Cognitive Behavioral Therapy in Social Anxiety Disorder: Current Concepts

Yıl 2015, Cilt: 7 Sayı: 3, 229 - 243, 12.07.2015

Nurhan Fistikci Ali Keyvan Evrim Erten Şahut Duran Mehmet Sungur

https://doi.org/10.5455/cap.20140719110703

Öz

Cognitive behavioral therapy is still one of the most important treatment modalities in social anxiety disorder with a high level of evidence. However, some patients do not fully benefit from these therapies and this fact leads to ongoing search for new approaches. This paper reviews use of cognitive behavioral therapy in social anxiety disorder studies and discusses related updated concepts. The frequent use of computer-assisted therapy for most of recent studies was found noteworthy. Recent studies regarding social anxiety disorder focused on concepts such as attention bias, biased information processing, attention training, judgment biases, internet-based cognitive behavioral therapies and social mishap exposure. Internet-based cognitive-behavioral therapy seemed to be a good option for people who were unable to access face to face treatment.

 

Anahtar Kelimeler

Social anxiety disorder, cognitive behavioral therapy

Sosyal Anksiyete Bozukluğunda Bilişsel Davranışçı Terapi: Güncel Kavramlar

Öz

Bilişsel davranışçı terapiler halen sosyal anksiyete bozukluğunda yüksek kanıt düzeyine sahip en önemli tedavi yöntemlerindendir. Ancak buna rağmen bazı hastaların tedaviden yeterince fayda görmemesi yeni arayışları sürdürmektedir. Bu yazıda yapılan sosyal anksiyete bozukluğunda bilişsel davranışçı terapiler konusunda yapılan çalışmalar gözden geçirilmiş güncel kavramlar tartışılmıştır. Güncel çalışmaların bilgisayar teknolojisini çokça kullanması dikkat çekicidir. Son yıllarda çalışmalar sosyal anksiyete bozukluğunda dikkat yanlılığı, yanlı bilgi işleme, dikkat eğitimi, yargı yanlılıkları, internet tabanlı bilişsel davranışçı terapiler ve sosyal aksiliklere alıştırma tedavisi üzerinde yoğunlaşmaktadır. İnternet tabanlı bilişsel davranışçı terapiler özellikle tedaviye ulaşma olanağı olmayan kişiler için iyi bir seçenek gibi durmaktadır.

 

