The Effectiveness of Cognitive-Behavioral Therapy on Fear of Negative Evaluation, Interpersonal Sensitivity, and Worry-Preoccupation States in Women with Generalized Anxiety Disorder

Abstract

Introduction and Aim: Generalized Anxiety Disorder (GAD) is one of the most prevalent anxiety disorders and is characterized by persistent worry, fear of future events, and difficulty controlling anxious thoughts. It is frequently associated with fear of negative evaluation and heightened interpersonal sensitivity. The present study aimed to investigate the effectiveness of Cognitive-Behavioral Therapy (CBT) on fear of negative evaluation, interpersonal sensitivity, and worry-preoccupation states among women diagnosed with GAD.

Methodology: This study employed a quasi-experimental pretest–posttest design with a control group. The statistical population consisted of women aged 18–35 years diagnosed with GAD who attended counseling and psychological clinics in Mashhad during 2026. Forty participants were selected through convenience sampling and randomly assigned to either an experimental group (n=20) or a control group (n=20). The experimental group received eight sessions of CBT based on the Heimberg and Becker (2002) protocol. Data were collected using the Generalized Anxiety Disorder Scale (GAD-7), Penn State Worry Questionnaire (PSWQ), Interpersonal Sensitivity Measure (IPSM), and the Brief Fear of Negative Evaluation Scale (BFNE). Data were analyzed using multivariate and univariate analyses of covariance (MANCOVA/ANCOVA) in SPSS version 26.

Findings: Multivariate analyses revealed significant differences between the experimental and control groups after controlling for pretest scores (Wilks’ Lambda, p < .001). Univariate ANCOVA results demonstrated that CBT significantly reduced symptoms of generalized anxiety disorder (F = 155.948, p < .001), worry (F = 142.968, p < .001), interpersonal sensitivity (F = 347.912, p < .001), and fear of negative evaluation (F = 202.575, p < .001). Bonferroni post hoc comparisons further confirmed significant differences between groups across all dependent variables (p < .05).

Conclusion: The findings indicate that Cognitive-Behavioral Therapy is an effective intervention for reducing fear of negative evaluation, interpersonal sensitivity, and pathological worry among women with GAD. By modifying maladaptive cognitions, reducing cognitive avoidance, enhancing exposure to anxiety-provoking situations, and strengthening adaptive coping skills, CBT contributes substantially to psychological and interpersonal functioning in this population.