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Objective: Eating disorders (EDs) often co‐occur with social anxiety disorder (SAD). However, little research has examined the influence of SAD symptoms on ED treatment outcomes in the context of individual outpatient cognitive‐behavior therapy for eating disorders (CBT‐ED). It is plausible that SAD symptom severity could improve as a result of ED treatment, given the high overlap between EDs and SAD. We sought to test whether baseline SAD symptoms moderate early response to CBT‐ED or post‐treatment outcomes in CBT‐ED, and the degree to which SAD symptoms improve during therapy despite SAD not being an explicit treatment target. Method: ED clients (N = 226) aged ≥16 years were treated with CBT‐ED. Outcomes were ED symptoms, clinical impairment, and SAD symptoms measured at baseline, session 5 and post‐treatment. Results: Baseline SAD was a weak moderator of early and post‐treatment ED symptoms and impairment. SAD symptoms improved moderately over treatment among clients who started with elevated levels of SAD symptomology. Discussion: Clients with EDs can experience good therapeutic outcomes regardless of their social anxiety severity at pre‐treatment. SAD symptoms reduced over CBT‐ED, but protocol enhancements such as exposure‐based strategies that directly target co‐occurring social‐evaluative concerns may help achieve larger reductions in SAD symptoms. Public significance: Eating disorders often co‐occur with anxiety disorders such as social anxiety. We found people who had both social anxiety and an eating disorder benefited as much from eating disorder treatment as people who did not have social anxiety. People who were socially anxious became less anxious as a by‐product of receiving eating disorder treatment. It may be possible to reduce social anxiety further by enhancing eating disorder treatment protocols. [ABSTRACT FROM AUTHOR]

Classic parametric statistical significance tests, such as analysis of variance and least squares regression, are widely used by researchers in many disciplines, including psychology. For classic parametric tests to produce accurate results, the assumptions underlying them (e.g., normality and homoscedasticity) must be satisfied. These assumptions are rarely met when analyzing real data. The use of classic parametric methods with violated assumptions can result in the inaccurate computation of p values, effect sizes, and confidence intervals. This may lead to substantive errors in the interpretation of data. Many modern robust statistical methods alleviate the problems inherent in using parametric methods with violated assumptions, yet modern methods are rarely used by researchers. The authors examine why this is the case, arguing that most researchers are unaware of the serious limitations of classic methods and are unfamiliar with modern alternatives. A range of modern robust and rank-based significance tests suitable for analyzing a wide range of designs is introduced. Practical advice on conducting modern analyses using software such as SPSS, SAS, and R is provided. The authors conclude by discussing robust effect size indices. (Contains 1 table.)

Background: Repetitive negative thinking is conceptualized to be a transdiagnostic process linked to the development and maintenance of psychopathology. Prior research distinguishes between disorder-specific exemplars (worry, rumination) and transdiagnostic measures of repetitive negative thinking with differences across disorders reported. However, establishing the measurement invariance of these measures is necessary to support meaningful comparisons across clinical groups. Method: Bayesian structural equation modelling was used to assess the approximate invariance of the Ruminative Response Scale, Penn State Worry Questionnaire, and the Repetitive Thinking Questionnaire across individuals with a principal diagnosis of either depressive disorder, social anxiety disorder, or generalized anxiety disorder. Results: All scales demonstrated approximate measurement invariance across the three disorder groups. The depressive disorder group reported a higher level of rumination than the generalized anxiety disorder group (Δµ = 0.25, 95% Credibility Interval [0.06, 0.45]), with no difference between the generalized anxiety disorder and social anxiety disorder groups. The depressive disorder and generalized anxiety disorder groups did not differ in their levels of trait repetitive negative thinking, but the social anxiety disorder group was markedly lower than the generalized anxiety disorder group (Δµ = −0.21 [−0.37, −0.05]). Similarly, levels of worry did not differ between the generalized anxiety disorder and depressive disorder group but were lower in the social anxiety disorder group than the generalized anxiety disorder group (Δµ = −0.23 [−0.41, −0.06]). Conclusions: The Ruminative Response Scale, Penn State Worry Questionnaire, and Repetitive Thinking Questionnaire are measuring trait repetitive negative thinking in a consistent manner across individuals with a principal diagnosis of depressive disorder, social anxiety disorder, or generalized anxiety disorder. This supports their use in transdiagnostic contexts and indicates that it is appropriate to directly compare the scores on these measures between diagnostic groups. [ABSTRACT FROM AUTHOR]

Classic parametric statistical significance tests, such as analysis of' variance and least squares regression, are widely used by researchers in many disciplines, including psychology. For classic parametric tests to produce accurate results, the assumptions underlying them (e.g., normality and homoscedasticity) must be satisfied. These assumptions are rarely met when analyzing real data. The use of classic parametric methods with violated assumptions can result in the inaccurate computation of p values. effect sizes, and confidence intervals. This may lead to substantive errors in the interpretation of data. Many modern robust statistical methods alleviate the problems inherent in using parametric methods with violated assumptions, vet modern methods are rarely used by researchers. The authors examine why this is the case, arguing that most researchers are unaware of the serious limitations of classic methods and are unfamiliar with modern alternatives. A range of modern robust and rank-based significance tests suitable for analyzing a wide range of designs is introduced. Practical advice on conducting modern analyses using software such as SPSS, SAS, and R is provided. The authors conclude by discussing robust effect size indices. Keywords: robust statistics, nonparametric statistics, effect size, significance testing, software

