Skip to main content
SpringerLink
Log in

Cognitive behavioral group treatment for social phobia: Comparison with a credible placebo control

  • Published:
Cognitive Therapy and Research Aims and scope Submit manuscript

Abstract

Forty-nine patients participated in a study comparing cognitive-behavioral group treatment (CBGT) for social phobia with a credible placebo control. CBGT consisted of exposure to simulated phobic events, cognitive restructuring of maladaptive thoughts, and homework for self-directed exposure and cognitive restructuring between sessions. Control patients received a treatment package consisting of lecture-discussion and group support that was comparable to CBGT on measures of treatment credibility and outcome expectations. At pretest, posttest, and 3- and 6-month follow-ups, patients completed assessments that included clinician ratings, self-report measures, and behavioral, physiological, and cognitive-subjective measures derived from a behavioral simulation of a personally relevant phobic event. Both groups improved on most measures, but, at both posttest and follow-up, CBGT patients were rated as more improved than controls and reported less anxiety before and during the behavioral test. At follow-up, CBGT patients also reported significantly fewer negative and more positive self-statements than controls on a thought-listing task following the behavioral test. Regardless of treatment condition, follow-up changes in clinician-rated phobic severity were significantly related to changes on the thought-listing measure.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • American Psychiatric Association. (1980).Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: Author.

    Google Scholar 

  • American Psychiatric Association. (1987).Diagnostic and statistical manual of mental disorders (3rd ed., rev.). Washington, DC: Author.

    Google Scholar 

  • Amies, P. L., Gelder, M. G., & Shaw, P. M. (1983). Social phobia: A comparative clinical study.British Journal of Psychiatry, 142 174–179.

    PubMed  Google Scholar 

  • Arnkoff, D. B., & Glass, C. R. (1989). Cognitive assessment in social anxiety and social phobia.Clinical Psychology Review, 9 61–74.

    Google Scholar 

  • Barlow, D. H. (1985). The dimensions of anxiety disorders. In A. H. Tuma & J. D. Maser (Eds.),Anxiety and the anxiety disorders (pp. 479–500). Hillsdale, NJ: Erlbaum

    Google Scholar 

  • Barlow, D. H., & Beck, J. G. (1984). The psychosocial treatment of anxiety disorders: Current status, future directions. In J. B. W. Williams & R. L. Spitzer (Eds.),Psychotherapy research: Where are we and where should we go? (pp. 29–66). New York: Guilford Press.

    Google Scholar 

  • Barlow, D. H., O'Brien, G. T., & Last, C. G. (1984). Couples treatment of agoraphobia.Behavior Therapy, 15 41–58.

    Google Scholar 

  • Beck, A. T., Ward, C. H., Mendelson, M. J., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression.Archives of General Psychiatry, 4 561–571.

    PubMed  Google Scholar 

  • Biran, M., Augusto, F., & Wilson, G. T. (1981).In vivo exposure vs. cognitive restructuring in the treatment of scriptophobia.Behaviour Research and Therapy, 19 525–532.

    PubMed  Google Scholar 

  • Borkovec, T. D., & Nau, S. D. (1972). Credibility of analogue therapy rationales.Journal of Behavior Therapy and Experimental Psychiatry, 3 257–260.

    Google Scholar 

  • Burns, D. D. (1980)Feeling good: The new mood therapy. New York: William Morrow.

    Google Scholar 

  • Butler, G. (1985). Exposure as a treatment for social phobia: Some instructive difficulties.Behaviour Research and Therapy, 23 651–657.

    PubMed  Google Scholar 

  • Butler, G. Cullington, A., Munby, M., Amies, P., & Gelder, M. (1984). Exposure and anxiety management in the treatment of social phobia.Journal of Consulting and Clinical Psychology, 52 642–650.

    PubMed  Google Scholar 

  • Cacioppo, J. T., Glass, C. R., & Merluzzi, T. V. (1970). Self-statements and self-evaluations: A cognitive-response analysis of heterosocial anxiety.Cognitive Therapy and Research, 3 249–262.

    Google Scholar 

  • Chiauzzi, E. J., Heimberg, R. G., Becker, R. E., & Gansler, D. (1985). Personalized versus standard role plays in the assessment of depressed patients' social skill.Journal of Psychopathology and Behavioral Assessment, 7 121–133.

    Google Scholar 

  • Christensen, L., & Mendoza, J. L. (1986). A method of assessing change in a single subject: An alteration of the RC index.Behavior Therapy, 17 305–308.

