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Behavior Modification, Vol. 32, No. 4, 504-518 (2008)
DOI: 10.1177/0145445507309302

The Exposure Hierarchy as a Measure of Progress and Efficacy in the Treatment of Social Anxiety Disorder

Marina Katerelos

Anxiety Treatment and Research Centre, St. Joseph's Healthcare

Lance L. Hawley

Anxiety Treatment and Research Centre, St. Joseph's Healthcare

Martin M. Antony

Anxiety Treatment and Research Centre, St. Joseph's Healthcare, Ryerson University, Toronto

Randi E. McCabe

Anxiety Treatment and Research Centre, St. Joseph's Healthcare, McMaster University, Hamilton, Canada

This study explored the psychometric properties and utility of the exposure hierarchy as a measure of treatment outcome for social anxiety disorder (SAD). An exposure hierarchy was created for each of 103 individuals with a diagnosis of SAD who completed a course of cognitive behavioral group therapy. Exposure hierarchy ratings were collected on a weekly basis, and a series of self-report measures were collected before and after treatment. Results indicated that the exposure hierarchy demonstrated high test-retest reliability, as well as significant convergent validity, as participants' exposure hierarchy ratings correlated positively with scores on conceptually related measures. Hierarchy ratings were significantly associated with changes in SAD symptoms over time. However, exposure hierarchy ratings were correlated to general measures of psychopathology, suggesting limited discriminant validity. The study highlights the clinical and scientific utility of the exposure hierarchy.

Key Words: exposure hierarchy • cognitive behavioral therapy • social anxiety disorder


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