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Psychosocial Treatments for Social Phobia

Published online by Cambridge University Press:  07 November 2014

Abstract

Increasing recognition of the prevalence and impairment associated with social phobia has spurred the development of effective psychosocial treatments for this disorder. Exposure-based interventions have the most empirical support. This article applies the tripartite model of anxiety to social phobia, describes state-of-the-art psychosocial treatments, and highlights studies on the comparative and combined efficacy of psychological and pharmacologic treatments. Clinical issues related to treatment implementation, limitations of extant psychosocial interventions, and suggestions for future research are also discussed.

Type
Feature Articles
Copyright
Copyright © Cambridge University Press 1999

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References

REFERENCES

1.Schneier, FR, Johnson, J, Hornig, C, Liebowitz, MR, Weissman, MM. Social phobia: comorbidity and morbidity in an epidemiologic sample. Arch Gen Psychiatry. 1992;49:282288.CrossRefGoogle Scholar
2.Beidel, DC, Turner, SM, Dancu, CV. Physiological, cognitive, and behavioral aspects of social anxiety. Behav Res Ther. 1985;23:109117.CrossRefGoogle ScholarPubMed
3.Turner, SM, Beidel, DC, Larkin, KT. Situational determinants of social anxiety in clinic and non-clinic samples: physiological and cognitive correlates. J Consult Clin Psychol. 1986;54:523527.CrossRefGoogle Scholar
4.Rapee, R. Descriptive psychopathology of social phobia. In: Heimberg, RG, Liebowitz, MR, Hope, DA, Scheneier, F, eds. Social Phobia: Diagnosis, Assessment, and Treatment. New York, NY: Guilford Press; 1995:4168.Google Scholar
5.Beidel, DC, Turner, SM. Shy Children, Phobic Adults: Nature and Treatment of Social Phobia. Washington, DC: American Psychological Association; 1998.CrossRefGoogle Scholar
6.Heimberg, RG, Juster, HR. Cognitive-behavioral treatments: literature review. In: Heimberg, RG, Liebowitz, MR, Hope, DA, Scheneier, F, eds. Social Phobia: Diagnosis, Assessment, and Treatment. New York, NY: Guilford Press; 1995:261309.Google Scholar
7.Barlow, DH, Wolfe, BE. Behavioral approaches to anxiety disorders: a report on the NIMH-SUNY Albany research conference. J Consult Clin Psychol. 1981;49:448454.CrossRefGoogle ScholarPubMed
8.Masia, CL, McNeil, DW, Cohn, LG, Hope, DA. Exposure to social anxiety words: treatment for social phobia based on the Stroop paradigm. Cognitive and Behavioral Practice. In press.Google Scholar
9.Al-Kubaisy, T, Marks, IM, Logsdail, S, et al.Role of exposure homework in phobia reduction: a controlled study. Behav Ther. 1992;23:599621.CrossRefGoogle Scholar
10.Alstrom, JE, Nordlund, CL, Persson, G, Harding, M, Ljungqvist, C. Effects of four treatment methods on social phobic patients not suitable for insight-oriented psychotherapy. Acta Psychiatr Scand. 1984;70:97110.CrossRefGoogle Scholar
11.Biran, M, Augusto, F, Wilson, GT. In vivo exposure vs. cognitive restructuring in the treatment of scriptophobia. Behav Res Ther. 1981;19:525532.CrossRefGoogle ScholarPubMed
12.Butler, G, Cullington, A, Munby, M, Amies, P, Gelder, M. Exposure and anxiety management in the treatment of social phobia. J Consult Clin Psychol. 1984;52:642650.CrossRefGoogle ScholarPubMed
13.Newman, MG, Hofmann, SG, Trabert, W, Roth, WE, Taylor, CB. Does behavioral treatment of social phobia lead to cognitive changes? Behav Ther. 1994;25:503517.CrossRefGoogle Scholar
14.Turner, SM, Beidel, DC, Jacob, RG. Social phobia: a comparison of behavior therapy and atenolol. J Consult Clin Psychol. 1994;62:350358.CrossRefGoogle ScholarPubMed
15.Wlazlo, Z, Schroeder-Hartwig, K, Hand, I, Kaiser, G, Munchau, N. Exposure in vivo vs. social skills training for social phobia: long-term outcome and differential effects. Behav Res Ther. 1990;28:181193.CrossRefGoogle ScholarPubMed
