The aim of this work was to test the contribution of cognitive therapy to exposure in vivo in the group treatment of generalized social phobia. Seventy-one severely disabled social phobics, selected according to DSM-III-R criteria, were assigned at random to: (a) self-exposure in vivo, (b) self-exposure in vivo with cognitive therapy, or (c) a waiting-list control group. A multigroup experimental design with repeated measures of assessment (pretreatment, posttreatment, and 1-, 3-, 6-, and 12-month follow-ups) was used. Additionally, half of the patients in both therapeutic groups were given self-help manuals for managing anxiety. Most patients that were treated (64%) showed significant improvement at the 12-month follow-up, but there were no differences between the two therapeutic modes. No improvement was shown by the control-group participants at the 6-month follow-up. The results of the present trial do not support the beneficial effects of adding cognitive therapy or a self-help manual to exposure alone. Finally, several topics that may contribute to future research in this field are discussed.
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References
1.
American Psychiatric Association (APA) . (1987). Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.). Washington: Author.
2.
American Psychiatric Association (APA) . (1994). Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Washington: Author.
3.
Beck, A. T. , Emery, G., & Greenberg, R. L. (1985). Anxiety Disorders and phobia. New York: Basic Books.
4.
Beck, A. T. , Ward, C. H., Mendelsohn, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561-571.
5.
Beidel, D. C. , Turner, S. M., & Dancu, C. U. (1985). Physiological, cognitive, and behavioral aspects of social anxiety. Behaviour Research and Therapy, 23, 109-117.
6.
Biran, M. , Augusto, F., & Wilson, G. T. (1981). In vivo exposure versus cognitive restructuring in the treatment of scritophobia. Behaviour Research and Therapy, 19, 525-532.
7.
Butler, G. (1985). Exposure as a treatment for social phobia. Some instructive difficulties. Behaviour Research and Therapy, 23, 651-659.
8.
Butler, G. (1990). Manejo de la ansiedad. Pamplona. Consejeria de Salud del Gobierno de Navarra. (Original work published in 1985)
9.
Butler, G. , Cullington, A., Munby, M., Amies, P., & Gelder, M. (1984). Exposure and anxiety management in the treatment of social phobia. Journal of Consulting and Clinical Psychology, 52, 642-650.
10.
Di Nardo, P. A. , & Barlow, D. H. (1988). Anxiety disorders interview schedule-revised (ADIS-R). Albany, NY: Phobic and Anxiety Disorders Clinic.
11.
Echeburta, E. (1993). Fobia social. Barcelona: Martinez Roca.
12.
Echeburdia, E. (1995). Manual prdctico de evaluacion y tratamiento de la fobia social. Barcelona: Martinez Roca.
13.
Echeburua, E., & Corral, P. (1987). Escala de Adaptaci6n. Unpublished manuscript.
14.
Echeburua, E. , & Salaberria, K. (1991). Tratamientos psicol6gicos de la fobia social: Un analisis critico. Psicothema, 3, 7-23.
15.
Echeburuia, E. , & Salaberria, K. (1994). Exposici6n y t6cnicas cognitivas en el tratamiento de la fobia social. En M. Garaigordobil & C. Maganto (Eds.), Socializacion y conducta prosocial en la infancia y en la adolescencia. Bilbao: Universidad del Pais Vasco.
16.
Edelman, R. E. , & Chambless, D. L. (1995). Adherence during sessions and homework in cognitive-behavioral group treatment of social phobia. Behaviour Research and Therapy, 33, 573-577.
17.
Feske, U. , & Chambless, D. L. (1995). Cognitive behavioral versus exposure only treatment for social phobia: A meta-analysis. Behavior Therapy, 26, 695-720.
18.
Heimberg, R. G. , Hope, D. A., Rapee, R. M., & Bruch, M. A. (1988). The validity of the Social Avoidance and Distress Scale and the Fear of Negative Evaluation Scale with social phobic patients. Behaviour Research and Therapy, 26, 407-410.
19.
Heimberg, R. G. , Salzman, D. G., Holt, C. S., & Blendell, K. A. (1993). Cognitive-behavioral group treatment for social phobia: Effectiveness at five-year follow up. Cognitive Therapy and Research, 17, 325-341.
20.
Hope, D. A. , Heimberg, R. G., & Bruch, M. A. (1995). Dismandling cognitive-behavioral group therapy for social phobia. Behaviour Research and Therapy, 33, 637-650.
21.
Hope, D. A. , Herbert, J. D., & White, C. (1995). Diagnostic subtype, avoidant personality disorder, and efficacy of cognitive-behavioral group therapy for social phobia. Cognitive Therapy and Research, 19, 399-417.
