Sosyal Anksiyete Bozukluğunda Bilişsel Davranışçı Terapinin Etkinliği Semptomlara Göre Farklılık Gösteriyor Mu?

Öz

Amaç: Sosyal anksiyete bozukluğu (SAB), bireysel farklılıklar nedeniyle farklı semptomlar ve klinik görü-nümlerle ortaya çıkabilir. Bu farklılıkları açıklamada kategorik modellerin sunduğu açıklamalar sınırlı kalabilir. SAB tanısı alan bireylerden bazıları performans durumlarında, bazıları ise sosyal durumlarda daha yüksek anksiyete gösterebilir. Bu çalışmadaki amacımız, klinik özellikler ve bilişsel davranışçı terapi (BDT) tedavi etkinliği açısından semptom büyüklüğündeki farklılıkları değerlendirmektir. Materyal ve Metod: Mart 2022 ve Haziran 2023 tarihleri arasında SAB tanısıyla SSRI tedavisine ek olarak BDT alan 12-18 yaş arasındaki 23 ergenin dosyası retrospektif olarak taranarak çalışmaya dahil edilmiştir. Katılımcıların dosyalarından elde edilen bilgiler ile Liebowitz Sosyal Anksiyete Ölçeği (LSAS) puanlarına göre genelleşmiş tip (GT) ve kısıtlı tip (KT) olarak iki gruba ayrılmış ve Çocuklar için Depresyon Ölçeği (CDI), Çocuklar için Anksiyete Bozuklukları Tarama Ölçeği (CADSS), Çapa Çocuk ve Ergen Sosyal Fobi Ölçeği (CASPS) ile LSAS alt ölçek puanları BDT öncesi ve sonrası karşılaştırılmıştır. Bulgular: BDT öncesinde GT (n=13) ve KT (n=10) gruplarının ölçek puanları karşılaştırıldığında, GT gru-bundaki ergenlerin CDI, CADSS, CASPS ve LSAS puanları istatistiksel olarak anlamlı derecede daha yük-sek bulunmuştur. BDT sonrası LSAS alt ölçekleri ve CADSS puanları karşılaştırıldığında ise her iki grupta da ölçek puanlarının GT grubunda daha yüksek olduğu görülmüştür. Sonuç: Bu çalışma, SAB semptomlarına göre kategorik tanı yapıldığında, özellikle depresif semptomlar ve diğer anksiyete bozuklukları eşlik eden vakalarda BDT etkinliğinin azalabileceğini düşündürmektedir.

Anahtar Kelimeler

• sosyal anksiyete bozukluğu
• ergen
• bilişsel davranışçı terapi

Does the Effectiveness of Cognitive Behavioural Therapy in Social Anxiety Disorder Differ According to Symptoms?

Öz

Background: Social anxiety disorder (SAD) presents with different symptoms and clinical appearances due to individual differences. The explanations provided by categorical models for these differences may be limited. Some individuals diagnosed with SAD may exhibit higher anxiety in performance situa-tions, while others may exhibit higher anxiety in social situations. Our aim in this study is to evaluate the difference in symptom size in terms of clinical features and cognitive behavioural therapy (CBT) treatment effectiveness. Materials and Methods: The records of 23 adolescents aged 12-18 who received CBT in addition to SSRI treatment for SAD between March 2022 and June 2023 were retrospectively reviewed and in-cluded in the study. Based on the information obtained from the participants' records, they were divided into two groups as generalized type (GT) and restrictive type (RT) according to their Liebowitz Social Anxiety Scale (LSAS) scores. The Children’s Depression Inventory (CDI), Children’s Anxiety Disor-ders Screening Scale (CADSS), Capa Child and Adolescent Social Phobia Scale (CASPS), and LSAS subscale scores were compared before and after CBT. Results: When the RT (n=10) and GT (n=13) pre-treatment scale scores were compared, the CDI, CADSS, CAPSS and LSAS scores of the adolescents in the GT group were statistically significantly higher. When the LSAS subscales and CADSS scores of both groups were compared after CBT treatment, the scale scores were found to be higher in the GT group. Conclusions: This study suggests that the effectiveness of CBT may be reduced when categorical diagno-sis is made according to symptoms in SAD, especially in cases accompanied by depressive symptoms and other anxiety disorders.

