Contains Video1Social Mishap Exposures for Social Anxiety Disorder: An Important Treatment Ingredient
Highlights
► Social mishap exposures target patients’ exaggerated social cost by confronting them with the consequences of such mishaps. ► Data suggest that protocols that include social mishap exposures show greater efficacy than traditional CBT protocols. ► The current study provides a case example outlining how social mishap exposures can be incorporated into treatment. ► Social mishap exposures should be specifically tailored to the core fear of the patient.
Section snippets
Theoretical Models of SAD
There is strong empirical evidence supporting a cognitive-behavioral model of SAD (Davidson et al., 2004, Heimberg et al., 1990, Heimberg et al., 1998). The cognitive-behavioral model proposes that SAD develops and is maintained by maladaptive cognitive and behavioral processes, which negatively reinforce avoidance strategies and contribute to a cycle of anxiety and avoidance (Clark and Wells, 1995, Rapee and Heimberg, 1997). The following discussion is based on the maintenance model developed
Method
The Anxiety Disorders Interview Schedule (ADIS-IV; DiNardo, Brown, & Barlow, 1994) was administered at the intake evaluation. The ADIS-IV is a semistructured clinical interview that assesses mood and anxiety disorders according to DSM-IV (American Psychiatric Association, 1994) criteria. The Liebowitz Social Anxiety Scale (LSAS; Liebowitz, 1987) is a 24-item clinician-administered measure that assesses fear and avoidance of social situations (each rated on a 0- to 3-point scale with a range of
Discussion
Although Mary improved in a clinically meaningful way by the end of the treatment, she presented certain challenges to the therapists who led her group. One primary difference in Mary's case compared to the other group members was that Mary had a longer duration of illness (she was the oldest member of the group) and she had a higher baseline severity of symptoms than the other members. She had therefore developed highly evolved and idiosyncratic avoidance strategies. For example, it was not
References (26)
- et al.
An analysis of post-event processing in social anxiety disorder
Clinical Psychology Review
(2008) - et al.
Information processing in social phobia
Biological Psychiatry
(2002) Self-focused attention before and after treatment of social phobia
Behaviour Research and Therapy
(2000)- et al.
A cognitive-behavioral model of anxiety in social phobia
Behaviour Research and Therapy
(1997) - et al.
Social phobia: The role of in-situation safety behaviors in maintaining anxiety and negative beliefs
Behavior Therapy
(1995) - et al.
Epidemiology, patterns of comorbidity, and associated disabilities of social phobia
Psychiatric Clinics of North America
(2001) Diagnostic and statistical manual of mental disorders
(1994)Diagnostic and statistical manual of mental disorders
(2000)- et al.
Cognitive therapy versus fluoxetine in generalized social phobia: A randomized placebo-controlled trial
Journal of Consulting and Clinical Psychology
(2003) - et al.
A cognitive model of social phobia
Fluoxetine, comprehensive cognitive behavioral therapy, and placebo in generalized social phobia
Archives of General Psychiatry
Anxiety Disorders Interview Schedule for DSM-IV: Client Interview Schedule
Cognitive behavioral group treatment for social phobia: Comparison with a credible placebo control
Cognitive Therapy and Research
Cited by (21)
Emotions in social anxiety disorder: A review
2023, Journal of Anxiety DisordersOut of the shadows and into the spotlight: Social blunders fuel fear of self-exposure in social anxiety disorder
2015, Journal of Anxiety DisordersCitation Excerpt :Based on the established findings that inflated social cost estimates play a central role in the persistence and treatment of SAD (Hofmann, 2004; Foa, Franklin, Perry, & Herbert, 1996; McManus, Clark, & Hackmann, 2000; Smits, Rosenfield, McDonald, & Telch, 2006; Taylor & Alden, 2008), some investigators have promoted the value of integrating intentional social mishap exposures into cognitive behavioral treatment protocols for SAD. During such exposures, perceived social costs are targeted by having patients repeatedly commit blunders for the purpose of observing and learning that feared consequences (e.g., being ridiculed by others) do not typically occur (Hofmann & Scepkowski, 2006; Fang, Sawyer, Asnaani, & Hofmann, 2013). Despite the potential utility of this intervention, a recent experimental study showed that social mishap exposures may be less effective than cognitive restructuring for facilitating reductions in social cost biases and reducing symptoms of social anxiety (Possis et al., 2013).
The Art of Exposure: Putting Science Into Practice
2015, Cognitive and Behavioral PracticeCitation Excerpt :Furthermore, research should examine particular exposures or specific features that may be especially important for anxiety remittance. For example, social mishap exposures, based in the theory of overlearning in which individuals purposefully engage in social blunders (Feng, Sawyer, Asnaami & Hofmann, 2013; Hofmann, 2007), have yet to be examined with anxious youth. Finally, even though research to date suggests that evidence-based treatments such as CBT are probably efficacious for ethnic minority youth (Huey & Polo, 2008), data are limited and more evidence is needed to understand what and how cultural variables might impact the structure of psychosocial treatment (Ollendick, Lewis, & Fraire, 2010).
Perfectionism and Perfectionistic Self-Presentation in Social Anxiety: Implications for Assessment and Treatment
2014, Social Anxiety: Clinical, Developmental, and Social PerspectivesTheory-based training strategies for modifying practitioner concerns about exposure therapy
2013, Journal of Anxiety DisordersCitation Excerpt :Although exposure tasks devised in clinical practice are always individualized to the patient's unique presentation, many exposure tasks share common themes. For example, socially phobic patients often overestimate the severity of acting in an embarrassing manner, a cognitive bias often treated with social mishap tasks such as spilling a drink in a crowded restaurant (Fang, Sawyer, Asnaani, & Hofmann, 2013). Just as patients are able to learn via these tasks that embarrassment is more tolerable and acceptable than expected, therapists’ perceptions of intolerability of exposure and its emotional consequences may also be violated.
Psychological treatment of social anxiety disorder improves body dysmorphic concerns
2013, Journal of Anxiety DisordersCitation Excerpt :As cognitive restructuring instructs the patient to identify and challenge negative and dysfunctional automatic thoughts, patients may have applied this skill not only to dysfunctional thoughts about social situations, but also to dysfunctional thoughts about their appearance. Some of the treatment components, such as videotape feedback and social mishap exposures (Fang et al., 2013), might be particularly effective for challenging and modifying maladaptive body dysmorphic concerns. Many of the social mishap exposures used in the current protocol were intended to target the fear of being negatively evaluated.
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Video patients/clients are portrayed by actors.