The Effectiveness of Cognitive Behavioral Therapy Including Updating the Early Life Experiences and Images with the Empty Chair Technique on Social Anxiety

Abstract

Specific memories of early negative life experiences (ENLE) and images play an important role in the cause and persistence of social anxiety. In this study, we aimed to investigate the effectiveness of individual Cognitive Behavior Therapy (iCBT), which includes updating a specific memory of ENLE and related images using the empty chair technique, on the social anxiety of university students. In addition to this, how iCBT applied affects the students’ general self-efficacy and psychological well-being is also examined. The current study was carried out with a total of eight university students, six female and two male. Participants attended iCBT sessions for 12 weeks. Changes in participants were evaluated with Liebowitz Social Anxiety Scale (LSAS), General Self-Efficacy Scale (GSES), and Flourishing Scale (FS) before iCBT, and one week, three months and six months after iCBT ended. The findings show that participants’ social anxiety decreased both statistically and clinically in post-tests and follow-up measures. There were statistically and clinically significant increases in general self-efficacy and psychological well-being. In addition, the changes in the participants’ social anxiety, general self-efficacy and psychological well-being post-test and follow-up measures have a large effect size. This study shows that iCBT, which includes updating of specific memories of ENLE and images, is effective in reducing social anxiety and increasing general self-efficacy and psychological well-being. These findings show that iCBT, which includes updating a specific memory of ENLE and related images, using the empty chair technique is an effective method reducing for university students’ social anxiety.

Keywords

• Cognitive behavioral therapy
• Social anxiety
• Negative life experiences
• Imagery
• Empty chair

References

1. Aderka, I.M., Hofmann, S.G., Nickerson, A., Hermesh, H., Gilboa-Schechtman, E., & Marom, S. (2012). Functional impairment in social anxiety disorder. Journal of Anxiety Disorders, 26(3), 393-400. https://doi.org/10.1016/j.janxdis.2012.01.003
2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
3. Arnkoff, D. B. (1981). Flexibility in practicing cognitive therapy. In G. Emery, S. D. Hollon, & R. C. Bedrosian (Eds.), New directions in cognitive therapy (1st ed., pp. 203-223). The Guilford Press.
4. Arntz, A. (2011). Imagery rescripting for personality disorders. Cognitive and Behavioral Practice, 18(4), 466-481. https://doi.org/10.1016/j.cbpra.2011.04.006
5. Atkins, D.C., Bedics, J.D., McGlinchey, J.B., & Beauchaine, T.P. (2005). Assessing clinical significance: Does it matter which method we use? Journal of Consulting and Clinical Psychology, 73(5), 982-989. https://doi.org/10.1037/0022-006x.73.5.982
6. Aypay, A. (2010). Genel özyeterlik ölçeği’nin (GÖYÖ) Türkçe’ye uyarlama çalışması [The adaptation study of general self-efficacy (GSE) scale to Turkish]. İnönü Üniversitesi Eğitim Fakültesi Dergisi, 11(2), 113–131. https://dergipark.org.tr/tr/download/article-file/92265
7. Bandura, A. (1977a). Self–efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84(2), 191–215. https://doi.org/10.1016/0146-6402(78)90002-4
8. Bandura, A. (1977b). Social learning theory (1st ed.). Prentice Hall.

