TY - JOUR T1 - Employing an Eclectic Approach to Reduce Social Anxiety: An Adolescent Case Report AU - Akbağ, Müge AU - Ay, Tuğba PY - 2025 DA - June Y2 - 2025 JF - Research on Education and Psychology PB - Bülent DİLMAÇ WT - DergiPark SN - 2602-3733 SP - 221 EP - 243 VL - 9 IS - 1 LA - en AB - The purpose of this case report study is to evaluate, on a case-specific basis, whether individual counseling sessions based on a technical eclecticism approach are effective in reducing performance anxiety and avoidance behaviors related to social anxiety in a 16-year-old adolescent referred to school counseling.The study is a single-subject, intervention-based case report. The case was evaluated and formulated using a technical eclecticism approach based on Lazarus' BASIC ID model. The intervention process consisted of eight sessions of psychological counseling, supported by supervision. The main techniques used were Metacognitive Therapy and Hypno-meditative Reprocessing Therapy, along with techniques from Schema Therapy and Behavioral Therapy. The results of the visual analysis, together with pre-, post- and follow-up measures using the Brief Symptom Inventory, showed a significant and sustained reduction in the client's anxiety levels and avoidance behaviours. The Reliable Change Index (RCI), calculated using the Jacobson and Truax JT method, confirmed the clinical significance of the changes observed. Furthermore, the therapeutic alliance is considered to be a contributing factor to the positive outcomes. In addition, clients' subjective evaluations of the counseling process also confirmed that the intervention was beneficial. The findings are expected to provide valuable insights for psychological counselors and mental health professionals working with individuals experiencing different types and levels of anxiety. KW - BASIC ID KW - Case study KW - Hypno-meditative reprocesssing therapy KW - Metacognitive therapy KW - Social anxiety KW - Technical eclecticism CR - Abdollahi, A., Hosseinian, S., Panahipour, H., & Allen, K. A. (2021). Cognitive behavioural therapy as an effective treatment for social anxiety, perfectionism, and rumination. Current Psychology, 40, 4698-4707. https://doi.org/10.1007/s12144-019-00411-w CR - Ahi, S., & Yurtseven, C. S. (2022). Sosyal fobide bilişsel davranışçı terapi tedavi ve teknikleri: Bir olgu sunumu [Cognitive behavioral therapy treatment and techniques in social phobia: Case report]. The Journal of Academic Social Science, 132, 326-346. http://dx.doi.org/10.29228/ ASOS.63795 CR - Alan Gencer, S. S., & Alan, H. (2023). Komplike yas tedavisinde hipnomeditatif yeniden işleme terapisi [Hypnomeditative reprocessing therapy in the treatment of complicated grief]. Anadolu Tıbbi Dergisi, 2(3), 1-6. CR - Alan, H., & Güzel, S. (2018). İleri hipnoz teknikleriyle hipnoterapi [Hypnotherapy with advanced hypnosis techniques]. Psikoterapi Enstitüsü Eğitim Yayınları. CR - Alan, H. (2019). Hipnotik (hipnomeditatif) yeniden işleme terapisi: HYT [Hypnotic (hypno-meditative) reprocessing therapy: HRT]. Klinik Hipnoz Akademisi Yayınları Ders Notları. CR - Alnahdi, G. H. (2015). Single-subject designs in special education: Advantages and limitations. Journal of Research in Special Educational Needs, 15(4), 257-265. https://doi.org/10.1111/1471-3802.12039 CR - Amerikan Psikiyatri Birliği. (2014). Ruhsal bozuklukların tanısal ve sayımsal el kitabı [Diagnostic and statistical manual of mental