Background: The Bivalent Fear of Evaluation Model proposes that the fears of positive and negative evaluation each uniquely contribute to social anxiety severity. However, the debate continues as to whether these are distinct constructs, and, if so, the degree of influence each has on social anxiety severity. This study used a longitudinal evaluation of these relationships in a clinical sample to identify whether the two fears differentially change over time and differentially relate to social anxiety severity.Methods: Individuals with a social anxiety disorder (N = 105) completed measures of fears of negative and positive evaluation weekly, and social interaction anxiety monthly, for 12 weeks. Temporal relationships were assessed using residual dynamic structural equation modeling.Results: Fears of positive and negative evaluation both predicted the future status of the other (ϕ = 0.18, 95% credibility interval [0.10-0.28] and ϕ = 0.22 [0.12-0.35], respectively). Fear of negative evaluation (ϕ = 0.16 [0.05-0.28]) but not positive evaluation (ϕ < 0.01 [-0.09 to 0.10]) directly predicted future social anxiety severity. Fear of positive evaluation only indirectly predicted anxiety severity via fear of negative evaluation.Conclusions: Previous fears of negative evaluation could not fully explain future fears of positive evaluation (or vice-versa), which is consistent with the two constructs being likely distinct in social anxiety disorder. Given its more direct relationship with social anxiety severity, fear of negative evaluation should be targeted in treatment, as this could both directly reduce social anxiety severity and minimize the indirect impact of fear of positive evaluation. [ABSTRACT FROM AUTHOR]

The most common strategy for comparing two independent groups is in terms of some measure of location intended to reflect the typical observation. However, it can be informative and important to compare the lower and upper quantiles as well, but when there are tied values, extant techniques suffer from practical concerns reviewed in the paper. For the special case where the goal is to compare the medians, a slight generalization of the percentile bootstrap method performs well in terms of controlling Type I errors when there are tied values [Wilcox RR. Comparing medians. Comput. Statist. Data Anal. 2006;51:1934–1943]. But our results indicate that when the goal is to compare the quartiles, or quantiles close to zero or one, this approach is highly unsatisfactory when the quantiles are estimated using a single order statistic or a weighted average of two order statistics. The main result in this paper is that when using the Harrell–Davis estimator, which uses all of the order statistics to estimate a quantile, control over the Type I error probability can be achieved in simulations, even when there are tied values, provided the sample sizes are not too small. It is demonstrated that this method can also have substantially higher power than the distribution free method derived by Doksum and Sievers [Plotting with confidence: graphical comparisons of two populations. Biometrika 1976;63:421–434]. Data from two studies are used to illustrate the practical advantages of the method studied here. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Method Results Discussion Interpersonal problems have been identified as a plausible mechanism underlying the onset and maintenance of eating disorders. The Interpersonal Relationships in Eating Disorders (IR‐ED) scale is the first eating disorders‐specific measure of interpersonal problems, which was developed in a nonclinical sample. The aims of the current study were to (a) confirm the factor structure of the IR‐ED within a large clinical sample, (b) investigate measurement invariance of the IR‐ED across nonclinical and clinical samples, (c) examine the convergent validity of the IR‐ED using a generic measure of interpersonal problems, and (d) investigate the incremental clinical utility of the IR‐ED in uniquely predicting eating disorder symptomatology.Treatment‐seeking individuals (N = 437) completed the IR‐ED at their initial assessment appointment at a specialist eating disorder outpatient service.A multiple‐group confirmatory factor analysis supported an invariant bifactor structure comprising a general interpersonal problems factor and two group factors—Avoidance of Body Evaluation and Food‐Related Interpersonal Tension. Convergent validity was demonstrated by a large, statistically significant correlation with a generic measure of interpersonal problems (r = 0.62, p < 0.001). A series of structural equation models further revealed unique incremental predictive utility of the IR‐ED for eating disorder symptomatology.The IR‐ED has strong psychometric properties and may prove beneficial in the assessment, formulation, and treatment of eating‐specific interpersonal problems among patients with eating disorders. [ABSTRACT FROM AUTHOR]

Background: Cognitive behavior therapy (CBT) is effective for most patients with a social anxiety disorder (SAD) but a substantial proportion fails to remit. Experimental and clinical research suggests that enhancing CBT using imagery-based techniques could improve outcomes. It was hypothesized that imagery-enhanced CBT (IE-CBT) would be superior to verbally-based CBT (VB-CBT) on pre-registered outcomes., Methods: A randomized controlled trial of IE-CBT v. VB-CBT for social anxiety was completed in a community mental health clinic setting. Participants were randomized to IE (n = 53) or VB (n = 54) CBT, with 1-month (primary end point) and 6-month follow-up assessments. Participants completed 12, 2-hour, weekly sessions of IE-CBT or VB-CBT plus 1-month follow-up., Results: Intention to treat analyses showed very large within-treatment effect sizes on the social interaction anxiety at all time points (ds = 2.09-2.62), with no between-treatment differences on this outcome or clinician-rated severity [1-month OR = 1.45 (0.45, 4.62), p = 0.53; 6-month OR = 1.31 (0.42, 4.08), p = 0.65], SAD remission (1-month: IE = 61.04%, VB = 55.09%, p = 0.59); 6-month: IE = 58.73%, VB = 61.89%, p = 0.77), or secondary outcomes. Three adverse events were noted (substance abuse, n = 1 in IE-CBT; temporary increase in suicide risk, n = 1 in each condition, with one being withdrawn at 1-month follow-up)., Conclusions: Group IE-CBT and VB-CBT were safe and there were no significant differences in outcomes. Both treatments were associated with very large within-group effect sizes and the majority of patients remitted following treatment.