9. Bandura, A. (1997). Self–efficacy: The exercise of control (1st ed.). W: H. Freeman & Company.
10. Baptista, C.A., Loureiro, S. R., Osorio, F.D., Zuardi, A.W., Magalhaes, P.V., Kapczinski, F., Santos, A., Freitas-Ferrari, M.C., & Crippa, J.A.S. (2012). Social phobia in Brazilian university students: Prevalence, under-recognition and academic impairment in women. Journal of Affective Disorders, 136(3), 857 861. https://doi.org/10.1016/j.jad.2011.09.022
11. Bauer, S., Lambert, M. J., & Nielsen, S. L. (2004). Clinical significance methods: A comparison of statistical techniques. Journal of Personality Assessment, 82(1), 60-70. https://doi.org/10.1207/s15327752jpa8201_11
12. Binelli, C., Ortiz, A., Muñiz, A., Gelabert, E., Ferraz, L., Filho, A. S., Crippa, J. A. S., Nardi, A. E., Subira, S., & Martin-Santos, R. (2012). Social anxiety and negative early life events in university students. Revista Brasileira De Psiquiatria, 34(1), 69-74. https://doi.org/10.1590/s1516-44462012000500006
13. Biran, M., & Wilson, G. T. (1981). Treatment of phobic disorders using cognitive and exposure methods: A self-efficacy analysis. Journal of Consulting and Clinical Psychology, 49(6), 886-899. https://doi.org/10.1037/0022-006x.49.6.886
14. Bogels, S.M., Wijts, P., Oort, F. J., & Sallaerts, S.J.M. (2014). Psychodynamic psychotherapy persus cognitive behavior therapy for social anxiety disorder: An efficacy and partial effectiveness trial. Depression and Anxiety, 31(5), 363 373. https://doi.org/10.1002/da.22246
15. Brook, C.A., & Willoughby, T. (2015). The social ties that bind: Social anxiety and academic achievement across the university years. Journal of Youth and Adolescence, 44(5), 1139-1152. https://doi.org/10.1007/s10964-015-0262-8
16. Clark, D.M. (2001). A cognitive perspective on social phobia. In W. R. Crozier & L. E. Alden (Eds.), International handbook of social anxiety: Concepts, research and interventions relating to the self and shyness (1st ed., pp. 405-430). John Wiley & Sons Ltd.
17. Clark, D.M., Ehlers, A., Hackmann, A., McManus, F., Fennell, M., Grey, N., Waddington, L., & Wild, J. (2006). Cognitive therapy versus exposure and applied relaxation in social phobia: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 74(3), 568-578. https://doi.org/10.1037/0022-006x.74.3.568
18. Clark, D.M., Ehlers, A., McManus, F., Hackmann, 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 Consulting and Clinical Psychology, 71(6), 1058-1067. https://doi.org/10.1037/0022-006x.71.6.1058
19. Clark, D.M., & Wells, A. (1995). A cognitive model of social phobia. In R. G. Heimberg, M. R. Liebowitz, D.A. Hope, & F.R. Schneier (Eds.), Social phobia: Diagnosis, assessment and treatment (1st ed., pp. 69-93). The Guilford Press.
20. Datta, S., & Das, S. (2016). Cognitive behaviour therapy in social phobia: A case study. SIS Journal of Projective Psychology & Mental Health, 23(3), 88-95.
21. Diener, E., Wirtz, D., Tov, W., Kim-Prieto, C., Choi, D. W., Oishi, S., & Biswas-Diener, R. (2010). New well–being measures: Short scales to assess flourishing and positive and negative feelings. Social Indicators Research, 97(2), 143 156. https://doi.org/10.1007/s11205-009-9493-y
22. Faravelli, C., Zucchi, T., Viviani, B., Salmoria, R., Perone, A., Paionni, A., Scarpato, A., Vigliaturo, D., Rosi, S., D'adamo, D., Bartolozzi, D., Cecchi, C., & Abrardi, L. (2000). Epidemiology of social phobia: A clinical approach. European Psychiatry, 15(1), 17-24. https://doi.org/10.1016/S0924-9338(00)00215-7
23. Fava, G.A., Rafanelli, C., Cazzaro, M., Conti, S., & Grandi, S. (1998). Well-being therapy. A novel psychotherapeutic approach for residual symptoms of affective disorders. Psychological Medicine, 28(2), 475-480. https://doi.org/10.1017/S0033291797006363