Anahtar Kelimeler

• Social anxiety disorder
• adolescent
• cognitive behavioural therapy

Kaynakça

1. 1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington (DC): APA Press; 2013.
2. 2. Wittchen HU, Stein MB, Kessler RC. Social fears and social phobia in a community sample of adolescents and young adults: prevalence, risk factors, and comorbidity. Psychol Med. 1999;29(2):309-23.
3. 3. Bandelow B, Zohar J, Hollander E, Kasper S, Möller HJ, Montgomery SA, et al. WFSBP Task Force on Treatment Guidelines for Anxiety, Obsessive-Compulsive, and Post-Traumatic Stress Disorders. World J Biol Psychiatry. 2008;9(4):248-312.
4. 4. Silverman WK, Pina AA, Viswesvaran C. Evidence-based psychosocial treatments for phobic and anxiety disorders in children and adolescents. J Clin Child Adolesc Psychol. 2008;37(1):105-30.
5. 5. Kermen U, Erden Ş. Bilişsel Davranışçı Yaklaşım Temelli Bir Psikolojik Danışma Programının Ergenlerin Sosyal Fobi ve Mizah Düzeylerine Etkisi. Mersin Üniversitesi Eğitim Fakülte-si Dergisi. 2019;15(3):831-44.
6. 6. Özer Ö, Yalçın İ. Bilişsel-Davranışçı Terapiye Dayalı Psiko-Eğitim Programının Üniversite Öğrencilerinin Sosyal Anksiye-te Düzeylerine Etkisi. Kahramanmaraş Sütçü İmam Üniversi-tesi Eğitim Araştırmaları Dergisi. 2020;2(2):161-68.
7. 7. Bandelow B, Michaelis S, Wedekind D. Treatment of anxiety disorders. Dialogues Clin Neurosci. 2017;19(2):93-107.
8. 8. Mennin DS, Heimberg RG, Jack MS. Comorbid generalized anxiety disorder in primary social phobia: symptom severity, functional impairment, and treatment response. J Anxiety Disord. 2000;14(4):325-43.

