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Comparison of Attention Training and Cognitive Therapy in the Treatment of Social Phobia: A Preliminary Investigation

  • Juliet Donald (a1), Maree J. Abbott (a1) and Evelyn Smith (a2)

Abstract

Background: Prominent models of social phobia highlight the role played by attentional factors, such as self-focused attention, in the development and maintenance of social phobia. Elevated self-focused attention is associated with increases in self-rated anxiety. Treatments that aim to modify and change attentional processes, specifically self-focused attention, will have a direct effect on social phobia symptoms. Thus, Attention Training targets attentional focus. Aim: The present study aimed to investigate the efficacy of Attention Training in comparison to an established treatment for social phobia, Cognitive Therapy. Method: Participants (Intention-to-treat = 45; completers = 30) were allocated to either 6 weeks of Attention Training or Cognitive Therapy. It was hypothesized that both treatments would be effective in reducing social phobia symptoms, but that Attention Training would work primarily by reducing levels of self-focused attention. Results: The results found an overall effectiveness of both treatment conditions in reducing social phobia symptoms. However, Attention Training significantly improved scores on the Self-Focused Attention questionnaire and the Brief Fear of Negative Evaluation questionnaire compared to Cognitive Therapy. Conclusion: Attention Training seems to be a promising treatment for social phobia.

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Corresponding author

Reprint requests to Evelyn Smith, University of New South Wales, School of Psychiatry, 34 Botany Street, Randwick, New South Wales 2031, Australia. E-mail: evelyn.smith@unsw.edu.au