24. Fehm, L., Beesdo, K., Jacobi, F., & Fiedler, A. (2008). Social anxiety disorder above and below the diagnostic threshold: prevalence, comorbidity and impairment in the general population. Social Psychiatry and Psychiatric Epidemiology, 43(4), 257-265. https://doi.org/10.1007/s00127-007-0299-4
25. Freeman, D., Pugh, K., Dunn, G., Evans, N., Sheaves, B., Waite, F., Černis, E.R.L., & Fowler, D. (2014). An early phase II randomised controlled trial testing the effect on persecutory delusions of using CBT to reduce negative cognitions about the self: The potential benefits of enhancing self confidence. Schizophrenia Research, 160(1–3), 186-192 https://doi.org/10.1016/j.schres.2014.10.038
26. Frets, P.G., Kevenaar, C., & van der 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.org/10.1016/j.jbtep.2013.09.006
27. Gaudiano, B.A., & Herbert, J.D. (2003). Preliminary psychometric evaluation of a new self-efficacy scale and its relationship to treatment outcome in social anxiety disorder. Cognitive Therapy and Research, 27(5), 537 555. https://doi.org/10.1023/A:1026355004548
28. Ghaedi, G., Tavoli, A., Bakhtiari, M., Melyani, M., & Sahragard, M. (2010). Quality of life in college students with and without social phobia. Social Indicators Research, 97(2), 247-256. https://doi.org/10.1007/s11205-009-9500-3
29. Gil, P.J.M., Carrillo, F. X. M., & Meca, J. S. (2001). Effectiveness of cognitive-behavioural treatment in social phobia: A meta-analytic review. Psychology in Spain, 5(1), 17-25.
30. Goldin, P.R., Ziv, M., Jazaieri, H., Hahn, K., Heimberg, R., & Gross, J. J. (2013). Impact of cognitive behavioral therapy for social anxiety disorder on the neural dynamics of cognitive reappraisal of negative self-beliefs: Randomized clinical trial. Jama Psychiatry, 70(10), 1048-1056. https://doi.org/10.1001/jamapsychiatry.2013.234
31. Goldin, P.R., Ziv, M., Jazaieri, H., Werner, K., Kraemer, H., Heimberg, R.G., & Gross, J.J. (2012). Cognitive reappraisal self-efficacy mediates the effects of individual cognitive-behavioral therapy for social anxiety disorder. Journal of Consulting and Clinical Psychology, 80(6), 1034-1040. https://doi.org/10.1037/a0028555
32. Gordon, D., Wong, J., & Heimberg, R.G. (2014). Cognitive–behavioral therapy for social anxiety disorder: The state of the science. In J.W. Weeks (Ed.), The wiley blackwell handbook of social anxiety disorder (1st ed., pp. 477–497). John Wiley & Sons.
33. Greenberg, L.S. (2010). Emotion-focused therapy: A clinical synthesis. The Journal of Lifelong Learning in Psychiatry, 81(1), 32-42. https://doi.org/10.1176/foc.8.1.foc32
34. Gultekin, B.K., & Dereboy, I.F. (2011). Üniversite öğrencilerinde sosyal fobinin yaygınlığı ve sosyal fobinin yaşam kalitesi, akademik başarı ve kimlik oluşumu üzerine etkileri [The prevalence of social phobia, and its impact on quality of life, academic achievement, and identity formation in university students]. Turk Psikiyatri Dergisi, 22(3), 150-158. https://www.turkpsikiyatri.com/PDF/C22S3/150-158
35. Hackmann, A., Clark, D.M., & McManus, F. (2000). Recurrent images and early memories in social phobia. Behaviour Research and Therapy, 38(6), 601 610. https://doi.org/10.1016/S0005-7967(99)00161-8
36. Hackmann, A., Surawy, C., & Clark, D.M. (1998). Seeing yourself through others’ eyes: A study of spontaneously occurring images in social phobia. Behavioural and Cognitive Psychotherapy, 26, 3-12. https://doi.org/10.1017/S1352465898000022
37. Harwood, T.M., Beutler, L.E., & Charvat, M. (2010). Cognitive–behavioral therapy and psychotherapy integration. In K. S. Dobson (Ed.), Handbook of cognitive–behavioral therapies (3rd ed., pp. 94-130). The Guilford Press.
