Social Phobia

Psychotherapy, Cognitive Behavior, Medication

Treatment Summary: Successful treatment begins with careful diagnosis, especially as we become aware of the values of specific syndromes. Clinicians should expect only partial response to treatment in many cases and should educate patients accordingly. Patients should be warned about periods of recurrent anxiety and agitation and encouraged to try to ride out time-limited episodes using behavioral techniques such as distraction, relaxation, or cognitive strategies, rather than immediately turning to increased medication.

• Reference: Sadavoy, Joel, LeClair, Kenneth, J. (1997). Treatments of Anxiety Disorders in Late Life. Canadian Journal of Psychiatry. Vol. 42, Suppl 1.
• Submitter:

Treatment Summary: Focus issues on the design short forms is used to measure social interaction anxiety scale (SIAS) and social phobia scale (SPS) to discriminate between anxious and non-anxious core latent traits. Treatment Report The two major design short-form instruments are social interaction anxiety scale (SIAS) and social phobia (SPS) were supported by the utilization of non-parametric item response theory method (IRT). Either of the parametric and non-parametric item response models can be utilized when plotting/graphing the mathematical functions of individual items of the basic latent traits. The IRT granted a statistical structure for evaluating likert-type test items by graphically plotting the option characteristic curves (OCC) , the performance of a given items are restrained by clarifying the slope, shape and the functional of the core of the latent traits. The design of a short-form instrument is illustrated by shortening or refining a more erudition measurement in the event to generalized a smaller scale with virtually the same psychometric properties that takes about 10 - 15 minutes to be completed. The two negative forms (SIAS and SP) used are briefly screened the fear of negative evaluation and depression anxiety stress scales in patients.

• Reference: eters, L., Matthew, S., and Andrews, G., Rapee, R., M. & Mattick, R. P. (2012). Development of a Short Form Social Interaction Anxiety (SIAS) and Social Phobia Scale (SPS) Using Nonparametric Item Response Theory: The SIAS-6 and the SPS-6. Psychological Assessment, 024(1), 066-076. Retrieve http://www.proquest.
• Submitter: N/A

Treatment Summary: The focus of this treatment report is to review the potential treatment options, and their efficacy, for those suffering from Post-Traumatic Stress Disorder (PTSD). Special attention was given to Eye Movement Desensitization and Reprocessing (EMDR) and Prolonged Exposure Therapy (PE), which are the two primary treatment options within the Department of Defense (DoD) and the Veterans Administration (VA). Taylor et al (2003) studied PE, EMDR, and Relaxation Training (RT) in order to determine the most effective treatment for those suffering with PTSD. Their study consisted of 60 participants who met the DSM -IV-TR criteria for PTSD. Summing their study, they concluded the PE and EMDR were the most efficacious treatment protocols for PTSD, with greater results achieved by PE. Sharpless and Barber (2011) studied both pharmacological and psychological approaches to treating PTSD. Their studied concluded that paroxetine (Paxil), and sertraline (Zoloft) were effective pharmacological interventions, while recognizing that not all those suffering with PTSD may be comfortable such treatments for extended periods of time. They examined 11 other psychological treatment models (PE, Cognitive Processing Therapy (CPT), EMDR, Stress Inoculation Training, Exposure Therapy with Virtual Reality, Relaxation Training, Cognitive Behavioral Group Therapies, Psychodynamic Therapy, Interpersonal Psychotherapy, Dialectical Behavioral Therapy, and Hypnosis) and concluded that PE, CPT, and EMDR were the recommended treatment protocols, with priority given to PE Based on the literature reviewed thus far, it appears that the two most effective treatments for PTSD are PE and EMDR.

• Reference: Sharpless, B.A., Barber, J.P. (2011) A clinician's guide to PTSD treatments for returning veterans. Professional Psychology: Research and Practice. 42, 1, 8-15. DOI: 10.1037/a0022351 Taylor, S., Fedoroff, I.C., Lovell, K., Maxfield, L., Thordarson, D.S. (2003) Comparative efficacy, speed, and adverse effects of three PTSD treatments: exposure therapy, EMDR, and relaxation training. Journal of Consulting and Clinical Psychology, 71, 2, 330-338. DOI: 10.1037/0022-006X.71.2.330
• Submitter: N/A

Cognitive Behavioral Therapy

Treatment Summary: Cognitive behavior therapy delivered on an individual basis or in a group setting has been proven to significantly help clients diagnosed with social phobia (McEvoy & Perini, 2009). Cognitive behavior therapy helps clients with social phobia by using exposure, cognitive, and assertiveness therapy (Klinger et al., 2005). Exposure therapy involves frequent exposure to anxiety provoking situations. Cognitive therapy involves helping the client modify their negative thoughts about social situations. Assertiveness therapy assists the client with learning and using behaviors that are more efficient. Specifically, cognitive behavior therapy helps clients learn that their social interactions are not likely to lead to the anxiety provoking outcomes that they actually expect (Moscovitch, 2009).

