Social Phobialatest.ppt
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Social Phobia
Lecture Overview
? Nature and epidemiology
? Empirically-supported treatments
? Efficacy data
? Moderator variables
? Clinical tips in working with social anxiety clients
? Class discussion
Epidemiology 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.
Epidemiology of Social Phobia
? Defining features cont.
- 4. Marked impairment;
- 5. Not better accounted for by a medical problem or other mental disorder
Epidemiology of Social Phobia
? Subtypes
- Generalized
- Specific
Epidemiology of Social Phobia
? Prevalence
Prevalence of Anxiety Disorders
Epidemiology of Social Phobia
? Onset and course
- Early age of Onset (14.8 girls; 16.3 boys)
- Chronic unremitting course
Epidemiology 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)
Epidemiology of Social Phobia
? Comorbidity
- Simple phobia (59.0)
- Agoraphobia (44.9)
- Alcohol abuse (18.8)
- Depression (16.6)
Based on: (Schneier et al (1992)
Pharmacological Treatments for Social Phobia
? Standard MAOIs
? Selective reversible MAOIs
? Benzodiazepines
? SSRIs
? Beta Blockers
Psychosocial Treatments for Social Phobia
? CBGT
? Exposure
? Cognitive therapy
Cognitive-Behavioral Group Treatment (CBGT)
? Potential advantages of group treatment
- Vicarious learning
- Fostering independence
- Learning through helping others
- Having similar problems
- Public commitment
- Encouragement through others' successes
Cognitive-Behavioral Group Treatment (CBGT)
? Procedural Components
- Education
- Exposure simulations
- Cognitive restructuring
- Home-based skill practice
? self-monitoring
? cognitive-restructuring
? in vivo exposure
Advantages 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;
Advantages 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.
Examples 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 wall being observed
Examples 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 information
Integrating 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 simulation
Integrating 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 occur
Integrating Cognitive Restructuring and Exposures
? After an exposure simulation
- Review the patient's goal and assess goal attainment
- Review the occurrence of automatic thoughts listed before the exposure simulation
- Review and evaluate the use of rational responses
- Examine the occurrence of unexpected automatic thoughts and patients' attempt to cope with them
- Examine the covariation between automatic thoughts, rational responses, and SUDS ratings
Summary of Homework Procedures
? Before attempting assignment
- Imagine yourself in the target situation
- Record AT on self-monitoring form
- Identify cognitive distortions
- Ask yourself which AT is most problematic
- Come up with the rational response for each AT
Summary of Homework Procedures
? While attempting the assignment
- Focus on the goals that you have set
- Tolerate whatever anxiety you experience to the best of your ability
- Use your rational responses to help control your anxiety
- Keep your eyes open and try to learn whatever you can from the assignment
Summary of Homework Procedures
? After attempting the assignment
- Set aside a period of cognitive debriefing
- Assess whether or not you made your goals
- Examined the list of automatic thought you recorded before the assignment
- Record automatic thoughts that occurred since you did the assignment
- Relax
CBGT Efficacy Data
? Heimberg et al, (1990)
? Heimberg et al. (1993)
? Gelernter et al. (1991)
? NIMH Multicenter Study......（后略) ......
Social Phobia
Lecture Overview
? Nature and epidemiology
? Empirically-supported treatments
? Efficacy data
? Moderator variables
? Clinical tips in working with social anxiety clients
? Class discussion
Epidemiology 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.
Epidemiology of Social Phobia
? Defining features cont.
- 4. Marked impairment;
- 5. Not better accounted for by a medical problem or other mental disorder
Epidemiology of Social Phobia
? Subtypes
- Generalized
- Specific
Epidemiology of Social Phobia
? Prevalence
Prevalence of Anxiety Disorders
Epidemiology of Social Phobia
? Onset and course
- Early age of Onset (14.8 girls; 16.3 boys)
- Chronic unremitting course
Epidemiology 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)
Epidemiology of Social Phobia
? Comorbidity
- Simple phobia (59.0)
- Agoraphobia (44.9)
- Alcohol abuse (18.8)
- Depression (16.6)
Based on: (Schneier et al (1992)
Pharmacological Treatments for Social Phobia
? Standard MAOIs
? Selective reversible MAOIs
? Benzodiazepines
? SSRIs
? Beta Blockers
Psychosocial Treatments for Social Phobia
? CBGT
? Exposure
? Cognitive therapy
Cognitive-Behavioral Group Treatment (CBGT)
? Potential advantages of group treatment
- Vicarious learning
- Fostering independence
- Learning through helping others
- Having similar problems
- Public commitment
- Encouragement through others' successes
Cognitive-Behavioral Group Treatment (CBGT)
? Procedural Components
- Education
- Exposure simulations
- Cognitive restructuring
- Home-based skill practice
? self-monitoring
? cognitive-restructuring
? in vivo exposure
Advantages 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;
Advantages 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.
Examples 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 wall being observed
Examples 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 information
Integrating 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 simulation
Integrating 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 occur
Integrating Cognitive Restructuring and Exposures
? After an exposure simulation
- Review the patient's goal and assess goal attainment
- Review the occurrence of automatic thoughts listed before the exposure simulation
- Review and evaluate the use of rational responses
- Examine the occurrence of unexpected automatic thoughts and patients' attempt to cope with them
- Examine the covariation between automatic thoughts, rational responses, and SUDS ratings
Summary of Homework Procedures
? Before attempting assignment
- Imagine yourself in the target situation
- Record AT on self-monitoring form
- Identify cognitive distortions
- Ask yourself which AT is most problematic
- Come up with the rational response for each AT
Summary of Homework Procedures
? While attempting the assignment
- Focus on the goals that you have set
- Tolerate whatever anxiety you experience to the best of your ability
- Use your rational responses to help control your anxiety
- Keep your eyes open and try to learn whatever you can from the assignment
Summary of Homework Procedures
? After attempting the assignment
- Set aside a period of cognitive debriefing
- Assess whether or not you made your goals
- Examined the list of automatic thought you recorded before the assignment
- Record automatic thoughts that occurred since you did the assignment
- Relax
CBGT Efficacy Data
? Heimberg et al, (1990)
? Heimberg et al. (1993)
? Gelernter et al. (1991)
? NIMH Multicenter Study......（后略) ......