Anahtar Kelimeler

Sosyal anksiyete bozukluğu, bilişsel davranışçı terapiler

Kaynakça

• Alden LE, Taylor CT, Laposa MJ, Mellings T (2006) Impact of social developmental experiences on cognitive-behavioral therapy for generalized social phobia. J Cogn Psychother, 20:7-16.
• Alden LE, Taylor CT, Mellings TM, Laposa JM (2008) Social anxiety and the interpretation of positive social events. J Anxiety Disord, 22:577-590.
• Alentiner DP, Mounts NS, Durik AM, Gier-Lonsway SL (2011) Shyness mindset: Applying mindset theory to the domain of inhibited social behavior. Pers Individ Dif, 50:1174-1179.
• Amir N, Beard C, Taylor CT, Klumpp H, Elias J et al. (2009) Attention training in individuals with generalized social phobia: A randomized controlled trial. J Consult Clin Psychol, 77:961-973.
• Amir N, Taylor CT, Donohue MC (2011) Predictors of response to an attention modification program in generalized social phobia. J Consult Clin Psychol, 79:533-541.
• Andersson G, Carlbring P, Holmström A, Sparthan E, Furmark T, Nilsson-Ihrfelt E et al. (2006) Internet-based self-help with therapist feedback and in vivo group exposure for social phobia: a randomized controlled trial. J Consult Clin Psychol, 74:677- 686.
• Anderson B, Goldin PR, Kurita K, Gross JJ (2008) Self-representation in social anxiety disorder: linguistic analysis of autobiographical narratives. Behav Res Ther, 46:1119-1125.
• Anderson PL, Zimand E, Hodges LF, Rothbaum BO (2005) Cognitive behavioral therapy for public-speaking anxiety using virtual reality for exposure. Depress Anxiety, 22:156-158.
• Andrews G, Davies M, Titov N (2011) Effectiveness randomized controlled trial of face to face versus Internet cognitive behaviour therapy for social phobia. Aust NZ J Psychiatry, 45:337-340.
• Beard C, Amir N (2008) A multi-session interpretation modification program: changes in interpretation and social anxiety symptoms. Behav Res Ther, 46:1135-1141.
• Beard C (2011) Cognitive bias modification for anxiety: current evidence and future directions. Expert Rev Neurother, 11:299-311.
• Beck AT, Dozios DJA (2011) Cognitive therapy: current status and future directions. Annu Rev Med, 62:397-409.
• Berger T, Hohl E, Caspar F (2009) Internet‐based treatment for social phobia: a randomized controlled trial. J Clin Psychol, 65(Suppl10):S1021-S1035.
• Boden MT, John OP, Goldin PR, Werner K, Heimberg RG, Gross JJ et al. (2012) The role of maladaptive beliefs in cognitive- behavioral therapy: Evidence from social anxiety disorder. Behav Res Ther, 50:287-291.
• Bogels SM (2006) Task concentration training versus applied relaxation, in combination with cognitive therapy, for social phobia patients with fear of blushing, trembling, and sweating. Behav Res Ther, 44:1199-1210.
• Botella C, Gallego MJ, Garcia-Palacios A, Guillen V, Banos RM, Quero S et al. (2010) An Internet-based self-help treatment for fear of public speaking: a controlled trial. Cyberpsychol Behav Soc Netw, 13:407-421.
• Brozovich F, Heimberg RG (2008) An analysis of post-event processing in social anxiety disorder. Clin Psychol Rev, 28:891-903.
• Bruce LC, Heimberg RG, Goldin PR, Gross JJ (2013) Childhood maltreatment and response to cognitive behavioral therapy among individuals with social anxiety disorder. Depress Anxiety, 30:662-669.
• Buckner JD, Maner JK, Schmidt NB (2010) Difficulty disengaging attention from social threat in social anxiety. Cognit Ther Res,
• Campbell-Sills L, Barlow DH, Brown TA, Hofmann SG (2006) Acceptability and suppression of negative emotion in anxiety and mood disorders. Emotion, 6:587-595.
• Carlbring P, Apelstrand M, Sehlin H, Amir N, Rousseau A, Hofmann SG et al. (2012) Internet-delivered attention bias modification training in individuals with social anxiety disorder--a double blind randomized controlled trial. BMC Psychiatry, 25:12-66.
• Carlbring P, Nordgren LB, Furmark T, Andersson G (2009) Long-term outcome of Internet-delivered cognitive-behavioural therapy for social phobia: a 30-month follow-up. Behav Res Ther, 47:848-850.
• Clark DM, Wells A (1995) A cognitive model of social phobia. In Social phobia: Diagnosis, assessment, and treatment (Eds RG Heimberg, MR Liebowitz, DA Hope, FR Schneier ):69-93. New York, NY, Guilford Press.
• Clark DM, McManus F (2002) Information processing in social phobia. Biol Psychiatry 51: 92-100.
• Dalrymple KL, Herbert JD (2007) Acceptance and commitment therapy for generalized social anxiety disorder: a pilot study. Behav Modif, 31(Suppl5):543-568.