disorders]. E. Köroğlu (Çev. Ed.). Hekimler Yayın Birliği. CR - Amin, N., Foa, E. B., & Coles, M. E. (1998). Negative interpretation bias in social phobia. Behaviour Research and Therapy, 36(10), 945–957. https://doi.org/10.1016/S0005-7967(98)00060-6 CR - Avşar, V. (2019). Bilişsel davranışçı terapiye dayalı bireysel psikolojik danışmanın sosyal kaygı, özyeterlik ve psikolojik iyi oluş üzerindeki etkisi. [The effect of individual psychological counseling based on cognitive behavioral therapy on social anxiety, self-efficacy, and psychological well-being]. (Yayınlanmamış doktora tezi). Ankara Üniversitesi. Retrieved from https://tez.yok.gov.tr/UlusalTezMerkezi/ CR - Avşar, V., & Şengül Avşar, A. (2021). Ruh sağlığı çalışmalarında klinik anlamlılık [Clinical significance in mental health research]. Journal of Cognitive Behavioral Psychotherapies and Research, 10(1), 109-121. https://doi.org/10.5455/JCBPR.88460 CR - Ay, T., & Alan, H. (2020). Kalıcı komplike yas tedavisinde hipnotik yeniden işleme terapisinin hızlı etkinliği. [Rapid efficiency of the hypnotic reprocessing therapy in treatment of complicated grief disorder]. Journal of Traditional Medical Complementary Therapies, 3(2), 280-284. https://doi.org/10.5336/jtracom.2019-72444 CR - Ayaslı, A., Ay, T., & Alan, H. (2020). Olumsuz yaşam deneyimlerine bağlı anksiyetede hipnotik yeniden işleme terapisinin etkinliği: Olgu sunumu [Effectiveness of hypnotic reprocessing therapy in anxiety due to negative life experiences: Case report]. Geleneksel ve Tamamlayıcı Anadolu Tıbbı Dergisi, 2(2), 36-41. CR - Bamber, M. (2004). The good, the bad and defenceless Jimmy, a single case study of schema mode therapy. Clinical Psychology & Psychotherapy, 11(6), 425–438. https://doi.org/10.1002/cpp.422 CR - Baysal, A. (2004). Psikolojik danışma ve rehberlikte başlıca hizmet türleri [Main types of services in psychological counseling and guidance]. In A. Kaya (Ed.), Psikolojik danışma ve rehberlik [Psychological counseling and guidance ] (pp. 35-62). Anı Yayıncılık. CR - Beck, A., & Emery, G. (1985). Anxiety disorders and phobias: A cognitive perspective. Basic Books. CR - Borders, L. D., & Brown, L. L. (2005). The new handbook of counseling supervision. NJ: Lawrence Erlbaum Association. CR - Bordin, E. S. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research &Practice, 16(3), 252. CR - Bögels, S. M., Alden, L., Beidel, D. C., Clark, L. A., Pine, D. S., Stein, M. B., & Voncken, M. (2010). Social anxiety disorder: Questions and answers for the DSM‐V. Depression and Anxiety, 27(2), 168–189. https://doi.org/10.1002/da.20670 CR - Butiuc, L. (2016). An overview of eclectic intervention in emotional disorders: A case study. Romanian Journal of Cognitive Behavioral Therapy and Hypnosis, 3(1), 30-36. CR - Büyüköztürk, Ş., Çakmak, E. K., Akgün, Ö. E., Karadeniz, Ş., & Demirel, F. (2024). Bilimsel araştırma yöntemleri [Scientific research methods] (35. baskı). PEGEM Akademi CR - Carpenter, R., Waldrop, J., & Carter‐Templeton, H. (2021). Statistical, practical and clinical significance and doctor of nursing practice projects. Nurse Author & Editor, 31(3-4), 50-53. https://doi.org/10.1111/nae2.27 CR - Corey, G. (2008). Theory and practice of counseling and psychotherapy (8th edition). Thomson Brooks/Cole. CR - Cox, B. J., Clara, I. P., Sareen, J., & Stein, M. B. (2008). The structure of feared social situations among individuals with a lifetime diagnosis of social anxiety disorder in two