38. Hirsch, C., Meynen, T., & Clark, D. (2004). Negative self-imagery in social anxiety contaminates social interactions. Memory, 12(4), 496 506. https://doi.org/10.1080/09658210444000106
39. Hirsch, C.R., Clark, D.M., Mathews, A., & Williams, R. (2003). Self-images play a causal role in social phobia. Behaviour Research and Therapy, 41(8), 909 921. https://doi.org/10.1016/S0005-7967(02)00103-1
40. Hirsch, C.R., Mathews, A., Clark, D.M., Williams, R., & Morrison, J.A. (2006). The causal role of negative imagery in social anxiety: A test in confident public speakers. Journal of Behavior Therapy and Experimental Psychiatry, 37(2), 159 170. https://doi.org/10.1016/j.jbtep.2005.03.003
41. Holaway, R.M., & Heimberg, R.G. (2004). Cognitive–behavioral therapy for social anxiety disorder: A treatment review. In B. Bandelow & D.J. Stein (Eds.), Social anxiety disorder (1st ed., pp. 207–220).
42. Howes, J.L., & Parrott, C.A. (1991). Conceptualization and flexibility in cognitive therapy. In T.M. Vallis, J.L. Howes, & P.C. Miller (Eds.), The challenge of cognitive therapy: Applications to nontraditional populations (pp. 25-42). Springer.
43. Huppert, F.A. (2009). Psychological well-being: Evidence regarding its causes and consequences. Applied Psychology: Health and Well Being, 1(2), 137-164. https://doi.org/10.1111/j.1758-0854.2009.01008.x
44. Izgic, F., Akyuz, G., Dogan, O., & Kugu, N. (2004). Social phobia among university students and its relation to self-esteem and body image. The Canadian Journal of Psychiatry, 49(9), 630-634. https://doi.org/10.1177/070674370404900910
45. Jacobson, N.S., Follette, W.C., & Revenstorf, D. (1984). Psychotherapy outcome research: Methods for reporting variability and evaluating clinical significance. Behavior Therapy, 15(4), 336-352. https://doi.org/10.1016/S0005-7894(84)80002-7
46. 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
47. Jafari, M., Shahidi, S., & Abedin, A. (2012). Comparing the effectiveness of cognitive behavioral therapy and stages of change model on improving abstinence self-efficacy in Iranian substance dependent adolescents. Iranian Journal of Psychiatry and Behavioral Sciences, 6(2), 7-15.
48. Kashdan, T.B., Julian, T., Merritt, K., & Uswatte, G. (2006). Social anxiety and posttraumatic stress in combat veterans: Relations to well-being and character strengths. Behaviour Research and Therapy, 44(4), 561-583. https://doi.org/10.1016/j.brat.2005.03.010
49. Kellogg, S. (2004). Dialogical encounters: Contemporary perspectives on "chairwork" in psychotherapy. Psychotherapy: Theory, Research, Practice, Training, 41(3), 310-320. https://doi.org/10.1037/0033-3204.41.3.310
50. Keshi, A.K., & Basavarajappa. (2013). Effectiveness of cognitive behavior therapy on self-efficacy among high school students. Asian Journal of Management Sciences & Education, 2(4), 68–79.
51. Kessler, R.C., Petukhova, M., Sampson, N.A., Zaslavsky, A.M., & Wittchen, H.U. (2012). Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. International Journal of Methods in Psychiatric Research, 21(3), 169-184. https://doi.org/10.1002/mpr.1359
52. Knutsson, J., Nilsson, J.E., Eriksson, Å., & Järild, L. (2020). Imagery rescripting and exposure in social anxiety: A randomized trial comparing treatment techniques. Journal of Contemporary Psychotherapy, 50(3), 233-240. https://doi.org/10.1007/s10879-019-09448-1
53. Krans, J., de Bree, J., & Bryant, R.A. (2014). Autobiographical memory bias in social anxiety. Memory, 22(8), 890-897. https://doi.org/10.1080/09658211.2013.844261