• Davidson JR, Foa EB, Huppert JD, Keefe FJ, Franklin ME, Compton JS et al. (2004) Fluoxetine, comprehensive cognitive behavioral therapy, and placebo in generalized social phobia. Arch Gen Psychiatry, 61:1005-1013.
• Doehrmann O, Ghosh SS, Polli FE, Reynolds GO, Horn F, Keshavan A et al. (2013) Predicting treatment response in social anxiety disorder from functional magnetic resonance imaging. JAMA Psychiatry, 70:87-97.
• Dweck CS (2006) Mindset: The New Psychology of Success. New York, Random House.
• Ehrenreich JT, Fairholme CP, Buzzella BA, Ellard KK, Barlow DH (2007) The role of emotion in psychological therapy. Clin Psychol (New York), 14:422-428.
• Elliott R, Watson J, Goldman R, Greenberg LS (2003) Learning emotion-focused therapy: the process-experiential approach to change. Washington, DC, APA.
• Fang A, Sawyer AT, Asnaani A, Hofmann SG (2013) Social mishap exposures for social anxiety disorder: an important treatment ingredient. Cogn Behav Pract, 20:213-220.
• Furmark T, Carlbring P, Hedman E, Sonnenstein A, Clevberger P, Bohman B et al. (2009) Guided and unguided self-help for social anxiety disorder: randomised controlled trial. Br J Psychiatry, 19:440-447.
• Garner M, Mogg K, Bradley BP (2006) Orienting and maintenance of gaze to facial expressions in social anxiety. J Abnorm Psychol, 115:760-770.
• Ginzburg DM, Bohn C, Hofling V, Weck F, Clark DM, Stangier U et al. (2012) Treatment specific competence predicts outcome in cognitive therapy for social anxiety disorder. Behav Res Ther, 50:747-752.
• Goldin PR, Gross JJ (2010) Effects of mindfulness-based stress reduction (MBSR) on emotion regulation in social anxiety disorder. Emotion, 10:83-91.
• Goldin PR, Manber T, Hakimi S, Canli T, Gross JJ (2009) Neural bases of social anxiety disorder: emotional reactivity and cognitive regulation during social and physical threat. Arch Gen Psychiatry, 66:170-180.
• Goldin PR, Manber-Ball T, Werner K, Heimberg R, Gross JJ (2009) Neural mechanisms of cognitive reappraisal of negative self- beliefs in social anxiety disorder. Biol Psychiatry, 66:1091-1099.
• Grey S, Mathews A (2000) Effects of training on interpretation of emotional ambiguity. Q J Exp Psychol, 53:1143-1162.
• Haga SM, Kraft P, Corby EK (2009) Emotion regulation: antecedents and well-being outcomes of cognitive reappraisal and expressive suppression in cross-cultural samples. J Happiness Stud, 10:271-291.
• Harbort J, Witthoft M, Spiegel J, Nick K, Hecht H (2013) The widening of the gaze cone in patients with social anxiety disorder and its normalization after CBT. Behav Res Ther, 51:359-367.
• Harve AG, Clark DM, Ehlers A, Rapee RM (2000) Social anxiety and self-impression: cognitive preparation enhances the beneficial effects of video feedback following a stressful social task. Behav Res Ther, 38:1183-1192.
• Hayes SC, Wilson KG, Gifford EV, Follette VM, Strosahl K (1996) Experimental avoidance and behavioral disorders: a functional dimensional approach to diagnosis and treatment. J Consult Clin Psychol, 64:1152-1168.
• Hedman E, Andersson G, Ljotsson B, Andersson E, Ruck C, Mörtberg E et al. (2011) Internet-based cognitive behavior therapy vs. cognitive behavioral group therapy for social anxiety disorder: a randomized controlled non-inferiority trial. PloS One, 6:e18001.
• Heeren A, Reese HE, McNally RJ, Philippot P (2012) Attention training toward and away from threat in social phobia: effects on subjective, behavioral, and physiological measures of anxiety. Behav Res Ther, 50:30-39.
• Heimberg RG, Becker RE (2002) Cognitive-behavioral Group Therapy for Social Phobia: Basic Mechanisms and Clinical Strategies (Treatment Manuals for Practitioners). New York, Guilford Press.
• Heinrichs N, Hofmann SG, Barlow DH (2004) Non-specific encoding of threat in social phobia and panic disorder. Cogn Behav Ther,
• Hertel PT, Brozovich F, Joormann J, Gotlib IH (2008) Biases in interpretation and memory in generalized social phobia. J Abnorm Psychol, 117:278-288.
• Hirsch CR, Clark DM (2004) Information-processing bias in social phobia. Clin Psychol Rev, 24:799-825.
• Hirsch CR, Mathews A, Clark DM, Williams R, Morrison JA (2006) The causal role of negative imagery in social anxiety: a test in confident public speakers. J Behav Ther Exp Psychiatry, 37:159-170.
• Hofmann SG, Gerlach AL, Wender A, Roth WT (1997) Speech disturbances and gaze behavior during public speaking in subtypes of social phobia. J Anxiety Disord, 11:573-585.
• Hofmann SG (2004) Cognitive mediation of treatment change in social phobia. J Consult Clin Psychol, 2:92-399.
