Clinical Experiences in Conducting Cognitive-Behavioral Therapy for Social Phobia
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.
References (71)
- et al.
Distinctive activities of cognitive–behavioral therapy: A review of the comparative psychotherapy process literature
Clinical Psychology Review
(2002) - et al.
Cognitive behavioral therapy for panic disorder and comorbidity: More of the same or less of more?
Behaviour Research and Therapy
(2007) - et al.
What can be learned when empirically supported treatments fail?
Cognitive and Behavioral Practice
(2011) - et al.
Cognitive behavioral versus exposure only treatment for social phobia: A meta-analysis
Behavior Therapy
(1995) - et al.
Behavior therapy: Redefining clinical strengths and limitations
Behavior Therapy
(1993) - et al.
On the dissemination of clinical experiences in using empirically supported treatments
Behavior Therapy
(2014) Cognitive and behavioral treatments for social phobia: A critical analysis
Clinical Psychology Review
(1989)- et al.
Social skills training augments the effectiveness of cognitive behavioral group therapy for social anxiety disorder
Behavior Therapy
(2005) - et al.
Acceptance and mindfulness-based therapy: New wave or old hat?
Clinical Psychology Review
(2008) - et al.
Conditioning theory: A model for the etiology of public speaking anxiety?
Behaviour Research and Therapy
(1995)
Social phobia with and without avoidant personality disorder: Preliminary behavior therapy outcome findings
Journal of Anxiety Disorders
Mindfulness and acceptance-based group therapy for Social Anxiety Disorder: An open trial
Cognitive and Behavioral Practice
Effectiveness of an empirically supported treatment for social phobia in the field
Behaviour Research and Therapy
Assertion training: Skill acquisition or cognitive restructuring
Behavior Therapy
Exposure and cognitive restructuring for social phobia: A controlled study
Behavior Therapy
Cognitive behavioural group therapy for social phobia: Evidence of transportability to community clinics
Behaviour Research and Therapy
Does behavioral treatment of social phobia lead to cognitive changes?
Behavior Therapy
Diagnostic comorbidity in adults with generalized anxiety disorder: Impact of comorbidity on psychotherapy outcome and impact of psychotherapy on comorbid diagnoses
Behavior Therapy
Clinical experiences in using cognitive-behavior therapy to treat panic disorder
Behavior Therapy
Psychotherapy process in the National Institute of Mental Health Treatment of Depression Collaborative Research Program
Journal of Consulting and Clinical Psychology
Psychological treatment of social anxiety disorder: A meta-analysis
Psychological Medicine
Diagnostic and statistical manual of mental disorders (4th ed., text rev.)
Resistance/reactance level
Journal of Clinical Psychology: In Session
“Negative process”: A recurrently discovered and underestimated facet of therapeutic process and outcome in the individual psychotherapy of adults
Clinical Psychology: Science and Practice
Distinctive features of short-term psychodynamic-interpersonal psychotherapy: A review of the comparative psychotherapy process literature
Clinical Psychology: Science and Practice
Validity of two questionnaires to assess social fears: The Dutch Social Phobia and Anxiety Inventory and the Blushing, Trembling and Sweating Questionnaire
Journal of Psychopathology and Behavioral Assessment
Motivation enhancement therapy can increase utilization of cognitive-behavioral therapy: The case of social anxiety disorder
Journal of Clinical Psychology
A common factors approach to psychotherapy training
Journal of Psychotherapy Integration
Predicting the effect of cognitive therapy for depression: A study of unique and common factors
Journal of Consulting and Clinical Psychology
Integrative cognitive therapy: A preliminary investigation
Journal of Psychotherapy Integration
Cognitive therapy versus exposure and applied relaxation in social phobia: A randomized controlled trial
Journal of Consulting and Clinical Psychology
Working with feelings: The importance of emotion in both cognitive-behavioral and interpersonal therapy in the NIMH Treatment of Depression Collaborative Research Program
Psychotherapy: Theory/Research/Practice/Training
Expectations
Journal of Clinical Psychology: In Session
Augmenting cognitive therapy for depression with an Expectancy Enhancement module: Preliminary efficacy
Integrative cognitive therapy for depression: A randomized pilot comparison
Psychotherapy: Theory, Research, Practice, Training
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