independent nationally representative mental health surveys. Behaviour Research and Therapy, 46(4), 477–486. https://doi.org/10.1016/j.brat.2008.01.011 CR - Derogatis, L. R. (1992). The Brief Symptom Inventory-BSI administration, scoring and procedures manual-II. Clinical Pscyhometric Research Inc. CR - Doğan, U. (2013). Ergenlerde performans kaygısını yordayan değişkenlerin modellenmesi ve buna yönelik psikoeğitim programının işlevselliği [Modeling the predictors of performance anxiety in adolescents and the effectiveness of a related psychoeducation program]. (Yayınlanmamış doktora tezi). Sakarya Üniversitesi. Retrieved from https://tez.yok.gov.tr/UlusalTezMerkezi/ CR - Erkuş, A. (2013). Davranış bilimleri için bilimsel araştırma süreci [The scientific research process for behavioral sciences]. Seçkin Yayıncılık. CR - Farrell, M. J., Reiss, N., & Shaw, A. I. (2016). Şema terapi: Klinisyenin rehberi [The schema therapy: Clinician's guide]. Psikonet Yayınları. CR - Frets, P. G., Kevenaar, C., & Heiden, C. (2014). Imagery rescripting as a stand–alone treatment for patients with social phobia: A case series. Journal of Behavior Therapy and Experimental Psychiatry, 45(1), 160–169. https://doi 10.1016/j.jbtep.2013.09.006 CR - Hedley, L. M., Hoffart, A., & Sexton, H. (2001). Early maladaptive schemas in patients with panic disorder with agoraphobia. Journal of Cognitive Psychotherapy, 15(2), 131-142. https://doi.org/10.1891/0889-8391.15.2.131 CR - Hook, J. N., & Valentiner, D. P. (2002). Are specific and generalized social phobias qualitatively distinct? Clinical Psychology, 9(4), 379–395. https://doi.org/10.1093/clipsy/9.4.379 CR - Horvath, A. O., & Luborsky, L. (1993). The role of the therapeutic alliance in psychotherapy. Journal of Consulting and Clinical Psychology, 61(4), 561-573. CR - Huppert, J. D., Roth Ledley, D., & Foa, E. B. (2006). The use of homework in behavior therapy for anxiety disorders. Journal of Psychotherapy Integration, 16(2), 128-139. https://psycnet.apa.org/doi/10.1037/1053-0479.16.2.128 CR - Jabrayilov, R., Emons, W. H., & Sijtsma, K. (2016). Comparison of classical test theory and item response theory in individual change assessment. Applied Psychological Measurement, 40(8), 559–572. https://doi.org/10.1177/0146621616664046 CR - Jacobson, N. S. & Truax, P. (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59(1), 12–19. https://doi.org/10.1037/0022-006X.59.1.12 CR - Jazaieri, H., Goldin, P. R., & Gross, J. J. (2017). Treating social anxiety disorder with CBT: Impact on emotion regulation and satisfaction with life. Cognitive Therapy and Research, 41(2), 406-416. https://doi.org/10.1007/s10608-016-9762-4 CR - Johnson, S. U., & Hoffart, A. (2016). Metacognitive therapy for comorbid anxiety disorders: A case study. Frontiers in Psychology, 7, 1515, 1-6. https://doi.org/10.3389/fpsyg.2016. 01515 CR - Kermen, U., & Erden, Ş. (2019). Bilişsel davranışçı yaklaşım temelli bir psikolojik danışma programının ergenlerin sosyal fobi ve mizah düzeylerine etkisi [The effect of a cognitive-behavioural psychological theory based psychological counselling program on adolescents' social phobia and humor level]. Mersin Üniversitesi Eğitim Fakültesi Dergisi, 15(3), 831-844. https://doi.org/10.17860/mersinefd.536697 CR - Lazarus, A. A. (1989). The practice of multimodal therapy: Systematic, comprehensive, and effective psychotherapy. Johns Hopkins University Press. CR - Lazarus, A. A. (2003). Multimodal