54. Kring, A.M., & Johnson, S.L. (2014). Abnormal Psychology (12th ed.). John Wiley & Sons, Inc.
55. Kuo, J.R., Goldin, P.R., Werner, K., Heimberg, R.G., & Gross, J.J. (2011). Childhood trauma and current psychological functioning in adults with social anxiety disorder. Journal of Anxiety Disorders, 25(4), 467-473. https://doi.org/10.1016/j.janxdis.2010.11.011
56. Lee, S.W., & Kwon, J.H. (2013). The efficacy of imagery rescripting (IR) for social phobia: A randomized controlled trial. Journal of Behavior Therapy and Experimental Psychiatry, 44(4), 351-360. https://doi.org/10.1016/j.jbtep.2013.03.001
57. 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://doi.org/10.1017/S1352465815000715
58. Liebowitz, M.R. (1987). Social phobia. Modern Problems of Pharmacopsychiatry, 22, 141-173. https://doi.org/10.1159/000414022
59. Luszczynska, A., Gutierrez-Dona, B., & Schwarzer, R. (2005). General self-efficacy in various domains of human functioning: Evidence from five countries. International Journal of Psychology, 40(2), 80-89. https://doi.org/10.1080/00207590444000041
60. Magee, W.J. (1999). Effects of negative life experiences on phobia onset. Social Psychiatry and Psychiatric Epidemiology, 34(7), 343-351. https://doi.org/10.1007/s001270050154
61. Makkar, S.R., & Grisham, J.R. (2011). Social anxiety and the effects of negative self-imagery on emotion, cognition, and post-event processing. Behaviour Research and Therapy, 49(10), 654-664. https://doi.org/10.1016/j.brat.2011.07.004
62. Maner, J.K., & Kenrick, D.T. (2010). When adaptations go awry: Functional and dysfunctional aspects of social anxiety. Social Issues and Policy Review, 4(1), 111-142. https://doi.org/10.1111/j.1751-2409.2010.01019.x
63. Mayo-Wilson, E., Dias, S., Mavranezouli, I., Kew, K., Clark, D.M., Ades, A.E., & Pilling, S. (2014). Psychological and pharmacological interventions for social anxiety disorder in adults: A systematic review and network meta-analysis. The Lancet Psychiatry, 1(5), 368-376. https://doi.org/10.1016/S2215-0366(14)70329-3
64. McManus, F., Sacadura, C., & Clark, D.M. (2008). Why social anxiety persists: An experimental investigation of the role of safety behaviours as a maintaining factor. Journal of Behavior Therapy and Experimental Psychiatry, 39(2), 147-161. https://doi.org/10.1016/j.jbtep.2006.12.002
65. Melkman, E.P. (2017). Childhood adversity, social support networks and well-being among youth aging out of care: An exploratory study of mediation. Child Abuse & Neglect, 72, 85–97. https://doi.org/10.1016/j.chiabu.2017.07.020
66. Mellings, T.M.B., & Alden, L.E. (2000). Cognitive processes in social anxiety: The effects of self-focus, rumination and anticipatory processing. Behaviour Research and Therapy, 38(3), 243-257. https://doi.org/10.1016/S0005-7967(99)00040-6
67. Mosley-Johnson, E., Garacci, E., Wagner, N., Mendez, C., Williams, J.S., & Egede, L.E. (2018). Assessing the relationship between adverse childhood experiences and life satisfaction, psychological well–being, and social well–being: United States longitudinal cohort 1995–2014. Quality of Life Research, Advance online publication. https://doi.org/10.1007/s11136-018-2054-6
