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

Abstract 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.

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Journal
BMC Psychology
Published
2026-11-10
DOI
https://doi.org/10.1186/s40359-026-05900-9
Primary Topic
Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Type
article
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article

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

Julia Anna Glombiewski, Andre Pittig, Anne‐Kathrin Bräscher, Wen Xu et al.
BMC Psychology
Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
article

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

Julia Anna Glombiewski, Andre Pittig, Anne‐Kathrin Bräscher, Wen Xu, Sylvia Helbig‐Lang, Stephan Bartholdy, Tobias Teismann, Ulrike Lueken, Patrizia Odyniec, Julia Velten, Tina In‐Albon, Rudolf M. Stark, Almut Rudolph, Christiane Hermann, Gabriele Wilz, Antonia Vehlen, Julian A. Rubel, Anya Pedersen, Brian Schwartz, Miriam Ina Hehlmann, Tabea L.K. Schweden, Katja Werheid, Tim Klucken, Tania M. Lincoln, Saskia Scholten, Andrea Hermann, Wolfgang Lutz, Thomas Forkmann, Babette Renneberg, Hanna Christiansen, Tanja Michael, Ulrike Willutzki, Anke Kirsch, Anne Katrin Risch, Jürgen Hoyer, Elisa-Maria Berger, Jürgen Margraf
article en

Abstract

Abstract 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.

BMC PsychologyVol. 14(1)
Witten/Herdecke University (DE), Universität Hamburg (DE), Philipps University of Marburg (DE), Osnabrück University (DE), University of Mannheim (DE), Johannes Gutenberg University Mainz (DE), Justus-Liebig-Universität Gießen (DE), Bielefeld University (DE), University of Siegen (DE), Christian-Albrechts-Universität zu Kiel (DE), Universität Greifswald (DE), Humboldt-Universität zu Berlin (DE), Rheinland-Pfälzische Technische Universität Kaiserslautern-Landau (DE), University of Duisburg-Essen (DE), University of Göttingen (DE), Freie Universität Berlin (DE), Friedrich Schiller University Jena (DE), Technische Universität Dresden (DE), Universität Trier (DE), Ruhr University Bochum (DE), Saarland University (DE), Leipzig University (DE)
Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
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