Social Phobia Lecture OverviewEpidemiology of Social PhobiaSlide 3Slide 4Slide 5Slide 6Prevalence of Anxiety DisordersSlide 8Slide 9Slide 10Pharmacological Treatments for Social PhobiaEffects of SertralinePsychosocial Treatments for Social PhobiaCognitive-Behavioral Group Treatment (CBGT)Slide 15Advantages of Exposure SimulationsSlide 17Examples of Common Exposure SimulationsSlide 19Integrating Cognitive Restructuring and ExposuresSlide 21Slide 22Summary of Homework ProceduresSlide 24Slide 25CBGT Efficacy DataHeimberg et al (1990)Gelernter et al (1991)NIMH Multicenter Study Post-Treatment FindingsHeimberg et al (1998) Treatment-free Follow-upSlide 31Lucas & Telch (Unpublished)Meta AnalysesSlide 34Moderators of Treatment OutcomeClinical Strategies in Treating Social PhobiaSlide 37Slide 3801/13/19 Treatment of Social Phobia 1Social PhobiaLecture Overview•Nature and epidemiology•Empirically-supported treatments•Efficacy data•Moderator variables•Clinical tips in working with social anxiety clients•Class discussion01/13/19 Treatment of Social Phobia 2Epidemiology of Social Phobia•Defining features–1. Persistent fear (recognized as excessive or unreasonable) of at least 6 months duration of one or more social situations in which the person is exposed to possible scrutiny by others. The primary fear is one of negative evaluation by others.–2. Exposure almost always provokes anxiety or panic (situationally-bound or predisposed). –3. Situations are avoided or endured with significant distress.01/13/19 Treatment of Social Phobia 3Epidemiology of Social Phobia•Defining features cont.–4. Marked impairment; –5. Not better accounted for by a medical problem or other mental disorder01/13/19 Treatment of Social Phobia 4Epidemiology of Social Phobia•Subtypes–Generalized–Specific01/13/19 Treatment of Social Phobia 5Epidemiology of Social Phobia•Course–Findings from Yonkers et al (2001)•Only 38 percent of women and 32 percent of men experienced a complete remission during the eight-year study period•Women were more likely to have concurrent agoraphobia, and men had a higher rate of comorbid substance use disorders•Social phobia had a more chronic course among women who had low Global Assessment of Functioning scores and a history of suicide attempts at baseline than among men who had these characteristics.01/13/19 Treatment of Social Phobia 6Epidemiology of Social Phobia•Prevalence01/13/19 Treatment of Social Phobia 7Prevalence of Anxiety DisordersDrugMale Female TotalLifetime 12-Mo Lifetime 12-Mo Lifetime 12-MoPanic Disorder2.0 1.3 5.0 3.2 3.5 2.3Social Phobia12.1 6.6 15.3 9.1 13.3 7.9Simple Phobia6.7 4.4 15.7 13.2 11.3 8.8Generalized Anxiety Disorder3.6 2.0 6.6 4.3 5.1 3.1Any Anxiety Disorder19.2 11.8 30.5 22.6 24.9 17.201/13/19 Treatment of Social Phobia 8Epidemiology of Social Phobia•Onset and course–Early age of Onset (14.8 girls; 16.3 boys)–Chronic unremitting course01/13/19 Treatment of Social Phobia 9Epidemiology of Social Phobia•Impairment/disability–Significant interference in work and social functioning (Davidson et al, 1993)–Inability to work, attend school, socialize, or marry are common in clinical samples (Liebowitz, 1985)–Most common co-existing anxiety disorder among alcoholics undergoing detoxification (Chambless et al, 1987)01/13/19 Treatment of Social Phobia 10Epidemiology of Social Phobia•Comorbidity–Simple phobia (59.0)–Agoraphobia (44.9)–Alcohol abuse (18.8)–Depression (16.6)Based on: (Schneier et al (1992)01/13/19 Treatment of Social Phobia 11Pharmacological Treatments for Social Phobia•Standard MAOIs•Selective reversible MAOIs•Benzodiazepines•Beta Blockers•SSRIs01/13/19 Treatment of Social Phobia 12Effects of SertralineVan Ameringen, et al (2001). Am J Psychiatry 158:275-28101/13/19 Treatment of Social Phobia 13Psychosocial Treatments for Social Phobia•CBGT•Exposure•Cognitive therapy01/13/19 Treatment of Social Phobia 14Cognitive-Behavioral Group Treatment (CBGT)•Potential advantages of group treatment–Vicarious learning–Fostering independence–Learning through helping others–Effects of sharing similar problems–Public commitment–Encouragement through others’ successes01/13/19 Treatment of Social Phobia 15Cognitive-Behavioral Group Treatment (CBGT)•Procedural Components–Education–Exposure simulations*–Cognitive restructuring–Home-based skill practice•self-monitoring•cognitive-restructuring•in vivo exposure01/13/19 Treatment of Social Phobia 16Advantages of Exposure Simulations•Exposure simulations are always available;•Exposure simulations can be scheduled in a graduated fashion;•Exposure simulations are more controllable;•Exposure simulations are moldable to the needs of the patient;•Exposure simulations occur under the observation of the therapist;01/13/19 Treatment of Social Phobia 17Advantages of Exposure Simulations•Exposure simulations are easily integrated with cognitive restructuring activities;•Exposure simulations are less easily avoided by patients•Exposure simulations may facilitate compliance with homework assignments.01/13/19 Treatment of Social Phobia 18Examples of Common Exposure Simulations•Initiating conversations•Asking for a date•Public speaking•Writing in front of others•Eating or drinking in front of others•Working or playing while being observed01/13/19 Treatment of Social Phobia 19Examples of Common Exposure Simulations•Assertion and interaction with authority figures•Job interviews•Joining ongoing conversations•Making mistakes in front of others•Expressing opinions•Revealing personal information01/13/19 Treatment of Social Phobia 20Integrating Cognitive Restructuring and Exposures•Prior to a simulated exposure–Prompted thought recall–Identify experienced or potential AT–Identify cognitive distortion–Dispute AT–Develop rationale response to the AT–Set appropriate goal for performance in the exposure simulation01/13/19 Treatment of Social Phobia 21Integrating Cognitive Restructuring and Exposures•During an exposure simulation–Patient gives SUDS ratings at one minute intervals–Patient reads rational responses aloud when giving SUDS rating–Patient uses rational responses as automatic thoughts occur01/13/19 Treatment of Social Phobia 22Integrating Cognitive Restructuring and Exposures•After an exposure simulation–Review the patient’s goal and assess goal attainment–Review
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