therapy: A primer. Continuing education course. Preuzeto u Januaru. https://drzur.com/multimodal-therapy/ CR - Lazarus, A. A., & Beutler, L. E. (1993). On technical eclecticism. Journal of Counseling & Development, 71(4), 381-385. CR - Lazarus, C. N., & Lazarus, A. A. (2019). Multimodal therapy. In J. C. Norcross, M. R. Goldfried (Eds.), Handbook of psychotherapy integration, 2 (pp. 125-140). Oxford University Press. CR - Lazarus, A. A., & Abramovitz, A. (2004). A multimodal behavioral approach to performance anxiety. Journal of Clinical Psychology, 60(8), 831–840. https://doi.org/10.1002/jclp.20041 CR - Liebowitz, M. R. (1987). Social phobia. Modern Problems of Pharmacopsychiatry, 22, 141-173. http://dx.doi.org/10.1159/000414022 CR - Leigh, E., & Clark, D. M. (2016). Cognitive Therapy for social anxiety disorder in adolescents: A development case series. Behavioural and Cognitive Psychotherapy, 44(1), 1–17. https://10.1017/S1352465815000715 CR - Mesa, F., Le, T. A., & Beidel, D. C. (2015). Social skill-based treatment for social anxiety disorder in adolescents. In K. Ranta, A. La Greca, L. J. Garcia-Lopez, M. Marttunen (Eds). Social anxiety and phobia in adolescents. Springer, Cham. https://doi.org/10.1007/978-3-319-16703-9_13 CR - Mercan, Ç. S., & Yavuzer, H. (2007). Bilişsel davranışçı yaklaşımla bütünleştirilmiş sosyal beceri eğitiminin ergenlerin sosyal kaygı düzeyine etkisi [The effect of social skills education program integrated with cognitive behavioral approach on social anxiety level of adolescents]. Elektronik Sosyal Bilimler Dergisi, 16(63), 1187-1202. https://doi.org/10.17755/esosder.291364 CR - Norcross, J. C. (2005). A primer on psychotherapy integration. In J. C. Norcross ve M. R. Goldfried (Eds.) Handbook of psychotherapy integration (pp. 3-23). Oxford University Press. CR - Nordahl, H. M. (2009). Effectiveness of brief metacognitive therapy versus cognitive-behavioral therapy in a general outpatient setting. International Journal of Cognitive Therapy, 2(2), 152–159. https://doi.org/10.1521/ijct.2009.2.2.152 CR - Öğütlü, B., & Karaaziz, M. (2023). Toplumsal kaygı bozukluğunda (sosyal fobi) bilişsel davranışçı terapi: Olgu sunumu [Cognitive behavioral therapy in social anxiety disorder (social phobia): A case report]. ISPEC International Journal of Social Sciences & Humanities, 7(3), 659-669. https://doi.org/10.5281/zenodo.8357001 CR - Özakkaş, T. (2018). Psikoterapi tarihi ve bütüncül psikoterapi [The history of psychotherapy and integrative psychotherapy]. Türkiye Bütüncül Psikoterapi Dergisi, 1(1), 1-24. CR - Piqueras, J. A. - Olivares, J., & López-Pina, J. A. (2008). A new proposal for the subtypes of social phobia in a sample of spanish adolescents. Journal of Anxiety Disorders, 22(1), 67-77. https://doi.org/10.1016/j.janxdis.2007.01.007 CR - Riley, D. S., Barber, M. S., Kienle, G. S., Aronson, J. K., von Schoen-Angerer, T., & Tugwell, P.,………Gagnier, J. J. (2017). CARE 2013 guidelines for case reports: Explanation and elaboration document. Journal of Clinical Epidemiology, 89, 218-235. https://doi.org/10.1016/j.jclinepi.2017.04.026 CR - Salmon, P. G. (1990). A psychological perspective on musical performance anxiety: A review of the literature. Medical Problems of Performing Artists, 5(1), 2-11. https://www.jstor.org/stable/45440271 CR - Saman, A., & Bakhtiar, M. (2020). The effect of behavioral rehearsal technique through group counseling for overcoming social anxiety of