• Hofmann SG, Smits JA, Rosenfield D, Simon N, Otto MW, Meuret AE et al. (2013) D-Cycloserine as an augmentation strategy with cognitive-behavioral therapy for social anxiety disorder. Am J Psychiatry, 170:751-758.
• Hofmann SG, Moscovitch DA, Kim HJ, Taylor AN (2004) Changes in self-perception during treatment of social phobia. J Consult Clin Psychol, 72:588-596.
• Holmes EA, Mathews A (2010) Mental imagery in emotion and emotional disorders. Clinical Clin Psychol Rev, 30:349-362.
• Horley K, Williams LM, Gonsalvez C, Gordon E (2003) Social phobics do not see eye to eye: a visual scanpath study of emotional expression processing. J Anxiety Disord, 17:33-44.
• Huppert JD, Pasupuleti RV, Foa EB, Mathews A (2007) Interpretation biases in social anxiety: response generation, response selection, and self-appraisals. Behav Res Ther, 45:1505-1515.
• Kashdan TB, Steger MF (2006) Expanding the topography of social anxiety: An experience-sampling assessment of positive emotions, positive events, and emotion suppression. Psychol Sci, 17:120-128.
• Kim HY, Lundh LG, Harvey A (2002) The enhancement of video feedback by cognitive preparation in the treatment of social anxiety. A single-session experiment. J Behav Ther Exp Psychiatry, 33:19-37.
• Klumpp H, Amir N (2009) Examination of vigilance and disengagement of threat in social anxiety with a probe detection task. Anxiety Stress Coping, 22:283-296.
• Koszycki D, Benger M, Shlik J, Bradwejn J (2007) Randomized trial of a meditation-based stress reduction program and cognitive behavior therapy in generalized social anxiety disorder. Behav Res Ther, 45:2518-2526.
• Lee HY, Cherng RJ, Lin CH (2004) Development of a virtual reality environment for somatosensory and perceptual stimulation in the balance assessment of children. Comput Biol Med, 34:719-733.
• Li S, Tan J, Qian M, Liu X (2008) Continual training of attentional bias in social anxiety. Behav Res Ther, 46:905-912.
• MacLeod C, Mathews A (2012) Cognitive bias modification approaches to anxiety. Annu Rev Clin Psychol, 8:189-217.
• MacLeod C, Mathews A, Tata P (1986) Attentional bias in emotional disorders. J Abnorm Psychol, 95:15-20.
• Magee WJ, Eaton WW, Wittchen HU, McGonagle KA, Kessler RC (1996) Agoraphobia, simple phobia and social phobia in the National Comorbidity Survey. Arch Gen Psychiatry, 53:159-68.
• Makkar SR, Grisham JR (2011) Social anxiety and the effects of negative self-imagery on emotion, cognition, and post-event processing. Behav Res Ther, 49:654-664.
• Mathews A, Mackintosh B (2000) Induced emotional interpretation bias and anxiety. J Abnorm Psychol, 109:602-615.
• Mathews A, Mackintosh B, Fulcher EP (1997) Cognitive biases in anxiety and attention to threat. Trends Cogn Sci, 1:340-345.
• Mobini S, Mackintosh B, Illingworth J, Gega L, Langdon P, Hoppitt L (2014) Effects of standard and explicit cognitive bias modification and computer-administered cognitive-behaviour therapy on cognitive biases and social anxiety. J Behav Ther Exp Psychiatry, 45:272-279.
• Mogg K, Bradley BP (2002) Selective orienting of attention to masked threat faces in social anxiety. Behav Res Ther, 40:1403- 1414.
• Moore SA, Zoellner LA, Mollenholt N (2008) Are expressive suppression and cognitive reappraisal associated with stress-related symptoms? Behav Res Ther, 46:993-1000.
• Moscovitch DA, Gavric DL, Senn JM, Santesso DL, Miskovic V, Schmidt LA et al. (2012) Changes in judgment biases and use of emotion regulation strategies during cognitive-behavioral therapy for social anxiety disorder: distinguishing treatment responders from nonresponders. Cogn Ther Res, 36:261-271.
• Moscovitch DA, Rodebaugh TL, Hesch BD (2012) How awkward social anxiety and the perceived consequences of social blunders. Behav Res Ther, 50:142-149.
• Moses EB, Barlow DH (2006) A new unified treatment approach for emotional disorders based on emotion science. Curr Dir Psychol Sci, 15:146-150.
• Murphy R, Hirsch CR, Mathews A, Smith K, Clark DM (2007) Facilitating a benign interpretation bias in a high socially anxious population. Behav Res Ther, 45:1517-1529.
• Niquee F, Samadi A (2013) Fear of Negative Evaluation and Fear of Positive Evaluation in Social Anxiety. Switzerland Research Park Journal, 102:550-557.
• Nilsson JE, Lundh LG, Viborg G (2012) Imagery rescripting of early memories in social anxiety disorder: an experimental study. Behav Res Ther, 50:387-392.
• Norton PJ, Price EC (2007) A meta-analytic review of adult cognitive-behavioral treatment outcome across the anxiety disorders. J Nerv Ment Dis, 195:521-531.