68. Mörtberg, E., Clark, D.M., Sundin, Ö., & Wistedt, A.Å. (2007). Intensive group cognitive treatment and individual cognitive therapy vs. treatment as usual in social phobia: A randomized controlled trial. Acta Psychiatrica Scandinavica, 115(2), 142-154. https://doi.org/10.1111/j.1600-0447.2006.00839.x
69. Narr, R.K., & Teachman, B.A. (2017). Using advances from cognitive behavioral models of anxiety to guide treatment for social anxiety disorder. Journal of Clinical Psychology, 73(5), 524-535. https://doi.org/10.1002/jclp.22450
70. Nilsson, J.E., Lundh, L.G., & Viborg, G. (2012). Imagery rescripting of early memories in social anxiety disorder: An experimental study. Behaviour Research and Therapy, 50(6), 387-392. https://doi.org/10.1016/j.brat.2012.03.004
71. Nordstrom, A.H., Goguen, L.M.S., & Hiester, M. (2014). The effect of social anxiety and self–esteem on college adjustment, academics, and retention. Journal of College Counseling, 17(1), 48-63. https://doi.org/10.1002/j.2161-1882.2014.00047.x
72. Norton, A.R., & Abbott, M.J. (2016). The efficacy of imagery rescripting compared to cognitive restructuring for social anxiety disorder. Journal of Anxiety Disorders, 40, 18-28. https://doi.org/10.1016/j.janxdis.2016.03.009
73. Norton, A.R., Abbott, M.J., Dobinson, K.A., Pepper, K.L., & Guastella, A.J. (2021). Rescripting social trauma: A pilot study investigating imagery rescripting as an adjunct to cognitive behaviour therapy for social anxiety disorder. Cognitive Therapy and Research, 45(6), 1180-1192. https://doi.org/10.1007/s10608-021-10221-9
74. Özbay, Y., & Palancı, M. (2001). Sosyal kaygı ölçeği: Geçerlik ve güvenirlik çalışması [Social anxiety scale: The validity and reliability study] VI. Ulusal Psikolojik Danışma ve Rehberlik Kongresi [VI. National Psychological Counseling and Guidance Congress], Ankara, Turkey.
75. Paivio, S.C., Hall, I.E., Holowaty, K.A.M., Jellis, J.B., & Tran, N. (2001). Imaginal confrontation for resolving child abuse issues. Psychotherapy Research, 11(4), 433-453. https://doi.org/10.1093/ptr/11.4.433
76. Pinjarkar, R.G., Sudhir, P.M., & Math, S.B. (2015). Brief cognitive behavior therapy in patients with social anxiety disorder: A preliminary investigation. Indian Journal of Psychological Medicine, 37(1), 20-25. https://doi.org/10.4103/0253-7176.150808
77. Priyamvada, R., Kumari, S., Prakash, J., & Chaudhury, S. (2009). Cognitive behavioral therapy in the treatment of social phobia. Industrial Psychiatry Journal, 18(1), 60-63. https://doi.org/10.4103/0972-6748.57863
78. Regis, J.M.O., Ramos-Cerqueira, A.T.A., Lima, M.C.P., & Torres, A.R. (2018). Social anxiety symptoms and body image dissatisfaction in medical students: Prevalence and correlates. Jornal Brasileiro de Psiquiatria, 67, 65 73. https://doi.org/10.1590/0047 2085000000187
79. Reimer, S.G., & Moscovitch, D.A. (2015). The impact of imagery rescripting on memory appraisals and core beliefs in social anxiety disorder. Behaviour Research and Therapy, 75, 48-59. https://doi.org/10.1016/j.brat.2015.10.007
80. Romano, M., Moscovitch, D.A., Huppert, J.D., Reimer, S.G., & Moscovitch, M. (2020). The effects of imagery rescripting on memory outcomes in social anxiety disorder. Journal of Anxiety Disorders, 69. https://doi.org/10.1016/j.janxdis.2019.102169
