Beneficial Effects of Role Reversal in Comparison to Role-playing on Negative Cognitions about Other’s Judgments for Social Anxiety Disorder
Hanieh Abeditehrani1, Corine Dijk1, Mohsen Dehghani Neyshabouri2, Arnoud Arntz1
1 University of Amsterdam, Department of Clinical Psychology, Amsterdam, The Netherlands
2 University of Social Welfare and Rehabilitation Sciences, Department of Clinical Psychology, Tehran, Iran
Abeditehrani, H., Dijk, C., Neyshabouri, M. D., & Arntz, A. (2021). Beneficial Effects of Role Reversal in Comparison to Role-Playing on Negative Cognitions about Others’ Judgments for Social Anxiety Disorder. Journal of Behavior Therapy and Experimental Psychiatry, 70, 101599. https://doi.org/10.1016/j.jbtep.2020.101599
Social Anxiety Disorder (SAD) is marked by a persistent fear of negative evaluation and avoidance of social situations. Cognitive models, such as those by Clark and Wells (1995) and Heimberg et al. (2010), emphasize that individuals with SAD maintain negative self-cognitions and a distorted perception of others, often seeing themselves in an overly critical way through the imagined perspective of others. These negative beliefs, combined with exaggerated perceptions of the likelihood and consequences of judgment, perpetuate the disorder. Addressing these distorted cognitions is critical for effective treatment, as research shows a strong association between reducing these beliefs and positive therapeutic outcomes (Foa et al., 1996).
One technique commonly used to address these cognitions is role-playing, which originates from psychodrama (Moreno, 1946) and behavioral therapy traditions (Kelly, 1955). Role-playing involves the enactment of social situations to simulate real-life experiences and is widely used in Cognitive Behavioral Therapy (CBT) as a method of exposure or social skills training (Heimberg & Becker, 2002). An extension of this technique, role reversal, adds a perspective-taking element by having the individual switch roles with a confederate during the reenactment. This allows the individual to experience the social interaction from another person’s perspective, potentially correcting distorted self-perceptions and beliefs about others’ judgments. The current study (Abeditehrani et al., 2021) aimed to compare the effectiveness of role-playing and role reversal in reducing negative cognitions in individuals with SAD.
Thirty-six participants diagnosed with SAD were recruited and randomly assigned to one of two experimental conditions. In the role-playing condition, participants enacted an anxiety-provoking situation twice. In the role reversal condition, participants first role-played the situation and then switched roles with the confederate, who mimicked the participant’s observed behaviors. Participants identified specific anxiety-inducing scenarios, such as job interviews, dating, or conversations with authority figures. They reported their negative cognitions about others’ judgments, along with ratings of the believability, probability, and cost of these judgments. These measures were collected at three time points: before the intervention, after the first block of role-playing, and after the second block of the experiment.
The findings revealed significant reductions in negative cognitions across both conditions, but role reversal demonstrated greater and more sustained effects. After the first block of role-playing, both groups showed a decline in the believability of their negative cognitions. However, in the second block, only the role reversal group experienced continued reductions in believability. Similar patterns were observed for the perceived probability of being judged negatively, where role reversal led to significant improvements after the second block, whereas the role-playing group showed no further change. Additionally, while both groups reported reduced estimates of the cost of negative judgments, the reductions were more pronounced in the role reversal group.
These results suggest that role reversal provides a unique corrective experience by facilitating perspective-taking. By assuming the role of another person and observing themselves through the confederate’s behavior, participants gained a new understanding of how they might be perceived in social interactions. This experiential shift appears to challenge and modify their distorted self-image and beliefs about others’ judgments more effectively than role-playing alone (Abeditehrani et al., 2021).
Interestingly, participants rated both techniques as moderately realistic, yet they were sufficient to elicit meaningful cognitive changes. This finding aligns with research on other experiential methods, such as video feedback, which has shown that moderate realism can still trigger significant therapeutic effects (Warnock-Parkes et al., 2017). Role reversal, however, offers additional benefits by engaging participants more actively in the social interaction and allowing them to experience its dynamics from a different vantage point.
The study has several limitations. First, the absence of a control group limits the ability to isolate the effects of role-playing itself. Second, the novelty of the role reversal task in the second block may have contributed to its greater impact, making it unclear whether the effects were due to the technique or the introduction of a new activity. Third, the study used DSM-IV criteria for SAD, and replication using DSM-5 standards would ensure broader applicability. Additionally, the wide variety of scenarios chosen by participants might have influenced the effectiveness of the interventions differently, highlighting the need for further research on how different types of social situations affect outcomes.
Despite these limitations, the findings underscore the potential of role reversal as a powerful therapeutic tool for SAD. By addressing the core fears of negative evaluation and distorted self-perception, role reversal complements existing CBT techniques and offers a promising avenue for improving treatment outcomes. Future studies should explore comparisons between role reversal and other methods, such as video feedback, to better understand its unique contributions to therapeutic change.
In conclusion, role reversal appears to be a highly effective technique for reducing negative cognitions in SAD. Its ability to facilitate perspective-taking and provide corrective experiences makes it a valuable addition to therapeutic practices. The study provides strong preliminary evidence supporting its use and highlights the need for further research to refine and expand its application in clinical settings.
References
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- Foa, E. B., Franklin, M. E., Perry, K. J., & Herbert, J. D. (1996). Cognitive biases in generalized social phobia. Journal of Abnormal Psychology, 105(3), 433–439.
- Heimberg, R. G., Brozovich, F. A., & Rapee, R. M. (2010). A cognitive-behavioral model of social anxiety disorder: Update and extension. In S. G. Hofmann & P. M. DiBartolo (Eds.), Social anxiety (2nd ed., pp. 395–422). Elsevier.
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- Warnock-Parkes, E., Wild, J., Stott, R., Grey, N., Ehlers, A., & Clark, D. M. (2017). Seeing is believing: Using video feedback in cognitive therapy for social anxiety disorder. Cognitive and Behavioral Practice, 24(2), 245–255. https://doi.org/10.1016/j.cbpra.2016.03.007