Cognitive-Behavioral Therapy for Social Anxiety Disorder
A review of major studies and suggestions for learning more
THE MAIN POINT:
Cognitive-Behavioral Therapy (CBT) is the only intervention for Social Anxiety Disorder (SAD) that has been widely studied and shown to be both efficacious (good outcomes in well-controlled studies in the laboratory) and effective (good outcomes in studies based outside of the laboratory. Given that this intervention has been demonstrated to be helpful for many people, it is important for professional to be familiar with what the intervention looks like, as well as some basic studies demonstrating the usefulness of the intervention. Suggestions for learning more about this intervention are also provided.
THE DETAILS:
What is CBT for SAD?
Rationale:
Hambrick, Weeks, Harb, and Heimberg (2003) state that CBT understands SAD as being the result of distorted thoughts about how one thinks they will be perceived by others. These thoughts, along with memories, and feelings about oneself then form representations, or schemas, which lead individuals to think that engaging in social situations will lead to embarrassment, failure, and greater anxiety. The belief in these negative consequences then leads individuals to avoid social situations as a means of avoiding anxiety. This avoidance is reinforced because the individual is often able to escape the anxiety produced by social situations by avoiding them; however, this avoidance also means that the individual doesn’t have an opportunity for new learning, which may lead to disconfirmation of their beliefs.
Therefore, CBT for social anxiety seeks to teach individuals skills to enhance their ability to perform well in social situations, challenge distorted cognitions, and reduce avoidance of social situations.
Methods as outlined by Heimberg (2002):
- Exposure: this method involves having the individual safely enter into anxiety producing situations in order for new learning to occur. The idea is that by exposing oneself to the feared situation, the individual will learn that they are able to handle the anxiety and that the consequences that they fear most are not very likely to occur.
- Cognitive Restructuring: this method teaches individuals how to “talk back” to their thoughts. This is done by teaching individuals to identify negative, distorted thoughts, evaluate the thoughts, and then develop alternative thoughts to challenge them.
- Relaxation Training: this method helps individuals to feel more in control of their anxious responses when in feared situations. This is done by teaching individuals techniques such as deep breathing and progressive muscle relaxation.
- Social-Skills Training: this method helps individuals with SAD by improving their actual interpersonal skills, which should aid individuals in feeling a greater sense of mastery in social situations and should improve the quality of their interactions.
Treatment Length:
- Treatment is time-limited and problem-focused.
- Typical individual treatment involves 12 weeks of 1 hour sessions (Herbert, Rheingold, Gaudiano, & Myers, 2004).
- Typical group treatment involves 12 weeks of 2.5 hours sessions (Heimberg, 2002).
What has research found with regards to this treatment?
Treatment works, overall:
Published reviews on CBT for SAD have shown that the treatment improves symptoms of social anxiety disorder, avoidance of social situations, and overall well-being (Hambrick et al., 2003; Heimberg, 2002).
Works for various age groups:
Published studies find that the treatment works for both adults and adolescents (Herbert et al., 2009).
Individual vs. Group?
Recent evidence suggests that there are some advantages of delivering the treatment in a group format, particularly for reducing avoidance (Dogahe, Mohammadkhani, & Dolatshahi, 2012)
Briefer may be better:
Some evidence suggests that treatment works best when it is delivered in the recommended number of sessions, rather than extending treatment (Herbert et al., 2004).
What are the implications of this research to the clients I work with who have SAD?
Research has shown that this treatment works well, on average, which suggests that it’s likely that this treatment will work for clients you work with. However, research has also shown that there are some individuals who do not respond to treatment (Herbert et al., 2004; Mululo, de Menezes, Vigne, & Fontenelle, 2012). For example, Mululo et al. (2012) found that factors such as the presence of other comorbid anxiety disorders and greater severity of SAD have been found to predict poorer treatment outcomes. As always, clinicians should use evidenced-based practice, and consider the research, clinical expertise and the client’s preferences/culture.
How can I learn more about this CBT for SAD?
If you would like to learn more about the research on sad, please click the following links to read some broad reviews on the treatment:
In addition, you may find it useful to click this link, which covers a case study using CBT for SAD.
http://ccs.sagepub.com/content/11/1/35.abstract
How can I learn more about how to deliver the treatment CBT for SAD?
If you would like to learn more about CBT for SAD, you may consider purchasing the individual therapist guide for the treatment or the guide for the group treatment.
If you are interested in purchasing the manual for the individual treatment, please click the following link:
http://www.oup.com/us/companion.websites/0195189930/?view=usa
If you are interested in purchasing the manual for the group treatment, please click the following link:
If you are interested in attending a workshop, you may find an APA approved sponsor of continuing education in your area:
http://www.apa.org/education/ce/sponsors.aspx
References
Dogahe, E. R., Mohammadkhani, P., & Dolatshahi, B. (2012). Comparison of the effectiveness of group and individual cognitive-behavior therapy on reducing social anxiety symptoms. Psychological Research, 14(2), 7-24.
Hambrick, J. P., Weeks, J. W., Harb, G. C., & Heimberg, R. G. (2003). Cognitive-behavioral therapy for social anxiety disorder: Supporting evidence and future directions. CNS Spectrums, 8(5), 373-381.
Heimberg, R. G. (2002). Cognitive-behavioral therapy for social anxiety disorder: Current status and future directions. Biological Psychiatry, 51(1), 101-108. doi: 10.1016/S0006-3223(01)01183-0
Herbert, J. D., Gaudiano, B. A., Rheingold, A. A., Moitra, E., Myers, V. H., Dalrymple, K. L., & Brandsma, L. L. (2009). Cognitive behavior therapy for generalized social anxiety disorder in adolescents: A randomized controlled trial. Journal of Anxiety Disorders, 23(2), 167-177. doi: 10.1016/j.janxdis.2008.06.004
Herbert, J. D., Rheingold, A. A., Gaudiano, B. A., & Myers, V. H. (2004). Standard Versus Extended Cognitive Behavior Therapy for Social Anxiety Disorder: A Randomized-Controlled Trial. Behavioural and Cognitive Psychotherapy, 32(2), 131-147. doi: 10.1017/S1352465804001171
Mululo, S. C. C., de Menezes, G. B., Vigne, P., & Fontenelle, L. F. (2012). A review on predictors of treatment outcome in social anxiety disorder. Revista Brasileira de Psiquiatria, 34(1), 92-100. doi: http://dx.doi.org/10.1590/S1516-44462012000100016
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