Elsevier

Behavior Therapy

Volume 45, Issue 1, January 2014, Pages 21-35
Behavior Therapy

Clinical Experiences in Conducting Cognitive-Behavioral Therapy for Social Phobia

https://doi.org/10.1016/j.beth.2013.09.008Get rights and content

Highlights

  • We conducted a survey of psychotherapists who have used CBT to treat Social Phobia.

  • Respondents indicated that CBT for SP is effective in over 75% of cases, but areas for improvement in CBT were also noted.

  • Barriers to treatment efficacy were difficulties with exposure, low patient motivation, and comorbid conditions.

  • Researchers can use the results of this survey to address the areas of concern among cognitive-behavioral therapists.

Abstract

Several authors have identified a disconnect between psychotherapy research, including research on cognitive behavioral therapy (CBT), and real-world psychotherapy practice. This disconnect has several negative consequences, potentially including less-than-optimal practice standards as well as a lack of input from practicing psychotherapists on how research can be improved and made more relevant in their day-to-day clinical work. As part of an ongoing effort to engage practicing psychotherapists in a feedback loop with psychotherapy researchers, this study reports the results of a survey of CBT therapists who have used CBT in the treatment of social phobia (SP). The survey was designed primarily to document how often certain potential problems, identified by expert researchers and CBT manuals, actually act as barriers to successful treatment when CBT is employed in nonresearch environments. The participants were 276 psychotherapists responding to email, online, and print advertisements completing the online survey. Participants varied considerably in psychotherapy experience, work environment, experience in using CBT for SP, and in some ways varied in their usual CBT techniques when treating SP. Among the most prominent barriers identified by many of the participants were patient motivation, comorbidity, logistical problems (especially with exposures), patient resistance, and severity and chronicity of SP symptoms. These findings may be useful for psychotherapy researchers as areas for potential study. The results may also suggest topics requiring clinical guidelines, innovations within CBT, and dissemination of successful techniques to address the barriers identified here.

Section snippets

Nature of Social Phobia

There are a number of characteristics that may affect the psychological treatment of SP and make it a unique clinical challenge, including both diagnostic and nondiagnostic features. One important aspect of SP as a diagnostic entity is its dimensional severity. Ruscio (2010), for instance, has shown through taxometric analyses that the distinction between diagnosable SP and subclinical traits is a continuous dimension rather than discrete categorization, and that a dimensional severity rating

CBT for SP

There have been several decades of research to support the use of cognitive and behavioral techniques with SP. Some early treatments in the behavioral tradition focused on social skills deficits by providing additional social skills training (Linehan, Goldfried, & Goldfried, 1979) as well as other purely behavioral treatments (Newman, Hofmann, Trabert, Roth, & Taylor, 1994). As noted above, however, it is not clear that a defining feature of SP is lack of social skills. Though such direct

The Present Study

As part of an effort to involve practicing clinicians in uncovering variables that may undermine the clinical effectiveness of CBT for SP, the present study was designed to survey psychotherapists who have used CBT to treat SP, seeking their experience of the types of interventions they use as well as the particular problems that they encounter when applying CBT in practice. This effort, described in Goldfried et al. (2014--this issue), serves as a “two-way bridge” between research and

Instruments

The general survey methods are described in Goldfried et al. (2014). To develop the current survey, the initial survey described by Wolf and Goldfried (2014) was revised to address SP rather than panic disorder, retaining the overall structure of that survey including the section headings and prompt stems. Emphasis was placed on identifying features unique to SP that might impact treatment adversely. Where additions were made, these were based on treatment manuals of CBT for social phobia (Hope

Results

Respondents’ endorsements of the different techniques they used in the treatment of SP are displayed in Table 2. It is notable that there were a set of techniques that may be considered “core” techniques as they were endorsed by over 80% of respondents. Among these were psychoeducation, cognitive restructuring, and assigning behavioral homework. The vast majority also reported typically using individual therapy. Many therapists reported using behavioral interventions, including developing a

Discussion

The main objective of this study was to document CBT for SP as it is practiced in the field, and to use therapists’ experience of applying CBT in their practice to identify potential barriers to successful treatment. It should be noted that the success rate reported by respondents (77.6%) is quite high in treating SP. This in and of itself suggests that most survey participants find CBT for SP to be largely efficacious—a promising result for the dissemination of CBT for SP. However, because it

Conflict of Interest Statement

The authors declare that there are no conflicts of interest.

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