(PS9-97) The Role of Self Focused Attention on Symptom Reduction and Functional Impairment in Social Anxiety and Body Dysmorphic Disorder

Abstract Text: Self-focused attention (SFA) refers to a cognitive bias toward internal thoughts, feelings, and physical states, which is activated by social situations in patients with Social Anxiety Disorder (SAD) and Body Dysmorphic Disorder (BDD). Studies have shown that SFA significantly improves during Cognitive Behavioral Therapy (CBT), but given its close association with rumination, it remains unclear whether improvements in SFA are uniquely associated with symptom change or with changes in rumination. In this study, we hypothesized that changes in SFA would be uniquely associated with symptom reduction as well as with improvements in functional impairment. A transdiagnostic sample of 30 clinical participants (N=15 SAD, 15 BDD) participated in a 12-week CBT protocol, with behavioral and fMRI data collected at baseline, mid, and post treatment. The Self-Consciousness Scales Revised (SCS-R) was used to assess SFA, Rumination Response Scale (RRS) to assess rumination, Sheehan Disability Scale (SDS) to assess functional impairment, and the Liebowitz Social Anxiety Scale (LSAS) and Yale-Brown Obsessive-Compulsive Scale Modified for Body Dysmorphic Disorder (BDD-YBOCS) to assess SAD- and BDD-specific symptoms, respectively. We performed a linear mixed model to test the relationship between SCS-R scores and symptom severity, as well as functional impairment, while controlling for rumination and time. Time was found to have a significant effect, with patients reporting significant improvements in SFA, rumination, impairment, and symptoms over the course of treatment. For symptoms, SCS-R marginally predicted symptom scores (β=0.96, SE=0.50, t(35.88)=1.94, p=0.06), whereas rumination did not (p = 0.90). Similarly for functional impairment, SCS-R significantly predicted SDS scores (β=0.53, SE=0.24, t(40.72)=2.19, p=0.034), but so did rumination (β=0.29, SE=0.06, t(42.66)=4.52, p< 0.001). Although this finding requires replication in a larger and more diverse sample, our preliminary results show support for our hypothesis that SFA reduces symptoms independent of rumination. These results also highlight potential SFA-related mechanisms during symptom change.