Psychology, Department of


Date of this Version

Summer 6-2012

Document Type



Emge, T. (2012). The Role of Engagement Across Conceptually Distinct Treatment Elements for Social Anxiety Disorder. PhD Diss., University of Nebraska - Lincoln.


A DISSERTATION Presented to the Faculty of The Graduate College at the University of Nebraska In Partial Fulfillment of Requirements For the Degree of Doctor of Philosophy, Major: Psychology, Under the Supervision of Debra A. Hope, Ph.D. Lincoln, Nebraska: June, 2012

Copyright (c) 2012 Timothy M. Emge


There are currently several efficacious treatments for social anxiety disorder (e.g. exposure therapy and cognitive therapy). Each of these treatments is thought to reduce symptoms of social anxiety by disrupting maintenance mechanisms of the disorder, yet mechanism of change research has not supported this view. The current study compared components from each therapy modality in order to better understand why symptoms reduce similarly between conceptually distinct treatments. Participants with high social anxiety were randomly assigned to give a speech with cognitive restructuring and engagement-enhancing procedures, cognitive preparation and video feedback, or a speech alone. Self-ratings of speech performance, confidence in public speaking, and cost and probability biases were measured at three time points (baseline, post-speech, and post-intervention). Self- and observer-ratings of engagement, peak anxiety, and speech quality were also gathered post-speech. Results indicated instructions designed to boost engagement were not successful, though self-rated engagement across all conditions was strongly related to symptoms improvement. All interventions, despite having distinct procedural elements, were not significantly different from each other in terms of the pattern of change or strength of symptom reduction. Self-ratings did not come into line with third-party observers, despite improvements in cognitive biases. Results regarding the role of engagement across treatments and the hypothesis that both behavioral and cognitive therapies for social anxiety function for similar reasons are discussed. Treatment implications, limitations of the study, and suggestions for future research are also discussed.

Adviser: Debra A. Hope