9. 9. Canadian Psychiatric Association. Clinical practice guidelines: management of anxiety disorders. Can J Psychiatry. 2006;51(8 Suppl 2):9S-15S.
10. 10. Bauer I, Wilansky-Traynor P, Rector NA. Cognitive-behavioral therapy for anxiety disorders comorbid with depression: a review. Int J Cogn Ther. 2012;5(2):118-56.
11. 11. Chambless DL, Tran GQ, Glass CR. Predictors of response to cognitive-behavioral group therapy for social phobia. J Anxi-ety Disord. 1997;11(3):221-40.
12. 12. Ledley DR, Huppert JD, Foa HB, Davidson JR, Heimberg RG, Fresco DM. The impact of depressive symptoms on the treatment of generalized social anxiety disorder. Depress Anxiety. 2005;22(4):161-67.
13. 13. Erwin BA, Heimberg RG, Juster H, Safren SA, Brown EJ, Schneier FR. Comorbidity of anxiety and mood disorders in individuals with social anxiety disorder. Behav Res Ther. 2002;40(1):19-35.
14. 14. Joormann J, Kosfelder J, Schulte D. The impact of comorbid depression on the course of anxiety treatments. Cogn Ther Res. 2005;29(5):569-91.
15. 15. Marom S, Gilboa-Schechtman E, Aderka IM, Hofmann SG, Craske MG, Barlow DH. The effect of depression on treat-ment efficacy and maintenance of gains in social phobia: a naturalistic study of cognitive-behavioral group therapy. De-press Anxiety. 2009;26(4):289-300.
16. 16. Liebowitz MR, Heimberg RG, Fresco DM, Travers J, Stein MB. Social phobia or social anxiety disorder: what’s in a na-me? Arch Gen Psychiatry. 2000;57(2):191-92.
17. 17. Pollard CA, Henderson JG. Four types of social phobia in a community sample. J Nerv Ment Dis. 1994;176(8):440-45.
18. 18. Kotov R, Krueger RF, Watson D, Achenbach TM, Althoff RR, Bagby RM, et al. The hierarchical taxonomy of psychopatho-logy (HiTOP): a dimensional alternative to traditional noso-logies. J Abnorm Psychol. 2017;126(4):454-77.
19. 19. Hofmann SG, Heinrichs N, Moscovitch DA. The nature and expression of social phobia: toward a new classification. Clin Psychol Rev. 2004;24(7):769-97.
20. 20. Kovacs M. Children’s depression inventory. Toronto (ON): Multi-Health Systems; 1992.
21. 21. Öy B. Çocuklar için depresyon ölçeği: geçerlik ve güvenirlik çalışması. Türk Psikiyatri Dergisi. 1991;2(3):132-36.
22. 22. Birmaher B, Brent D, Chiappetta L, Bridge J, Monga S, Baug-her M. Psychometric properties of the Screen for Child Anxi-ety Related Emotional Disorders (SCARED): a replication study. J Am Acad Child Adolesc Psychiatry. 1999;38(10):1230-36.
23. 23. Karaceylan Çakmakçı F. Çocuklarda anksiyete bozukluklarını tarama ölçeği geçerlik ve güvenirlik çalışması [uzmanlık te-zi]. Kocaeli: Kocaeli Üniversitesi Tıp Fakültesi; 2004.
24. 24. Demir T, Eralp-Demir D, Özmen E, Uysal Ö. Çapa çocuk ve ergenler için sosyal fobi ölçeğinin geçerlilik ve güvenilirliği. Düşünen Adam. 1999;12(4):23-30.
25. 25. Heimberg RG, Horner KJ, Juster HR, Safren SA, Brown EJ, Schneier FR, et al. Psychometric properties of the Liebowitz Social Anxiety Scale. Psychol Med. 1999;29(1):199-212.
26. 26. Dilbaz N. Liebowitz sosyal kaygı ölçeği geçerlik ve güvenilirli-ği. In: 37. Ulusal Psikiyatri Kongresi Özet Kitabı. İstanbul: Türk Psikiyatri Derneği; 2001. p. 132.
27. 27. Kessler RC, Berglund P, Demler O, Jin R, Walters EE. Lifetime prevalence and age-of-onset distributions of mental disor-ders in the World Health Organization's World Mental He-alth Survey Initiative. World Psychiatry. 2007;6(3):168-76.
28. 28. Grant BF, Hasin DS, Blanco C, Stinson FS, Chou SP, Goldstein RB, et al. The epidemiology of social anxiety disorder in the United States: results from the National Epidemiologic Sur-vey on Alcohol and Related Conditions. J Clin Psychiatry. 2005;66(11):1351-61.
29. 29. Weiller E, Bisserbe JC, Boyer P, Lépine JP, Lecrubier Y. Social phobia in general health care: an unrecognised undertreated disabling disorder. Br J Psychiatry. 1996;168(2):169-74.
