remain inconsistent. This study used data from 29 university outpatient clinics in Germany to estimate psychopathological symptom networks for patients with SAD at pre-treatment, explore critical symptoms and connections in pre- and post-treatment networks, and identify network changes in remitted vs. non-remitted patients. By using the Brief Symptom Inventory to measure transdiagnostic symptoms in 2,392 patients with SAD, 59.8% female, M ( SD ) age = 30.46 (10.71), we estimated six networks using Gaussian Graphical Models. Further, network comparisons were performed between patients who achieved remission ( n = 277) and those who did not achieve remission of SAD at post-treatment ( n = 266). In baseline networks, four themes emerged: negative self-evaluation, loneliness, problems with cognitive functioning, and fear-related experiences. The network structure and global connectivity of remitted networks were significantly changed after treatment ( M = 0.30, p = .012; S = 20.46, p < .001). The global strength of non-remitted networks increased, whereas the overall network structure remained largely unchanged after treatment ( M = 0.30, p = .203; S = 21.93, p = .011). This study identified four core symptom themes in networks of patients with SAD. Structural changes in these themes were associated with remission after treatment, whereas the themes remained present in patients who continued to meet the criteria for SAD. These results highlight the importance of targeting core symptom clusters and their interconnections in effective SAD treatment.