Abstract
Forty-nine patients participated in a study comparing cognitive-behavioral group treatment (CBGT) for social phobia with a credible placebo control. CBGT consisted of exposure to simulated phobic events, cognitive restructuring of maladaptive thoughts, and homework for self-directed exposure and cognitive restructuring between sessions. Control patients received a treatment package consisting of lecture-discussion and group support that was comparable to CBGT on measures of treatment credibility and outcome expectations. At pretest, posttest, and 3- and 6-month follow-ups, patients completed assessments that included clinician ratings, self-report measures, and behavioral, physiological, and cognitive-subjective measures derived from a behavioral simulation of a personally relevant phobic event. Both groups improved on most measures, but, at both posttest and follow-up, CBGT patients were rated as more improved than controls and reported less anxiety before and during the behavioral test. At follow-up, CBGT patients also reported significantly fewer negative and more positive self-statements than controls on a thought-listing task following the behavioral test. Regardless of treatment condition, follow-up changes in clinician-rated phobic severity were significantly related to changes on the thought-listing measure.
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References
American Psychiatric Association. (1980).Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: Author.
American Psychiatric Association. (1987).Diagnostic and statistical manual of mental disorders (3rd ed., rev.). Washington, DC: Author.
Amies, P. L., Gelder, M. G., & Shaw, P. M. (1983). Social phobia: A comparative clinical study.British Journal of Psychiatry, 142 174–179.
Arnkoff, D. B., & Glass, C. R. (1989). Cognitive assessment in social anxiety and social phobia.Clinical Psychology Review, 9 61–74.
Barlow, D. H. (1985). The dimensions of anxiety disorders. In A. H. Tuma & J. D. Maser (Eds.),Anxiety and the anxiety disorders (pp. 479–500). Hillsdale, NJ: Erlbaum
Barlow, D. H., & Beck, J. G. (1984). The psychosocial treatment of anxiety disorders: Current status, future directions. In J. B. W. Williams & R. L. Spitzer (Eds.),Psychotherapy research: Where are we and where should we go? (pp. 29–66). New York: Guilford Press.
Barlow, D. H., O'Brien, G. T., & Last, C. G. (1984). Couples treatment of agoraphobia.Behavior Therapy, 15 41–58.
Beck, A. T., Ward, C. H., Mendelson, M. J., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression.Archives of General Psychiatry, 4 561–571.
Biran, M., Augusto, F., & Wilson, G. T. (1981).In vivo exposure vs. cognitive restructuring in the treatment of scriptophobia.Behaviour Research and Therapy, 19 525–532.
Borkovec, T. D., & Nau, S. D. (1972). Credibility of analogue therapy rationales.Journal of Behavior Therapy and Experimental Psychiatry, 3 257–260.
Burns, D. D. (1980)Feeling good: The new mood therapy. New York: William Morrow.
Butler, G. (1985). Exposure as a treatment for social phobia: Some instructive difficulties.Behaviour Research and Therapy, 23 651–657.
Butler, G. Cullington, A., Munby, M., Amies, P., & Gelder, M. (1984). Exposure and anxiety management in the treatment of social phobia.Journal of Consulting and Clinical Psychology, 52 642–650.
Cacioppo, J. T., Glass, C. R., & Merluzzi, T. V. (1970). Self-statements and self-evaluations: A cognitive-response analysis of heterosocial anxiety.Cognitive Therapy and Research, 3 249–262.
Chiauzzi, E. J., Heimberg, R. G., Becker, R. E., & Gansler, D. (1985). Personalized versus standard role plays in the assessment of depressed patients' social skill.Journal of Psychopathology and Behavioral Assessment, 7 121–133.
Christensen, L., & Mendoza, J. L. (1986). A method of assessing change in a single subject: An alteration of the RC index.Behavior Therapy, 17 305–308.
DiNardo, P. A., O'Brien, G. T., Barlow, D. H., Waddell, M. T., & Blanchard, E. B. (1983). Reliability of DSM-III anxiety disorder categories using a new structured interview.Archives of General Psychiatry, 40 1070–1074.
Dodge, C. S., Hope, D. A., Heimberg, R. G., & Becker, R. E. (1981). Evaluation of the Social Interaction Self-Statement Test with a social phobic population.Cognitive Therapy and Research, 12 211–222.
Emmelkamp, P. M. G. (1982).Phobic and obsessive-compulsive disorders: Theory, research and practice. New York: Plenum Press.
Emmelkamp, P. M. G., Mersch, P. P., Vissia, E., & van der Helm, M. (1985). Social phobia: A comparative evaluation of cognitive and behavioral interventions.Behaviour Research and Therapy, 23 365–369.
Glass, C. R., & Furlong, M. (in press). Cognitive assessment of social anxiety: Affective and behavioral correlates.Cognitive Therapy and Research.
Glass, C. R., Merluzzi, T. V., Biever, J. L., & Larsen, K. H. (1982). Cognitive assessment of social anxiety: Development and validation of a self-statement questionnaire.Cognitive Therapy and Research, 6 37–55.
Hamilton, M. (1960). A rating scale for depression.Journal of Neurology, Neurosurgery, and Psychiatry, 23 56–62.
Heimberg, R. G. (1989). Cognitive and behavioral treatments for social phobia: A critical analysis.Clinical Psychology Review, 9 107–128.
Heimberg, R. G., Acerra, M., & Holstein, A. (1985). Partner similarity mediates interpersonal anxiety.Cognitive Therapy and Research, 9 436–445.