    Google Scholar 

  • DiNardo, P. A., O'Brien, G. T., Barlow, D. H., Waddell, M. T., & Blanchard, E. B. (1983). Reliability of DSM-III anxiety disorder categories using a new structured interview.Archives of General Psychiatry, 40 1070–1074.

    PubMed  Google Scholar 

  • Dodge, C. S., Hope, D. A., Heimberg, R. G., & Becker, R. E. (1981). Evaluation of the Social Interaction Self-Statement Test with a social phobic population.Cognitive Therapy and Research, 12 211–222.

    Google Scholar 

  • Emmelkamp, P. M. G. (1982).Phobic and obsessive-compulsive disorders: Theory, research and practice. New York: Plenum Press.

    Google Scholar 

  • Emmelkamp, P. M. G., Mersch, P. P., Vissia, E., & van der Helm, M. (1985). Social phobia: A comparative evaluation of cognitive and behavioral interventions.Behaviour Research and Therapy, 23 365–369.

    PubMed  Google Scholar 

  • Glass, C. R., & Furlong, M. (in press). Cognitive assessment of social anxiety: Affective and behavioral correlates.Cognitive Therapy and Research.

  • Glass, C. R., Merluzzi, T. V., Biever, J. L., & Larsen, K. H. (1982). Cognitive assessment of social anxiety: Development and validation of a self-statement questionnaire.Cognitive Therapy and Research, 6 37–55.

    Google Scholar 

  • Hamilton, M. (1960). A rating scale for depression.Journal of Neurology, Neurosurgery, and Psychiatry, 23 56–62.

    Google Scholar 

  • Heimberg, R. G. (1989). Cognitive and behavioral treatments for social phobia: A critical analysis.Clinical Psychology Review, 9 107–128.

    Google Scholar 

  • Heimberg, R. G., Acerra, M., & Holstein, A. (1985). Partner similarity mediates interpersonal anxiety.Cognitive Therapy and Research, 9 436–445.

    Google Scholar 

  • Heimberg, R. G., & Barlow, D. H. (1988). Psychosocial treatments for social phobia.Psychosomatics, 29 27–37.

    PubMed  Google Scholar 

  • Heimberg, R. G., Becker, R. E., Goldfinger, K., & Vermilyea, J. A. (1985). Treatment of social phobia by exposure, cognitive restructuring and homework assignments.Journal of Nervous and Mental Disease, 173 236–245.

    PubMed  Google Scholar 

  • Heimberg, R. G., Dodge, C. S., & Becker, R. E. (1987). Social phobia. In L. Michelson & M. Ascher (Eds.),Anxiety and stress disorders (pp. 280–309). New York: Guilford Press.

    Google Scholar 

  • Heimberg, R. G., Keller, K. E., & Peca-Baker, T. (1986). Cognitive assessment of social-evaluative anxiety in the job interview: Job Interview Self-Statement Schedule.Journal of Counseling Psychology, 33 190–195.

    Google Scholar 

  • Heimberg, R. G., Nyman, D. S., & O'Brien, G. T. (1987). Assessing variations of the thought-listing technique: Effects of stimulus intensity, stimulus modality, instructions, and scoring procedures.Cognitive Therapy and Research, 11 13–24.

    Google Scholar 

  • Jacobson, N. S., & Revenstorf, D. (1988). Statistics for assessing clinical significance of psychotherapy techniques: Issues, problems, and new developments.Behavioral Assessment, 10 133–145.

    Google Scholar 

  • Jerremalm, A., Jansson, L., & Ost, L. G. (1986). Cognitive and physiological reactivity and the effects of different behavioral methods in the treatment of social phobia.Behaviour Research and Therapy, 24 171–180.

    PubMed  Google Scholar 

  • Kanter, N. J., & Goldfried, M. R. (1979). Relative effectiveness of rational restructuring and self-control desensitization in the reduction of interpersonal anxiety.Behavior Therapy, 10 472–490.

    Google Scholar 

  • Kendall, P. C., & Hollon, S. D. (1981). Assessing self-referent speech: Methods in the measurement of self-statements. In P. C. Kendall & S. D. Hollon (Eds.),Assessment strategies for cognitive-behavioral interventions (pp. 85–118). New York: Academic Press.