81. Rosenthal, R. (1991). Meta-analytic procedures for social research (Revised ed., Vol. 6). Sage Publications.
82. Rudy, B.M., Davis Ill, T.E., & Matthews, R.A. (2012). The relationship among self-efficacy, negative self-referent cognitions, and social anxiety in children: A multiple mediator model. Behavior Therapy, 43(3), 619-628. https://doi.org/10.1016/j.beth.2011.11.003
83. Ruini, C., Belaise, C., Brombin, C., Caffo, E., & Fava, G.A. (2006). Well-being therapy in school settings: A pilot study. Psychotherapy and Psychosomatics, 75(6), 331-336. https://doi.org/10.1159/000095438
84. Ruscio, A.M., Brown, T.A., Chiu, W.T., Sareen, J., Stein, M.B., & Kessler, R.C. (2008). Social fears and social phobia in the USA: results from the National Comorbidity Survey Replication. Psychological Medicine, 38(1), 15 28. https://doi.org/10.1017/S0033291707001699
85. Ryff, C.D. (1989a). Beyond ponce de leon and life satisfaction: New directions in quest of successful ageing. International Journal of Behavioral Development, 12(1), 35–55. https://doi.org/10.1177/016502548901200102
86. Ryff, C.D. (1989b). Happiness is everything, or is it? Explorations on the meaning of psychological well-being. Journal of Personality and Social Psychology, 57(6), 1069-1081. https://doi.org/10.1037/0022-3514.57.6.1069
87. Ryff, C.D. (2014). Psychological well–being revisited: Advances in the science and practice of eudaimonia. Psychotherapy and Psychosomatics, 83(1), 10 28. https://doi.org/10.1159/000353263
88. Scherbaum, C.A., Cohen-Charash, Y., & Kern, M.J. (2006). Measuring general self-efficacy: A comparison of three measures using item response theory. Educational and Psychological Measurement, 66(6), 1047 1063. https://doi.org/10.1177/0013164406288171
89. Schwarzer, R. (1994). Optimism, vulnerability, and self-beliefs as health-related cognitions: A systematic overview. Psychology and Health, 9(3), 161 180. https://doi.org/10.1080/08870449408407475
90. Schwarzer, R., & Jerusalem, M. (1995). Generalized self–efficacy scale. In J. Weinman, S.C. Wright, & M. Johnston (Eds.), Measures in health psychology: A user’s portfolio (1st ed., pp. 35–37). NFER–Nelson.
91. Shorey, R.C., & Stuart, G.L. (2012). Manualized cognitive-behavioral treatment of social anxiety disorder: A case study. Clinical Case Studies, 11(1), 35 47. https://doi.org/10.1177/1534650112438462
92. Soykan, C., Ozguven, H. D., & Gencoz, T. (2003). Liebowitz social anxiety scale: The Turkish version. Psychological Reports, 93(3), 1059 1069. https://doi.org/10.2466/Pr0.93.7.1059-1069
93. Stangier, U., Heidenreich, T., Peitz, M., Lauterbach, W., & Clark, D.M. (2003). Cognitive therapy for social phobia: Individual versus group treatment. Behaviour Research and Therapy, 41(9), 991-1007. https://doi.org/10.1016/S0005-7967(02)00176-6
94. Stopa, L., & Jenkins, A. (2007). Images of the self in social anxiety: Effects on the retrieval of autobiographical memories. Journal of Behavior Therapy and Experimental Psychiatry, 38(4), 459-473. https://doi.org/10.1016/j.jbtep.2007.08.006
95. Taylor, S. (1996). Meta-analysis of cognitive-behavioral treatments for social phobia. Journal of Behavior Therapy and Experimental Psychiatry, 27(1), 1 9. https://doi.org/10.1016/0005-7916(95)00058-5
96. Telef, B.B. (2013). Psikolojik iyi oluş ölçeği: Türkçeye uyarlama, geçerlik ve güvenirlik çalışması [The Adaptation of psychological well-being into Turkish: A validity and reliability study]. Hacettepe Üniversitesi Eğitim Fakültesi Dergisi, 28(3), 374-384. https://dergipark.org.tr/tr/download/article-file/87222
97. Tsitsas, G.D., & Paschali, A.A. (2014). A Cognitive–behavior therapy applied to a social anxiety disorder and a specific phobia: Case study. Health Psychology Research, 2(1603), 78-82. https://doi.org/10.4081/hpr.2014.1603
98. Vassilopoulos, S.P. (2012). Social anxiety and memory biases in middle childhood: A preliminary study. Hellenic Journal of Psychology, 9(2), 114-131.