References

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Abbott, M., Gaston, J., Correia, H. and Rapee, R. (2006). 6 Session Group Attention Training Program for Social Phobia: therapist manual and client worksheets. Macquarie University.
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders (4th ed. text revised). Washington, DC: APA.
Andrews, G. and Peters, L. (1998). The psychometric properties of the composite international diagnostic interview. Social Psychiatry and Psychiatric Epidemiology, 33, 8088.
Bogels, S. M., Alberts, M. and de Jong, P. J. (1996). Self-consciousness, self-focused attention, blushing propensity and fear of blushing. Journal of Personality and Individual Differences, 21, 573581.
Bogels, S. M. and Lamers, C. T. J. (2002). The causal role of self-awareness in blushing-anxious, socially anxious, and social phobics individuals. Behavior Research and Therapy, 42, 13671384
Bogels, S. M., Rijsemus, W. and de Jong, P. J. (2002). Self-focused attention and social anxiety: the effects of experimentally heightened self-awareness on fear, blushing, cognitions and social skills. Cognitive Therapy and Research, 26, 461472.
Brown, T. A., Chorpita, B. F., Kortitsch, W. and Barlow, D. H. (1997). Psychometric properties of the depression anxiety stress scales (DASS) in clinical samples. Behavior Research and Therapy, 35, 7989.
Clark, D., Ehlers, A., McManus, F., Hackmann, A., Fennell, M., Campbell, C., et al. (2003). Cognitive therapy versus fluoxetine in generalized social phobia: a randomized placebo-controlled trial. Journal of Consulting and Clinical Psychology, 71, 10581067.
Clark, D. and Wells, A. (1995). A cognitive model of social phobia. In Heimberg, R., Liebowitz, M., Hope, D. and Schneier, F. (Eds.), Social Phobia: diagnosis, assessment and treatment (pp. 6993). New York: Guilford Press.
Collins, K., Westra, H., Dozois, D. and Stewart, S. (2005). The validity of the brief version of the Fear of Negative Evaluation Scale. Anxiety Disorders, 19, 345359.
Heimberg, R. and Juster, H. (1995). Cognitive behavioral treatments: literature review. In Heimberg, R., Liebowitz, M., Hope, D. and Schneier, F. (Eds.), Social Phobia: diagnosis, assessment and treatment (pp. 261309). New York: Guilford.
Heimberg, R., Salzman, D., Holt, C. and Blendell, K. (1993). Cognitive-behavioral group treatment for social phobia: effectiveness at five-year follow-up. Cognitive Therapy and Research, 17, 325339.
Hofmann, S. (2007). Cognitive factors that maintain social phobia: a comprehensive model and its treatment implications. Cognitive Behavioral Therapy, 36, 193209.
Hofmann, S. G. and Suvak, M. (2006). Treatment attrition during group therapy for social phobia. Journal of Anxiety Disorders, 20, 961972.
Hollis, S. and Campbell, F. (1999). What is meant by intention to treat analysis? Survey of published randomised controlled trials. British Medical Journal, 319, 670674.
Hope, D., Gansler, D. and Heimberg, R. (1989). Attentional focus and casual attributions in social phobia: implications from social psychology. Clinical Psychology Review, 9, 4960.
Jacobson, N. S. and Truax, P. (1991). Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 1219.
Kazis, L. E., Anderson, J. J. and Meenan, R. F. (1989). Effect sizes for interpreting changes in health status. Medical Care, 27, S178189.
Kessler, R. C., Nelson, C. B., McGonagle, K. A., Swartz, M. and Blazer, D. G. (1996). Comorbidity of DSM-III-R major depressive disorder in the general population: results from the US national co-morbidity survey. British Journal of Psychiatry, 168, 1730.
Leahy, R. (2003). Cognitive Therapy Techniques. New York: Guilford Press.
Leary, M. R. (1983). A brief version of the Fear of Negative Evaluation Scale. Personality and Social Psychology Bulletin, 9, 371375.
Lovibond, S. H. and Lovibond, P. F. (1995). Manual for the Depression Anxiety Stress Scale. Sydney, Australia: Psychology Foundation.
McEvoy, P. M. and Perini, , , S. (2009). Cognitive behavioral group therapy for social phobia with or without attention training: a controlled trial. Journal of Anxiety Disorders, 23, 519528.
Mellings, T. M. B. and Alden, , , L. E. (2000). Cognitive process in social anxiety: the effects of self-focused attention, rumination, and mood-congruent memory retrieval. Behaviour Research and Therapy, 3, 243257.
Miller, R. S. (1995). On the nature of embarrassability: shyness, social evaluation and social skill. Journal of Personality, 63, 315339.
Mobini, S. and Grant, A. (2007). Clinical implications of attentional bias in anxiety disorders: an integrative literature review. Psychotherapy: Theory, Research, Practice, Training, 44, 450462.
Osman, A., Barrios, F. X., Haupt, D., King, K., Osman, J. R. and Slavens, S. (1996). The Social Phobia and Anxiety Inventory: further validation in two nonclinical samples. Journal of Psychopathology and Behavioral Assessment, 18, 3541.