22.
Kanter, N. J. , & Goldfried, M. R. (1979). Relative efficacy of rational restructuring and self-control desensitization and the reduction of interpersonal anxiety. Behaviour Therapy, 10,472-490.
23.
Lucock, M. , & Salkovskis, P. (1988). Cognitive factors in social anxiety and its treatment. Behaviour Research and Therapy, 26, 297-302.
24.
Manuzza, S. , Schneier, F. R., Chapman, T. F., Liebowitz, M. R., Klein, D. F., & Fyer, A. J. (1995). Generalized social phobia: Reliability and validity. Archives of General Psychiatry, 52, 230-237.
25.
Mattick, R. P. , Peters, L., & Clarke, J. C. (1989). Exposure and cognitive restructuring for social phobia: A controlled study. Behavior Therapy, 20, 3-23.
26.
Mersch, P.P.A. (1995). 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. Behavior Research and Therapy, 33, 259-269.
27.
Mersch, P.P.A. , Emmelkamp, P.M.G., Bogels, S. M., & Van Der Sleen, J. (1989). Social phobia: Individual response patterns and the effects of behavioral and cognitive interventions. Behaviour Research and Therapy, 27, 421-434.
28.
Oei, T. , Kenna, D., & Evans, L. (1991). The reliability, validity and utility of the SAD and FNE scales for anxiety disorder patients. Personality and Individual Differences, 12, 111-116.
29.
Ost, L. G. (1989). A maintenance program for behavioral treatment of anxiety disorders. Behaviour Research and Therapy, 27, 123-130.
30.
Ost, L. G. , Jerremalm, A., & Johansson, J. (1981). Individual response patterns and the effects of different behavioral methods in the treatment of social phobia. Behaviour Research and Therapy, 19, 1-16.
31.
Rapee, R. M. , Sanderson, W. C., & Barlow, D. H. (1988). Social phobia features across the DSM-III-R Anxiety Disorders. Journal of Psychopathology and Behavioral Assessment, 10, 287-299.
32.
Rathus, A. (1973). A 30 items schedule for assessing assertive behavior. Behavior Therapy, 4, 398-406.
33.
Rosenberg , (1965). Society and the adolescent self-image. New Jersey: Princeton.
34.
Scholing, A. , & Emmelkamp, P.M.G. (1993a). Cognitive-behavioral treatment of fear blushing, trembling or sweating. Behaviour Research and Therapy, 23, 155-170.
35.
Scholing, A. , & Emmelkamnp, P.M.G. (1993b). Exposure with and without cognitive therapy for generalized social phobia: Effects of individual and group treatment. Behaviour Research and Therapy, 31, 667-681.
36.
Spielberger, C. D. , Gorsuch, R. L., & Lushene, R. E. (1970). The State-TraitAnxiety Inventory. Palo Alto, CA: Consulting Psychologist Press.
37.
Steer, R. A. , & Beck, A. T. (1988). Beck Depression Inventory. In M. Hersen & A.S. Bellack (Eds.), Dictionary of behavioral assessment techniques. New York: Pergamon.
38.
Stravynski, A. , & Greenberg, D. (1989). Behavioral psychotherapy for social phobia and dysfunction. International Review of Psychiatry, 30, 212-216.
39.
Stravynski, A. , Marks, I., & Yule, W. (1982). Social skills problems in neurotic outpatients: Social skills training with and without cognitive modification. Archives of General Psychiatry, 39, 1378-1385.
40.
Tran, G. Q. , & Chambless, D. L. (1995). Psychopathology of social phobia: Effects of subtype and of avoidant personality disorder. Journal of Anxiety Disorders, 9, 489-501.
41.
Turner, S. M. , & Beidel, D. C. (1989). Social phobia: Clinical syndrome. Diagnosis and comorbidity. Clinical Psychology Review, 9, 3-18.
42.
Turner, S. M. , Beidel, D. C., & Cooley-Quille, M. R. (1995). Two-year follow-up of social phobics treated with social effectiveness therapy. Behaviour Research and Therapy, 33, 553-555.
43.
Watson, D. , & Friend, R. (1969). Measurement of social-evaluative anxiety. Journal of Consulting and Clinical Psychology, 33, 448-457.
44.
Wlazlo, Z. , Schroeder-Hartwig, K., Hand, I., Kaiser, G., & Miinchan, N. (1990). Exposure in vivo versus social skills training for social phobia-long term outcome and differential effects. Behaviour Research and Therapy, 28, 181-195.
