The dynamics of change underlying the resolution of social anxiety in individuals receiving CBT treatment.

Cognitive models of social anxiety disorder (SAD) provide theoretical frameworks explaining maintaining factors and guide treatment protocols. While cognitive behaviour therapy (CBT) is efficacious for SAD, mechanisms of change remain under-investigated. This study modelled the synchrony of change among maintaining factors of SAD during CBT and investigated when and in what sequence change occurred. We analysed sessional data from 551 patients undertaking CBT for SAD up to 22 sessions in London (UK) primary care psychological treatment services. Dynamic Exploratory Graph Analysis was used to model velocity (rate of symptom improvement) and acceleration/deceleration (changes in the rate of improvement) of maintaining factors. This approach revealed synchronised change patterns, with peak change sequence plotting identifying critical periods of improvement. Results demonstrated pronounced synchronised change between self-referential processes and avoidance, forming a change component. A second change component that showed internal synchronisation comprised pre-event processing, state anxiety, functioning impairment, and depressive mood. Limited synchrony was observed between these two components, suggesting distinct change processes. Peak change analysis revealed three phases that map onto the CBT protocol: initial improvements (sessions 1-4), where the focus is on self-focused attention and safety behaviours; improvements in self-referential processes and avoidance (sessions 5-10), coinciding with behavioural experiments; and consolidation of change (sessions 10+) in second component factors. This study provides empirical validation of theoretical SAD models and illuminates temporal change dynamics. Clinicians should consider treatment momentum for two distinct change components given their different rates of change and limited inter-component synchrony. This understanding allows clinicians to strategically adapt and pace interventions.