Heimberg, R. G., & Barlow, D. H. (1988). Psychosocial treatments for social phobia.Psychosomatics, 29 27–37.
Heimberg, R. G., Becker, R. E., Goldfinger, K., & Vermilyea, J. A. (1985). Treatment of social phobia by exposure, cognitive restructuring and homework assignments.Journal of Nervous and Mental Disease, 173 236–245.
Heimberg, R. G., Dodge, C. S., & Becker, R. E. (1987). Social phobia. In L. Michelson & M. Ascher (Eds.),Anxiety and stress disorders (pp. 280–309). New York: Guilford Press.
Heimberg, R. G., Keller, K. E., & Peca-Baker, T. (1986). Cognitive assessment of social-evaluative anxiety in the job interview: Job Interview Self-Statement Schedule.Journal of Counseling Psychology, 33 190–195.
Heimberg, R. G., Nyman, D. S., & O'Brien, G. T. (1987). Assessing variations of the thought-listing technique: Effects of stimulus intensity, stimulus modality, instructions, and scoring procedures.Cognitive Therapy and Research, 11 13–24.
Jacobson, N. S., & Revenstorf, D. (1988). Statistics for assessing clinical significance of psychotherapy techniques: Issues, problems, and new developments.Behavioral Assessment, 10 133–145.
Jerremalm, A., Jansson, L., & Ost, L. G. (1986). Cognitive and physiological reactivity and the effects of different behavioral methods in the treatment of social phobia.Behaviour Research and Therapy, 24 171–180.
Kanter, N. J., & Goldfried, M. R. (1979). Relative effectiveness of rational restructuring and self-control desensitization in the reduction of interpersonal anxiety.Behavior Therapy, 10 472–490.
Kendall, P. C., & Hollon, S. D. (1981). Assessing self-referent speech: Methods in the measurement of self-statements. In P. C. Kendall & S. D. Hollon (Eds.),Assessment strategies for cognitive-behavioral interventions (pp. 85–118). New York: Academic Press.
Kendall, P. C., & Korgeski, G. P. (1979). Assessment and cognitive-behavioral interventions.Cognitive Therapy and Research, 3 1–21.
Kennedy, C. R., & Heimberg, R. G. (1986, November).Treatment credibility and client outcome expectancy: An evaluation of five treatment rationales. Paper presented at the annual meeting of the Association for the Advancement of Behavior Therapy, Chicago.
Lang, P. J. (1968). Fear reduction and fear behavior: Problems in treating a construct. In J. M. Shlien (Ed.),Research in psychotherapy (Vol. 3). Washington, DC: American Psychological Association.
Liebowitz, M. R., Gorman, J. M., Fyer, A. J., & Klein, D. F. (1985). Social phobia: Review of a neglected anxiety disorder.Archives of General Psychiatry, 42 729–736.
Marks, I. M., & Mathews, A. M. (1979). Brief standard self-rating for phobic patients.Behaviour Research and Therapy, 17 263–267.
Mattick, R. P., & Peters, L. (1988). Treatment of severe social phobia: Effects of guided exposure with and without cognitive restructuring.Journal of Consulting and Clinical Psychology, 56 251–260.
Moorey, S., & Burns, D. D. (1983). The apprenticeship model: Training in cognitive therapy by participation. In A. Freeman (Ed.),Cognitive therapy with couples and groups (pp. 303–321). New York: Plenum.
Myers, J. K., Weissman, M. M., Tischler, G. L., Holzer, C. E. III, Leaf, P. J., Orvaschel, H., Anthony, J. C., Boyd, J. H., Burke, J. D., Jr., Kramer, M., & Stolzman, R. (1984). Six-month prevalence of psychiatric disorders in three communities.Archives of General Psychiatry, 41 959–967.
Myszka, M. T., Galassi, J. P., & Ware, W. B. (1986). Comparison of cognitive assessment methods with heterosocially anxious women.Journal of Counseling Psychology, 33 401–407.
Paul G. L. (1966).Insight vs. desensitization in psychotherapy. Stanford, CA: Stanford University Press.
Sank, L. I., & Shaffer, C. S. (1984).A therapist's manual for cognitive behavior therapy in groups. New York: Plenum.
Schwartz, R. M., & Garamoni, G. L. (1986). A structural model of positive and negative states of mind: Assymetry in the internal dialogue. In P. C. Kendall (Ed.),Advances in cognitive-behavioral research and therapy (Vol. 5, pp. 1–62) New York: Academic Press.
Stravynski, A., Marks, I., & Yule, W. (1982). Social skills problems in neurotic outpatients: Social skills training with and without cognitive modification.Archives of General Psychiatry, 39 1378–1385.
Watson, D., & Friend, R. (1969). Measurement of social-evaluative anxiety.Journal of Consulting and Clinical Psychology, 33 448–457.
Watson, J. P., & Marks, I. M. (1971). Relevant and irrelevant fear in flooding—A crossover study of phobic patients.Behavior Therapy, 2 275–293.
Wolpe, J., & Lazarus, A. A. (1966).Behavior therapy techniques: A guide to the treatment of neuroses. Oxford: Pergamon.
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Heimberg, R.G., Dodge, C.S., Hope, D.A. et al. Cognitive behavioral group treatment for social phobia: Comparison with a credible placebo control. Cogn Ther Res 14, 1–23 (1990). https://doi.org/10.1007/BF01173521
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DOI: https://doi.org/10.1007/BF01173521