16.Clark, DM, Wells, A. A cognitive model of social phobia. In: Heimberg, RG, Liebowitz, MR, Hope, DA, Scheneier, F, eds. Social Phobia: Diagnosis, Assessment, and Treatment. New York, NY: Guilford Press; 1995:6993.Google Scholar
17.Mattick, RP, Peters, L. Treatment of severe social phobia: effects of guided exposure with and without cognitive restructuring. J Consult Clin Psychol. 1988;56:251260.CrossRefGoogle ScholarPubMed
18.Mattick, RP, Peters, L, Clarke, JC. Exposure and cognitive restructuring for social phobia: a controlled study. Behav Ther. 1989;20:323.CrossRefGoogle Scholar
19.Hope, DA, Heimberg, RG, Bruch, MA. Dismantling cognitive-behavioral group therapy for social phobia. Behav Res Ther. 1995;33:14.CrossRefGoogle ScholarPubMed
20.Mersch, PPA. The treatment of social phobia: the differential effectiveness of exposure in vivo and an integration of exposure in vivo, rational emotive therapy, and social skills training. Behav Res Ther. 1995;33:259269.CrossRefGoogle Scholar
21.Scholing, A, Emmelkamp, PMG. Cognitive and behavioral treatments of fear of blushing, trembling, or sweating. Behav Res Ther. 1993;31:155170.CrossRefGoogle ScholarPubMed
22.Feske, U, Chambless, DL. Cognitive-behavioral versus exposure treatment for social phobia: a meta-analysis. Behav Ther. 1995;26:695720.CrossRefGoogle Scholar
23.Heimberg, RG. A Manual for Conducting Cognitive-Behavioral Group Therapy for Social Phobia. 2nd ed. 1991. Available from the Social Phobia Program, Department of Psychology, Temple University, Philadelphia, Pa 19122-6085.Google Scholar
24.Heimberg, RG, Juster, HR, Hope, DA, Mattia, JI. Cognitive-behavioral group treatment: description, case presentation, and empirical support. In: Stein, MB, ed. Social Phobia: Clinical and Research Perspectives. Washington, DC: American Psychiatric Press; 1995:293322.Google Scholar
25.Heimberg, RG, Dodge, CS, Hope, DA, Kennedy, CR, Zollo, L, Becker, RE. Cognitive-behavioral group treatment of social phobia: comparison to credible placebo control. Cognit Ther Res. 1990;14:123.CrossRefGoogle Scholar
26.Heimberg, RG, Becker, RE, Goldfinger, K, Vermilyea, JA. Treatment of social phobia by exposure, cognitive restructuring, and homework assignments. J New Ment Dis. 1985;173:236245.CrossRefGoogle ScholarPubMed
27.Heimberg, RG, Salzman, DG, Holt, CS, Blendell, K. Cognitive-behavioral group treatment for social phobia: effectiveness at five-year follow-up. Cognit Ther Res. 1993;17:325339.CrossRefGoogle Scholar
28.Albano, AM, Marten, PA, Holt, CS. Therapist's Manual for Cognitive-Behavioral Group Therapy for Adolescent Social Phobia. 1991; unpublished manuscript, State University of New York, Albany. Available from the Child Study Center, Anne Marie Albano, NYU Medical Center, 550 First Ave, New York, NY 10016.Google Scholar
29.Albano, AM, Marten, PA, Holt, CS, Heimberg, RG, Barlow, DH. Cognitive-behavioral group treatment for adolescent social phobia: a preliminary study. J Nerv Ment Dis. 1995;183:649656.CrossRefGoogle ScholarPubMed
30.Clark, DB, Agras, WS. The assessment and treatment of performance anxiety in musicians. Am J Psychiatry. 1991;148:598605.Google ScholarPubMed
31.Fallcon, IRH, Lloyd, GG, Harpin, RE. Real-life rehearsal with nonprofessional therapists. J Nerv Ment Dis. 1981;169:180184.CrossRefGoogle Scholar
32.Liebowitz, MR, Schneier, F, Campeas, R, et al.Phenelzine vs atenolol in social phobia: a placebo-controlled comparison. Arch Gen Psychiatry. 1992;49:290300.CrossRefGoogle ScholarPubMed
33.van Vliet, IM, den Boer, JA, Westenberg, HGM, Pian, KLH. Clinical effects of buspirone in social phobia: a double-blind placebo-controlled study. J Clin Psychiatry. 1997;58:164168.CrossRefGoogle ScholarPubMed