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• Submitter: N/A

Virtual reality therapy

Treatment Summary: Virtual reality therapy imitates exposure therapy but eliminates the numerous constraints that real social situations or the in vivo technique produces. This therapy allows clients to experience real like social situations that produce strong reactions and feelings that the client would feel if they were actually encountering a real social situation. Another advantage of utilizing virtual reality therapy is that the client can work on modifying pessimistic thoughts and behaviors in the therapist's office without worrying about confidentiality being compromised. Five virtual environments were created to expose participants to specific cases of social anxiety. First, the participants were introduced to a neutral environment where they learned how to navigate the virtual setting, which included moving backwards and forwards and looking up and down. The second environment worked on participant's performance anxiety, wherein virtual reality exposure participants had to speak in front of an audience of seven other virtual reality humans in a conference room. The third environment focused on intimacy anxiety, with the participants engaging in small talk with neighbors and friends. The participants had to introduce themselves and answer questions that the virtual reality humans asked. For the fourth environment, participants learned how to move around a crowd and engaged in small talk, while under constant scrutiny from strangers. The fifth environment put the participants in social situations where he or she had to protect their interests and be respected. These virtual reality environments were created to help reduce anxiety reactions when the participants are in actual social situations.

• Reference: N/A
• Submitter: N/A

Internet-based cognitive behavioral therapy

Treatment Summary: Internet-based therapy substantially reduces face-to-face time with the therapist because the therapist supports and helps the client via email. One of the advantages of clients utilizing internet-based therapy is increased access to affordable evidence based treatment, especially for clients with social phobia who fear social situations, which could possibly include seeking and meeting a therapist for help. Internet-based therapy could possible lower the threshold for clients suffering with social phobia who are afraid to seek help. Clients navigate self help guides tailored for the internet. The self help guides used for this research study were based on cognitive behavior therapy. The participants attended a 10 week internet-based therapy treatment program that included the interactive self help guide, an instruction module on how to establish regular contact with their cognitive behavior therapist, and a monitoring and feedback system that constantly kept track of the participant's responses. The participants also had the opportunity to share their experiences with other participants who were taking part in the research study. This particular internet-based therapy is considered interactive because it allows participants to navigate through the self help guides without restrictions and/or go back to previously completed sessions. This program also responded to what participants did in previous sessions. The self help guides were split among 57 websites that are divided into five different sessions (Berger et al., 2009). In the first session, participants were asked to create a model of their own social anxiety from beginning to end. The participants were then instructed to input social situations that caused them anxiety and physiological symptoms as well as safety and avoidance behaviors they would utilize in that specific situation. The second session concentrated on how self-focused attention and safety behaviors influence anxiety during social performances. The third session focused on the significance of tackling real life situations that caused the participants anxiety. The participants were then encouraged to arrange and engage in two in vivo exposures. The fourth session facilitated the recognition and adjustment of negative thoughts associated with social situations. The sessions involved in this internet-based therapy build on previous sessions completed, and the participants could only advance to the next session if they completed all the tasks in the previous session. Therefore, the fifth session emphasized the significance of repetition. The participants are encouraged to go through the sessions again while discovering the importance of practicing the new skills they just acquired.

• Reference: Berger, T., Hohl, E., & Caspar, F. (2009). Internet-based treatment for social phobia: A randomized controlled trial. Journal of Clinical Psychology, 65, 1021-1035. doi:10.1002/jclp.20603 Klinger, E., Bouchard, S., Légeron, P., Roy, S., Lauer, F., Chemin, Ilist all authors, or use et al. Nugues, P. (2005). Virtual reality therapy versus cognitive behavior therapy for social phobia: A preliminary controlled study. CyberPsychology & Behavior, 8, 76-88. doi:10.1089/cpb.2005.8.76 Moscovitch, D. A. (2009). What is the core fear in social phobia? A new model to facilitate individualized case conceptualization and treatment. Cognitive and Behavioral Practice, 16, 123-134. doi:10.1016/j.cbpra.2008.042 McEvoy, P. M., & Perini, S. J. (2009). Cognitive behavioral group therapy for social phobia with or without attention training: A controlled trial. Journal of Anxiety Disorders, 23, 519-528. doi:10.1016/j.janxdis.2008.108
• Submitter: N/A

Applied Relaxation

Treatment Summary: Applied relaxation works best when written direction is given by the therapist. Muscle relaxation techniques, cue-controlled relaxation, and skill generalization are emphasized. Skill generalization includes involves relaxation training combined with exposure therapy. These instructions are given to the patient with SP, and they are instructed to apply them when they feel that their anxiety over social situations is getting too great. They may leave the area of anxiety to perform the relaxation techniques, but are usually instructed not to leave all together.

• Reference: Anthony, M., & Rowa, K. (2005). Psychological Treatments for Social Phobia. Canadian Journal of Psychiatry, 50(6), 308-316. Retrieved from Psychology andBehavioral Sciences Collection database.
• Submitter: Lauren Moore

Fluoxetine and self exposure

Treatment Summary: Patients who were treated with fluoxetine were given 20 mg. In week 2 or 3 the dose was increased to 40 mg and the maximum dose was 60 mg, which was normally administered by week 5 or 6. In addition to fluoxetine the participants were told they needed to expose themselves to social situations that they usually find fearful. Participants did not participate in exposure practice during therapy sessions, which lasted 30-40 minutes. However, the therapist told them what type of situations they needed to expose themselves to. This method showed substantial therapeutic gains.

• Reference: Clark, D., Ehlers, A., Mcmanus, F., Hackman, A. Fennell, M., Campbell, H., Flower,T., Davenport, C., Louis, B. (2003). Cognitive therapy versus fluoxetine in generalized social phobia: a randomized placebo controlled trial. Journal of Counseling and Clinical Psychology. 71(6) 1058-1067.
• Submitter: Sherone Smith