Santoft F, Salomonsson S, Hesser H, et al. - Given the efficacy of cognitive behavior therapy (CBT) for social anxiety disorder, researchers examined the predictive value of the proposed processes of change according to the cognitive model of social anxiety disorder, for subsequent symptom reduction in CBT delivered as therapist-guided bibliotherapy. Data from 61 patients with a social anxiety disorder who participated in an effectiveness trial of CBT in primary care, were analyzed. Reduced avoidance had a unidirectional effect on the subsequent decrease in social anxiety. Further, four of the proposed processes (ie, estimated probability and cost of adverse outcome, self-focused attention, and safety behaviors) were noted to have reciprocal influences on social anxiety. Subsequent social anxiety could not be predicted with the remaining two processes, (ie, anticipatory and post-event processing), However, prior symptom reduction could predict these processes. Findings thereby support the involvement of several of the change processes according to the cognitive model of social anxiety disorder in symptom improvement.