Can cognitive restructuring serve as a brief stand-alone treatment for social anxiety disorder in adolescence? An exploratory clinical trial


  • Ana Félix
  • Ana Ferreira
  • Paula Vagos Universidade Portucalense Infante D. Henrique



Adolescence, Social anxiety disorder, Cognitive restructuring, Change outcomes


Social anxiety disorder (SAD) is a debilitating and chronic condition that usually arises in adolescence. Cost-effective interventions provided early on may alter its usually chronic trajectory. This study evaluated changes following a brief cognitive restructuring intervention with 14 adolescent girls, against a waitlist control group, on social anxiety, fear of negative and positive evaluation and negative automatic thoughts. Predictors of post-intervention social anxiety scores were also investigated. Results show that social anxiety fluctuated similarly for both groups. Distinctive significant change was found only for performing in formal social situations following the intervention. Change in frequency of automatic negative thoughts significantly predicted post-intervention social anxiety for measures relating to anxiety when interacting and being observed by others. Cognitive restructuring may provide significant change by altering the content (and not the frequency) of thoughts and, in its current short form, may be relevant to the specific performance type of SAD. 


Não há dados estatísticos.


Albano, A. M & DiBartolo, P. M. (2007). Cognitive-behavioral therapy for social phobia in adolescents: Stand up, speak out, therapist guide—Oxford Clinical Psychology.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5.a ed.). American Psychiatric Association.

Barrera, T. L., Szafranski, D. D., Ratcliff, C. G., Garnaat, S. L., & Norton, P. J. (2016). An experimental comparison of techniques: Cognitive defusion, cognitive restructuring, and in-vivo exposure for social anxiety. Behavioural and Cognitive Psychotherapy, 44(2), 249–254.

Beesdo, K., Bittner, A., Pine, D. S., Stein, M. B., Höfler, M., Lieb, R., & Wittchen, H.-U. (2007). Incidence of social anxiety disorder and the consistent risk for secondary depression in the first three decades of life. Archives of General Psychiatry, 64(8), 903–912.

Bento, C. & Salvador, M. C. (2011). A escala de pensamento automáticos em situações sociais para adolescentes: Características psicométricas [The automatic thoughts in social situations for adolescents: Psychometric characteristics]. Poster presented at II Jornadas Internacionais do CINEICC, Coimbra.

Canvin, L. K., Janecka, M., & Clark, D. M. (2016). Focusing attention on oneself increases the perception of being observed by others. Journal of Experimental Psychopathology, 7(2), 160–171.

Correia, L., Vagos, P., & Rijo, D. (2014). A versão específica da Escala de Medo de Avaliação Negativa – Dimensionalidade e características psicométricas numa amostra de adolescentes. Laboratório de Psicologia, 12.

Cunha, M., Gouveia, J. P., & do Céu Salvador, M. (2008). Social fears in adolescence: The Social Anxiety and Avoidance Scale for Adolescents. European Psychologist, 13(3), 197–213.

Cunha, M., Pinto-Gouveia, J., Alegre, S., & do Céu Salvador, M. (2004). Avaliação da ansiedade na adolescência: A versão portuguesa da SAS-A. Psychologica, 35, 245–263.

D’Avanzato, C., & Dalrymple, K. L. (2016). Recent insight into the subtypes of social anxiety disorder. Current Psychiatry Reports, 18(5), 50.

Essau, C., Conradt, J., & Petermann, F. (1998). Frequency and comorbidity of social anxiety and social phobia in adolescents. Results of a Bremen adolescent study. Fortschritte der Neurologie-Psychiatrie, 66, 524–530.

Fredrick, J. W., & Luebbe, A. M. (2020). Fear of positive evaluation and social anxiety: A systematic review of trait-based findings. Journal of Affective Disorders, 265, 157–168.

Hayward, C., Varady, S., Albano, A. M., Thienemann, M., Henderson, L., & Schatzberg, A. F. (2000). Cognitive-behavioral group therapy for social phobia in female adolescents: Results of a pilot study. Journal of the American Academy of Child and Adolescent Psychiatry, 39(6), 721–726.

Heimberg, R. G., Brozovich, F. A., & Rapee, R. M. (2010). Chapter 15 - A cognitive behavioral model of social anxiety disorder: Update and extension. In S. G. Hofmann & P. M. DiBartolo (Eds.), Social anxiety - Second edition (pp. 395–422). Academic Press.

Hope, D. A., Burns, J. A., Hayes, S. A., Herbert, J. D., & Warner, M. D. (2010). Automatic thoughts and cognitive restructuring in cognitive behavioral group therapy for social anxiety disorder. Cognitive Therapy and Research, 34(1), 1–12.