30. 30. Schneier FR, Johnson J, Hornig CD, Liebowitz MR, Weissman MM. Social phobia: comorbidity and morbidity in an epide-miologic sample. Arch Gen Psychiatry. 1992;49(4):283-88.
31. 31. Davidson JR, Hughes DL, George LK, Blazer DG. The epide-miology of social phobia: findings from the Duke Epidemio-logic Catchment Area Study. Psychol Med. 1993;23(3):709-18.
32. 32. McEvoy PM, Grove R, Slade T. Epidemiology of anxiety disor-ders in the Australian general population: findings of the 2007 Australian National Survey of Mental Health and Well-being. Aust N Z J Psychiatry. 2011;45(11):957-62.
33. 33. Menezes GB, Fontenelle LF, Versiani M. Early-onset social anxiety disorder in adults: clinical and therapeutic features. Rev Bras Psiquiatr. 2005;27(1):32-36.
34. 34. Wittchen HU, Nelson CB, Lachner G. Prevalence of mental disorders and psychosocial impairments in adolescents and young adults. Psychol Med. 1998;28(1):109-17.
35. 35. Piqueras JA, Olivares J, López-Pina JA. A new proposal for the subtypes of social phobia in a sample of Spanish adoles-cents. J Anxiety Disord. 2008;22(1):67-77.
36. 36. Koyuncu A, Binbay Z, Özyıldırım İ, Ertekin E. Sosyal anksiyete bozukluğunda başlangıç yaşının klinik gidiş üzerine etkisi. Kli-nik Psikiyatri Dergisi. 2012;15(2):111-20.
37. 37. Wittchen HU, Nelson CB, Lachner G. Prevalence of mental disorders and psychosocial impairments in adolescents and young adults. Psychol Med. 1998;28:109-26.
38. 38. Chavira DA, Stein MB, Bailey K, Stein MT, Walker JR, Norton GR. Comorbidity of generalized social anxiety disorder and depression in a pediatric primary care sample. J Affect Dis-ord. 2004;80:163-71.
39. 39. Otto MW, Pollack MH, Maki KM, Smoller JW, Rosenbaum JF, Sachs GS. Childhood history of anxiety disorders among adults with social phobia: rates, correlates, and comparisons with patients with panic disorder. Depress Anxiety. 2001;14:209-13.
40. 40. Seligman LD, Ollendick TH. Cognitive-behavioral therapy for anxiety disorders in youth. Child Adolesc Psychiatr Clin N Am. 2017;20(2):217-38.
41. 41. Scaini S, Belotti R, Ogliari A. A comprehensive meta-analysis of cognitive-behavioral interventions for social anxiety disor-der in children and adolescents. J Anxiety Disord. 2016;42:105-12.
42. 42. Albano AM, DiBartolo PM. Cognitive-behavioral therapy for social phobia in adolescents: stand up, speak out. Oxford: Oxford University Press; 2016.
43. 43. Beidel DC, Turner SM, Morris TL. Social anxiety disorder in children and adolescents: epidemiology, assessment, and treatment. Clin Child Fam Psychol Rev. 2017;20(3):219-39.
44. 44. Essau CA, Ollendick TH. The Wiley handbook of anxiety di-sorders in children and adolescents. Hoboken (NJ): Wiley-Blackwell; 2017.
45. 45. Silverman WK, Pina AA, Viswesvaran C. Evidence-based psychosocial treatments for phobic and anxiety disorders in children and adolescents. J Clin Child Adolesc Psychol. 2016;37(1):105-30.
46. 46. Swan AJ, Kendall PC. Fear and missing out: youth anxiety and functional outcomes. Clin Psychol Rev. 2016;44:1-8.
47. 47. In-Albon T, Schneider S. Psychotherapy of childhood anxiety disorders: a meta-analysis. Psychother Psychosom. 2015;84(4):254-64.
48. 48. Kerns CE, Prinstein MJ. Social anxiety and peer relations in early adolescence: a prospective longitudinal study. J Clin Child Adolesc Psychol. 2017;46(5):744-54.
49. 49. Hofmann SG, Asnaani A, Vonk IJ, Sawyer AT, Fang A. The efficacy of cognitive behavioral therapy: a review of meta-analyses. Cogn Ther Res. 2016;36(5):427-40.
50. 50. Kashdan TB, McKnight PE. The dark side of social anxiety: when aggressive impulsivity prevails over shy inhibition. Curr Dir Psychol Sci. 2018;22(5):232-37.