    Google Scholar 

  • Kendall, P. C., & Korgeski, G. P. (1979). Assessment and cognitive-behavioral interventions.Cognitive Therapy and Research, 3 1–21.

    Google Scholar 

  • Kennedy, C. R., & Heimberg, R. G. (1986, November).Treatment credibility and client outcome expectancy: An evaluation of five treatment rationales. Paper presented at the annual meeting of the Association for the Advancement of Behavior Therapy, Chicago.

  • Lang, P. J. (1968). Fear reduction and fear behavior: Problems in treating a construct. In J. M. Shlien (Ed.),Research in psychotherapy (Vol. 3). Washington, DC: American Psychological Association.

    Google Scholar 

  • Liebowitz, M. R., Gorman, J. M., Fyer, A. J., & Klein, D. F. (1985). Social phobia: Review of a neglected anxiety disorder.Archives of General Psychiatry, 42 729–736.

    PubMed  Google Scholar 

  • Marks, I. M., & Mathews, A. M. (1979). Brief standard self-rating for phobic patients.Behaviour Research and Therapy, 17 263–267.

    PubMed  Google Scholar 

  • Mattick, R. P., & Peters, L. (1988). Treatment of severe social phobia: Effects of guided exposure with and without cognitive restructuring.Journal of Consulting and Clinical Psychology, 56 251–260.

    PubMed  Google Scholar 

  • Moorey, S., & Burns, D. D. (1983). The apprenticeship model: Training in cognitive therapy by participation. In A. Freeman (Ed.),Cognitive therapy with couples and groups (pp. 303–321). New York: Plenum.

    Google Scholar 

  • Myers, J. K., Weissman, M. M., Tischler, G. L., Holzer, C. E. III, Leaf, P. J., Orvaschel, H., Anthony, J. C., Boyd, J. H., Burke, J. D., Jr., Kramer, M., & Stolzman, R. (1984). Six-month prevalence of psychiatric disorders in three communities.Archives of General Psychiatry, 41 959–967.

    PubMed  Google Scholar 

  • Myszka, M. T., Galassi, J. P., & Ware, W. B. (1986). Comparison of cognitive assessment methods with heterosocially anxious women.Journal of Counseling Psychology, 33 401–407.

    Google Scholar 

  • Paul G. L. (1966).Insight vs. desensitization in psychotherapy. Stanford, CA: Stanford University Press.

    Google Scholar 

  • Sank, L. I., & Shaffer, C. S. (1984).A therapist's manual for cognitive behavior therapy in groups. New York: Plenum.

    Google Scholar 

  • Schwartz, R. M., & Garamoni, G. L. (1986). A structural model of positive and negative states of mind: Assymetry in the internal dialogue. In P. C. Kendall (Ed.),Advances in cognitive-behavioral research and therapy (Vol. 5, pp. 1–62) New York: Academic Press.

    Google Scholar 

  • Stravynski, A., Marks, I., & Yule, W. (1982). Social skills problems in neurotic outpatients: Social skills training with and without cognitive modification.Archives of General Psychiatry, 39 1378–1385.

    PubMed  Google Scholar 

  • Watson, D., & Friend, R. (1969). Measurement of social-evaluative anxiety.Journal of Consulting and Clinical Psychology, 33 448–457.

    PubMed  Google Scholar 

  • Watson, J. P., & Marks, I. M. (1971). Relevant and irrelevant fear in flooding—A crossover study of phobic patients.Behavior Therapy, 2 275–293.

    Google Scholar 

  • Wolpe, J., & Lazarus, A. A. (1966).Behavior therapy techniques: A guide to the treatment of neuroses. Oxford: Pergamon.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Center for Stress and Anxiety Disorders, Department of Psychology, University at Albany, State University of New York, 1535 Western Avenue, 12203, Albany, New York, USA

    Richard G. Heimberg, Cynthia S. Dodge, Debra A. Hope, Charles R. Kennedy & Linda J. Zollo

  2. Medical College of Pennsylvania at EPPI, USA

    Robert E. Becker

Authors
  1. Richard G. Heimberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cynthia S. Dodge
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Debra A. Hope
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Charles R. Kennedy
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Linda J. Zollo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Robert E. Becker
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Heimberg, R.G., Dodge, C.S., Hope, D.A. et al. Cognitive behavioral group treatment for social phobia: Comparison with a credible placebo control. Cogn Ther Res 14, 1–23 (1990). https://doi.org/10.1007/BF01173521

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01173521

Key words

Search

Navigation