Shifting as a key executive function underlying cognitive restructuring for individuals with elevated social anxiety

Objectives Previous studies have examined the relationship between executive functions and performance on cognitive behavioural therapy (CBT) tasks, such as cognitive restructuring. However, previous studies have used samples of older adults and only traditional measures of executive functions involving non-emotional stimuli. This study extends previous research to examine the specific executive function of shifting with regard to non-emotional and emotional stimuli and its relationship with cognitive restructuring, in a sample of young to middle-aged adults with elevated social anxiety. Design Cross-sectional study. Methods Participants (N = 49) completed a standard Wisconsin Card Sorting Test (WCST), an emotional version of the WCST (eWCST), and a cognitive restructuring task prior to an impromptu speech task. Per cent perseverative errors (an indicator of shifting) from the WCST and eWCST, along with planned covariates, were used to predict three indicators of cognitive restructuring task performance: task response quality (production of helpful alternative thoughts), change in belief in negative thought, and peak anxiety during speech. Results As expected, higher per cent perseverative errors (i.e., poorer shifting) on the WCST predicted poorer ability during the cognitive restructuring task to produce helpful alternative thoughts to a negative thought about the impending speech task. However, WCST per cent perseverative errors did not predict the other indicators of cognitive restructuring task performance. eWCST per cent perseverative errors did not predict any of the indicators of cognitive restructuring task performance. Conclusions The standard WCST may be sensitive to capturing the type of mental flexibility which is important for producing helpful alternative thinking during cognitive restructuring. Practitioner points Poorer shifting ability with regard to non-emotional stimuli in clients with elevated social anxiety may be related to poorer ability to produce helpful alternative thoughts during cognitive restructuring. For clinicians whose clients with elevated social anxiety are having difficulty with generating alternative thoughts during cognitive restructuring, clinicians should consider poor shifting ability as a potential contributing factor. Clinicians may need to provide further support for such clients during cognitive restructuring (e.g., greater emphasis on Socratic questioning to better facilitate alternative thinking).