99. Wang, J.L., Jackson, L.A., Gaskin, J., & Wang, H.Z. (2014). The effects of Social Networking Site (SNS) use on college students' friendship and well-being. Computers in Human Behavior, 37, 229-236. https://doi.org/10.1016/j.chb.2014.04.051
100. Weiss, B.J., Singh, J.S., & Hope, D.A. (2011). Cognitive–behavioral therapy for immigrants presenting with social anxiety disorder: Two case studies. Clinical Case Studies, 10(4), 324-342. https://doi.org/10.1177/1534650111420706
101. Weiss, L.A., Westerhof, G.J., & Bohlmeijer, E.T. (2016). Can we increase psychological well–being? The effects of interventions on psychological well-being: A meta-analysis of randomized controlled trials. Plos ONE, 11(6). https://doi.org/10.1371/journal.pone.0158092
102. Wersebe, H., Lieb, R., Meyer, A.H., Miche, M., Mikoteit, T., Imboden, C., Hoyer, J., Bader, K., Hatzinger, M., & Gloster, A. T. (2018). Well-being in major depression and social phobia with and without comorbidity. International Journal of Clinical and Health Psychology, 18(3), 201-208. https://doi.org/10.1016/j.ijchp.2018.06.004
103. Wild, J., & Clark, D.M. (2011). Imagery rescripting of early traumatic memories in social phobia. Cognitive and Behavioral Practice, 18(4), 433 443. https://doi.org/10.1016/j.cbpra.2011.03.002
104. Wild, J., & Clark, D.M. (2015). Experiential exercises and imagery rescripting in social anxiety disorder: New perspectives on changing beliefs. In N. C. Thoma & D. McKay (Eds.), Working with emotion in cognitive-behavioral therapy: Techniques for clinical practice (1st ed., pp. 216-236). The Guilford Press.
105. Wild, J., Hackmann, A., & Clark, D.M. (2007). When the present visits the past: Updating traumatic memories in social phobia. Journal of Behavior Therapy and Experimental Psychiatry, 38(4), 386-401. https://doi.org/10.1016/j.jbtep.2007.07.003
106. Wild, J., Hackmann, A., & Clark, D.M. (2008). Rescripting early memories linked to negative images in social phobia: A pilot study. Behavior Therapy, 39(1), 47 56. https://doi.org/10.1016/j.beth.2007.04.003
107. Wootton, B. M., Hunn, A., Moody, A., Lusk, B. R., Ranson, V. A., & Felmingham, K. L. (2018). Accelerated outpatient individual cognitive behavioural therapy for social anxiety disorder: A preliminary pilot study. Behavioural and Cognitive Psychotherapy, 46(6), 690-705. https://doi.org/10.1017/S1352465818000267
108. Yoshinaga, N., Kobori, O., Iyo, M., & Shimizu, E. (2013). Cognitive behaviour therapy using the Clark & Wells model: A case study of a Japanese social anxiety disorder patient. The Cognitive Behaviour Therapist, 6(3), 1 30. https://doi.org/10.1017/S1754470X13000081
109. Yoshinaga, N., Ohshima, F., Matsuki, S., Tanaka, M., Kobayashi, T., Ibuki, H., Asano, K., Kobori, O., Shiraishi, T., Ito, E., Nakazato, M., Nakagawa, A., Iyo, M., & Shimizu, E. (2013). A preliminary study of individual cognitive behavior therapy for social anxiety disorder in Japanese clinical settings: A single–arm, uncontrolled trial. BMC Research Notes, 6(74), 1-8. https://doi.org/10.1186/1756-0500-6-74