Peters, L., Clark, D. and Carroll, F. (1998). Are computerized interviews equivalent to human interviewers? CIDI-Auto versus CIDI in anxiety and depressive disorders. Psychological Medicine, 28, 893901.
Ponniah, K. and Hollon, S. D. (2008). Empirically supported psychological interventions for social phobia in adults: a qualitative review of randomized controlled trials. Psychological Medicine, 38, 314.
Rapee, R. M. and Abbott, M. J. (2007). Modelling relationships between cognitive variables during and following public speaking in participants with social phobia. Behavior Research and Therapy, 45, 29772989.
Rapee, R. M., Abbott, M. J., Baillie, A. and Gaston, J. E. (2007). Treatment of social phobia through pure self help and therapist-augmented self help. British Journal of Psychiatry, 191, 246252.
Rapee, R., Gaston, J. and Abbott, M. (2009). Testing the efficacy of theoretically-derived improvements in the treatment of social phobia. Journal of Consulting and Clinical Psychology, 77, 317327.
Rapee, R. and Heimberg, R. (1997). A cognitive behavioral model of anxiety in social phobia. Behavior, Research and Therapy, 35, 741756.
Rodebaugh, T. L., Woods, C. M., Thissen, D. M., Heimberg, R. G., Chambless, D. L. and Rapee, R. M. (2004).More information from fewer questions: the factor structure and item properties of the original and brief Fear of Negative Evaluation scale. Psychological Assessment, 16, 169181
Schinka, J., Velicer, W. and Weiner, I. (2003). Handbook of Psychology: research methods in psychology. New Jersey: John Wiley and Sons, Inc.
Schulz, S., Alpers, G. and Hofmann, S. (2008). Negative self-focused cognitions mediate the effect of trait social anxiety on state anxiety. Behavior Research and Therapy, 46, 438449.
Segal, Z. V., Williams, J. M. G. and Teasdale, J. D. (2002). Mindfulness-Based Cognitive Therapy for Depression: a new approach to preventing relapse. New York: Guilford Press.
Stangier, U., Heidenreich, T., Peitz, M., Lauterbach, W. and Clark, D. M. (2003). Cognitive therapy for social phobia: individual versus group treatment. Behaviour Research and Therapy, 49, 991–100
Stopa, L. and Clark, D. (1993). Cognitive processes in social phobia. Behavior Research and Therapy, 31, 255267.
Taylor, S. (1996). Meta-analysis of cognitive-behavioral treatment for social phobia. Journal of Behavior, Therapy and Experimental Psychiatry, 27, 19.
Taylor, S., Woody, S. R., Koch, W., Mclean, P., Paterson, R. and Anderson, K. (1997). Cognitive restructuring in the treatment of social phobia: efficacy and mode of action. Behavior Modification, 21, 487511.
Turner, S., Beidel, D. C., Dancu, C. V. and Stanley, M. A. (1989). An empirically derived inventory to measure social fears and anxiety: the Social Phobia and Anxiety Inventory. Psychological Assessment, 1, 3540.
Valentine, J. and Cooper, H. (2003). Effect Size Substantive Interpretation Guidelines: issues in the interpretation of effect sizes. Washington, DC: What Works Clearinghouse.
Weeks, J. W., Heimberg, R. G., Fresco, D. M., Hart, T. A., Turk, C. L. and Schneier, F. R. (2005). Empirical validation and psychometric evaluation of the Brief Fear of Negative Evaluation Scale in patients with social phobia. Psychological Assessment, 17, 179190
Wells, A. (1990). Panic disorder in association with relaxation induced anxiety: an attentional training approach to treatment. Behavior Therapy, 21, 273280.
Wells, A. (2000). New pathways for cognitive restructuring: attention modifications (ATT and SAR). In Wells, A. (Ed.), Emotional Disorders and Meta-Cognition. New York: Wiley.
Wells, A. and Papegeorgiou, C. (2001). Brief cognitive therapy for social phobia: a case series. Behaviour Research and Therapy, 39, 713720.
Wells, A., White, J. and Carter, K. (1997). Attention Training: effects on anxiety and beliefs in panic and social phobia. Clinical Psychology and Psychotherapy, 4, 226232.
Wlazlo, Z., Schroeder-Hartwig, K., Hand, I., Kaiser, G. and Munchau, N. (1990). Exposure in vivo vs. social skills training for social phobia: long term outcome and differential effects. Behavior, Research and Therapy, 28, 181193.
Woody, S. R. (1996). Effects of focus of attention on social phobic's anxiety and social performance. Journal of Abnormal Psychology, 105, 6169.
Woody, S. R., and Rodriguez, B. F. (2000). Self-focused attention and social anxiety in social phobics and normal controls. Cognitive Therapy and Research, 24, 473488.
World Health Organization (1993). The ICD-10 Classification of Mental and Behavioral Disorders. Geneva: World Health Organization.
World Health Organization (1997). Composite International Diagnostic Interview, version 2.1. Geneva: World Health Organization.

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Comparison of Attention Training and Cognitive Therapy in the Treatment of Social Phobia: A Preliminary Investigation

  • Juliet Donald (a1), Maree J. Abbott (a1) and Evelyn Smith (a2)
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