34.Gelernter, CS, Uhde, TW, Cimbolic, P, et al.Cognitive-behavioral and pharmacological treatments of social phobia. Arch Gen Psychiatry. 1991;48:938945.CrossRefGoogle ScholarPubMed
35.Heimberg, RG, Liebowitz, MR, Hope, DA, et al.Cognitive behavioral group therapy vs phenelzine therapy for social phobia. Arch Gen Psychiatry. 1998;55:11331141.CrossRefGoogle ScholarPubMed
36.Liebowitz, MR, Heimberg, RG, Schneier, FR, et al.Cognitive-behavioral group therapy versus phenelzine in social phobia: long term outcome. Depress Anxiety. In press.Google Scholar
37.Masia, CL, Anderson, C, McNeil, DW, Hawkins, RP. Managed care and graduate training: a call for action. The Behavior Therapist. 1997;20:145148.Google Scholar
38.Butler, G. Exposure as a treatment for social phobia: some instructive difficulties. Behav Res Ther. 1985;23:651657.CrossRefGoogle ScholarPubMed
39.Wells, A, Clark, DM, Salkovskis, P, Ludgate, J, Hackmann, A, Gelder, M. Social phobia: the role of in-situation safety behaviors in maintaining anxiety and negative beliefs. Behav Ther. 1995;26:153161.CrossRefGoogle Scholar
40.Markway, BG, Carmin, CN, Pollard, CA, Flynn, T. Dying of Embarrassment: Help for Social Anxiety and Phobia. New York, NY: New Harbinger Publications; 1993:315.Google Scholar
41.Stravynski, A, Marks, I, William, Y. Social skills problems in neurotic outpatients. Arch Gen Psychiatry. 1982;39:13781385.CrossRefGoogle ScholarPubMed
42.Mersch, PPA, Emmelkamp, PMG, Bogels, SM, van Der, Sleen J. Social phobia: individual response patterns and the effects of behavioral and cognitive interventions. Behav Res Ther. 1989;27:421434.CrossRefGoogle ScholarPubMed
43.Ost, LG, Jerramalm, A, Johansson, J. Individual response patterns and the effects of different behavioral methods in treatments of social phobia. Behav Res Ther. 1981;19:116.CrossRefGoogle ScholarPubMed
44.Lipsitz, JD, Markowitz, JC, Cherry, S, Fyer, AJ. An open trial of interpersonal psychotherapy for social phobia. Am J Psychiatry. In press.Google Scholar
45.Masia, CL, Morris, TL. Parental influence on social anxiety: methodological limitations and suggestions for integrated behavioral research. Clinical Psychology: Science and Practice. 1998;5:211228.Google Scholar
46.Schneier, FR, Juster, HR, Heimberg, RG, Liebowitz, MR. Diagnosis and treatment of social phobia. Journal of Practical Psychiatry and Behavioral Heath, 1996;2:94104.Google Scholar
47.Feske, U, Perry, KJ, Chambless, DL, Renneberg, B, Goldstein, AJ. Avoidant personality disorder as a predictor for treatment outcome among generalized social phobics. J Personal Disord. 1996;10:174184.CrossRefGoogle Scholar
48.Turner, SM, Beidel, DC, Wolff, PL, Spaulding, S, Jacob, RG. Clinical features affecting treatment outcome in social phobia. Behav Res Ther. 1996;34:795804.CrossRefGoogle ScholarPubMed
49.Boone, ML, McNeil, DW, Masia, CL, et al.Multimodal comparisons of social phobia subtypes and avoidant personality disorder. J Anxiety Disord. In press.Google Scholar
50.Brown, EJ, Heimberg, RG, Juster, HR. Social phobia subtype and avoidant personality disorder: effect on severity of social phobia, impairment, and outcome of cognitive-behavioral treatment. Behav Ther. 1995;26:467486.CrossRefGoogle Scholar
51.Hope, DA, Herbert, JD, White, C. Diagnostic subtypes, avoidant personality disorder, and efficacy of cognitive behavioral group therapy for social phobia. Cognit Ther Res. 1995;19:399417.CrossRefGoogle Scholar
52.Turner, SM, Beidel, DC, Cooley, MR, Woody, SR, Messer, SC. A multi-component behavioral treatment for social phobia: Social Effectiveness Therapy. Behav Res Ther. 1994;32:381390.CrossRefGoogle Scholar
53.Turner, SM, Beidel, DC, Cooley-Quille, MR. Two-year follow-up of social phobics treated with Social Effectiveness Therapy. Behav Res Ther. 1995;33:553555.CrossRefGoogle ScholarPubMed