• Özgüven H, Sungur MZ (1998) Sosyal Fobi. Turk Psikiyatrı Derg, 9:128-138.
• Parsons TD, Silva TM, Pair J, Rizzo AA (2008) Virtual environment for assessment of neurocognitive functioning: virtual reality cognitive performance assessment test. Stud Health Technol Inform, 132:351-356.
• Price M, Anderson PL (2011) The impact of cognitive behavioral therapy on post event processing among those with social anxiety disorder. Behav Res Ther, 49:132-137.
• Price M, Mehta N, Tone EB, Anderson PL (2011) Does engagement with exposure yield better outcomes? components of presence as a predictor of treatment response for virtual reality exposure therapy for social phobia. J Anxiety Disord, 25:763-770.
• Rapee RM, Abbott MJ, Baillie AJ, Gaston JE (2007) Treatment of social phobia through pure self-help and therapist-augmented self-help. Br J Psychiatry, 191:246-252.
• Rapee RM, Gaston JE, Abbott MJ (2009) Testing the efficacy of theoretically derived improvements in the treatment of social phobia. J Consult Clin Psychol, 77:317-327.
• Rapee RM, Hayman K (1996) The effects of video feedback on the self-evaluation of performance in socially anxious subjects. Behav Res Ther, 34:315-322.
• Rapee RM, Heimberg RG (1997) A cognitive-behavioral model of anxiety in social phobia. Behav Res Ther, 35:741-756.
• Ritter V, Leichsenring F, Strauss BM, Stangier U (2013) Changes in implicit and explicit self-esteem following cognitive and psychodynamic therapy in social anxiety disorder. psychotherapy research. Psychother Res, 23:547-558.
• Rodebaugh TL (2006) Self-efficacy and social behavior. Behav Res Ther, 44:1831-1838.
• Rothbaum BO, Hodges LF, Kooper R, Opdyke D, Williford JS, North M (1995) Effectiveness of computer-generated (virtual reality) graded exposure in the treatment of acrophobia. Am J Psychiatry, 152:626-628.
• Schmidt NB, Richey JA, Buckner JD, Timpano KR (2009) Attention training for generalized social anxiety disorder. J Abnorm Psychol, 118:5-14.
• Schofield CA, Coles ME, Gibb BE (2007) Social anxiety and interpretation biases for facial displays of emotion: emotion detection and ratings of social cost. Behav Res Ther, 45:2950-2963.
• Shapiro SL, Oman D, Thoresen CE, Plante TG, Flinders T (2008) Cultivating mindfulness: effects on well-being. J Clin Psychol, 64:840-862.
• Spokas M, Luterek JA, Heimberg RG (2009) Social anxiety and emotional suppression: the mediating role of beliefs. J Behav Ther Exp Psychiatry, 40:283-291.
• Sportel BE, de Hullu E, de Jong PJ, Nauta MH (2013) Cognitive bias modification versus CBT in reducing adolescent social anxiety: a randomized controlled trial. PloS One, 8:e64355.
• Taylor CT, Alden LE (2008) Self-related and interpersonal judgement biases in social anxiety disorder: Changes during treatment and relationship to outcome. Int J Cogn Ther, 1:125-137.
• Thomasson P, Psouni E (2010) Social anxiety and related social impairment are linked to self-efficacy and dysfunctional coping. Scand J Psychol, 51:171-178.
• Tran TB, Siemer M, Joormann J (2011) Implicit interpretation biases affect emotional vulnerability: a training study. Cogn Emot, 25:546-558.
• Turner R, Hoppitt L, Hodgekins J, Wilkinson J, Mackintosh B, Fowler D (2011) Cognitive bias modification in the treatment of social anxiety in early psychosis: a single case series. Behav Cogn Psychother, 39:341-347.
• Valentiner DP, Jencius S, Jarek E, Gier-Lonsway SL, McGrath PB (2013) Pre-treatment shyness mindset predicts less reduction of social anxiety during exposure therapy. J Anxiety Disord, 27:267-271.
• Webb CA, Derubeis RJ, Barber JP (2010) Therapist adherence/competence and treatment outcome: a meta-analytic review. J Consult Clin Psychol, 78:200-211.
• Weeks JW, Jakatdar TA, Heimberg RG (2010) Comparing and contrasting fears of positive and negative evaluation as facets of social anxiety. J Soc Clin Psychol, 29:68-94.
• Werner KH, Jazaieri H, Goldin PR, Ziv M, Heimberg RG, Gross JJ (2012) Self-compassion and social anxiety disorder. Anxiety Stress Coping, 25:543-558.
• Wild J, Hackmann A, Clark DM (2008) Rescripting early memories linked to negative images in social phobia: a pilot study. Behav Ther, 39(Suppl1):S47-S56.
• Wilson EJ, MacLeod C, Mathews A, Rutherford EM (2006) The causal role of interpretive bias in anxiety reactivity. J Abnorm Psychol, 115:103-111.
• Wittchen HU, Fehm L (2001) Epidemiology, patterns of comorbidity, and associated disabilities of social phobia. Psychiatr Clin North Am, 24:617-641.