students. COUNS-EDU: The International Journal of Counseling and Education, 5(1), 15-22. http:// doi.org/10.23916/0020200525110 CR - Shapiro, F. (2001). Eye movement desensitization and reprocessing (EMDR): Basic principles, protocols, and procedures (2nd ed.). Guilford Press. CR - Soundia, S. (2014). Eclectic therapy for dual diagnosis: A case study. The European Journal of Counselling Psychology, 3(1), 42-53. https://doi.org/10.5964/ejcop.v3i1.26 CR - Soygüt, G. (1999). Interpersonal processes in cognitive psychotherapy: Therapeutic alliance and therapeutic alliance rupture. Turkish Psychological Articles, 2(4), 1–14. CR - Stemberger, R. T., Turner, S. M., Beidel, D. C., & Calhoun, K. S. (1995). Social phobia: An analysis of possible developmental factors. Journal of Abnormal Psychology, 104(3), 526-531. https://psycnet.apa.org/doi/10.1037/0021-843X.104.3.526 CR - Şahin, H. N., Uğurtaş, S.,& Batıgün, D. A. (2002). Kısa semptom envanteri (KSE): Ergenler için kullanımının geçerlik, güvenilirlik ve faktör yapısı [Brief Symptom Inventory (BSI): Validity, reliability, and factor structure for use with adolescents]. Türk Psikiyatri Dergisi, 13(2), 125-135. CR - Tekin İftar, E. (2018). Eğitim ve davranış bilimlerinde tek-denekli araştırmalar [Single-subject research in education and behavioral sciences]. (2. Baskı). Anı Yayıncılık. CR - Tuzgöl Dost, M. (2020). Psikolojik danışma ve psikoterapide bütünleşmeye doğru [Towards integration in psychological counseling and psychotherapy]. OPUS International Journal of Society Researches, 15(10), 5252-5276. https://doi.org/10.26466/opus.688166 CR - Uğurses, S. (2020). Travmaya entegratif bir yaklaşım olarak Hipnotik yeniden işleme terapisinin (HYT) otonomik ölçümlerle incelenmesi [An investigation of Hypnotic Reprocessing Therapy (HRT) as an integrative approach to trauma through autonomic measurements]. (Yayınlanmamış yüksek lisans tezi). Üsküdar Üniversitesi. Retrieved from https://tez.yok.gov.tr/UlusalTezMerkezi/ CR - Watson, D., & Friend, R. (1969). Measurement of social-evaluative anxiety. Journal of Consulting and Clinical Psychology, 33(4), 448-457. https://psycnet.apa.org/doi/10.1037/h0027806 CR - Wells, A. (2009). Metacognitive therapy for anxiety and depression. The Guilford Press. CR - Wesner, R. B., Noyes, R., & Davis, T. L. (1990). The occurence of performance anxiety among musicians. Journal of Affective Disorders, 18(3), 177-185. https://doi.org/10.1016/0165-0327(90)90034-6 CR - van Loon, A. W. G., Creemers, H. E., Vogelaar, S., Miers, A. C., Saab, N., Westenberg, M. P., & Asscher, J. J. (2023). The effectiveness of school-based skills-training programs reducing performance or social anxiety: Two randomized controlled trials. Child Youth Care Forum, 52(6), 1323-1347. https://doi.org/10.1007/s10566-023-09736-x CR - Vanheule, S., Inslegers, R., Meganck, R., Ooms, E., Desmet, M., In Giancarlo, D., & Paul, H. L. (2010). Interpersonal problems in alexithymia: A review. In G. Dimaggio & P. H. Lysaker (Eds.) Metacognition in severe adult disorders: From research to treatments (pp.161-176). Routledge/Taylor & Francis Group. CR - Young, J. E., Klosko, J. S., & Weishaar, E. M. (2003). Schema therapy: A practitioner’s guide. The Guilford Press. CR - Young, J. E., & Klosko, J. S. (2014). Hayatı yeniden keşfedin [Reinventing your life]. Psikonet Yayınları. UR - https://dergipark.org.tr/en/pub/rep/issue//1698012 L1 - https://dergipark.org.tr/en/download/article-file/4864231 ER -