Jystad, I., Bjerkeset, O., Haugan, T., Sund, E. R., & Vaag, J. (2021). Sociodemographic correlates and mental health comorbidities in adolescents with social anxiety: The Young-HUNT3 Study, Norway. Frontiers in Psychology, 12.

Kodal, A., Bjelland, I., Gjestad, R., Wergeland, G. J., Havik, O. E., Heiervang, E. R., & Fjermestad, K. (2017). Subtyping social anxiety in youth. Journal of Anxiety Disorders, 49, 40–47.

Leigh, E., Chiu, K., & Clark, D. M. (2020). The effects of modifying mental imagery in adolescent social anxiety. PloS One, 15(4), e0230826.

Masia, C. L., Klein, R. G., Storch, E. A., & Corda, B. (2001). School-based behavioral treatment for social anxiety disorder in adolescents: Results of a pilot study. Journal of the American Academy of Child and Adolescent Psychiatry, 40(7), 780–786.

Norton, A. R., & Abbott, M. J. (2016). The efficacy of imagery rescripting compared to cognitive restructuring for social anxiety disorder. Journal of Anxiety Disorders, 40, 18–28.

Rao, P. A., Beidel, D. C., Turner, S. M., Ammerman, R. T., Crosby, L. E., & Sallee, F. R. (2007). Social anxiety disorder in childhood and adolescence: Descriptive psychopathology. Behaviour Research and Therapy, 45(6), 1181–1191.

Reichenberger, J., & Blechert, J. (2018). Malaise with praise: A narrative review of 10 years of research on the concept of Fear of Positive Evaluation in social anxiety. Depression and Anxiety, 35(12), 1228–1238.

Rijo, D., Brazão, N., Barroso, R., da Silva, D. R., Vagos, P., Vieira, A., Lavado, A., & Macedo, A. M. (2016). Mental health problems in male young offenders in custodial versus community based-programs: Implications for juvenile justice interventions. Child and Adolescent Psychiatry and Mental Health, 10, 40.

Rodebaugh, T. L., Heimberg, R. G., Brown, P. J., Fernandez, K. C., Blanco, C., Schneier, F. R., & Liebowitz, M. R. (2011). More reasons to be straightforward: Findings and norms for two scales relevant to social anxiety. Journal of Anxiety Disorders, 25(5), 623–630.

Spence, S. H., Donovan, C., & Brechman-Toussaint, M. (2000). The treatment of childhood social phobia: The effectiveness of a social skills training-based, cognitive-behavioural intervention, with and without parental involvement. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 41(6), 713–726.

Vagos, P., Pereira, A., & Cunha, M. (2014). Evaluating social fears in late adolescence: Study with a Portuguese sample. European Journal of Developmental Psychology, 11(3), 373–385.

Vagos, P., Salvador, M., do C., Rijo, D., Santos, I., Weeks, J., & Heimberg, R. (2015). Measuring evaluation fears in adolescence: Psychometric validation of the portuguese versions of the Fear of Positive Evaluation Scale and the Specific Fear of Negative Evaluation Scale. Measurement and Evaluation in Counseling and Development, 49.

Warner, C. M., Fisher, P. H., Shrout, P. E., Rathor, S., & Klein, R. G. (2007). Treating adolescents with social anxiety disorder in school: An attention control trial. Journal of Child Psychology and Psychiatry, 48(7), 676–686.

Weeks, J. W., Heimberg, R. G., Rodebaugh, T. L., Goldin, P. R., & Gross, J. J. (2012). Psychometric evaluation of the Fear of Positive Evaluation Scale in patients with social anxiety disorder. Psychological Assessment, 24(2), 301–312.

Weeks, J., & Howell, A. (2012). The Bivalent Fear of Evaluation Model of Social Anxiety: Further Integrating Findings on Fears of Positive and Negative Evaluation. Cognitive behaviour therapy, 41, 83–95.

Wild, J., & Clark, D. M. (2011). imagery rescripting of early traumatic memories in social phobia. Cognitive and Behavioral Practice, 18(4), 433–443.

Wong, Q. J. J., & Rapee, R. M. (2016). The aetiology and maintenance of social anxiety disorder: A synthesis of complimentary theoretical models and formulation of a new integrated model. Journal of Affective Disorders, 203, 84–100.



Como Citar

Félix, A., Ferreira, A., & Vagos, P. (2022). Can cognitive restructuring serve as a brief stand-alone treatment for social anxiety disorder in adolescence? An exploratory clinical trial. PSICOLOGIA, 36(2), 99–107.