Kognitiewe terapie en blootstelling in die behandeling van sosiale fobie

[摘要] ENGLISH ABSTRACT: The objective of this study was to investigate and compare the effectiveness of a combined exposure andcognitive restructuring programme versus exposure only in the treatment of social phobia.The 44 participants in the study met the DSM-IV diagnostic criteria for social phobia at pre-treatmentassessment, and presented mainly with general interactional social fears. They were allocated to a groupwhich received a combined exposure and cognitive restructuring treatment (n = 15), a group treated withexposure only (n = 15), and a waiting-list control group (n = 14). For treatment purposes, both treatmentgroups were subdivided into two smaller groups of 7 and 8 participants each.The effects and differential effects of the treatments were compared in terms of four broad categories ofvariables: target phobia variables (anxiety/avoidance/escape in relation to a specific target phobia), socialphobia variables (associated with the degree, nature, aspects and/or consequences of social phobia),cognitive variables (thought functionality, fear-of-negative-evaluation, and attentional bias), and severityof depression.Participants were individually assessed before treatment, immediately after treatment, and at follow-upafter three months. Treatment were conducted by two co-therapists in 12 weekly group sessions of twohours each.Compared to a waiting-list control condition, both treated groups showed a significant improvement of thetarget phobia variables at post-treatment and, with the exception of target phobia anxiety for the exposureonly condition, the significant effects were maintained at follow-up after three months.As for the social phobia variables, cognitive restructuring and exposure combined showed a significantlylarger improvement compared to the waiting-list control condition on four of the variables (social phobiaavoidance, social phobia observation anxiety, social phobia general symptomatology, and social phobiadisturbance/disablement), and these significant effects were maintained at follow-up. The exposure onlygroup showed significantly larger effects on only two variables (social phobia avoidance and social phobiadisturbance/disablement) and only the effects on social phobia avoidance were maintained for the followupperiod of three months.With regard to the cognitive variables, the combined treatment led to significanly larger improvements inthought functionality compared to the waiting-list control condition and these effects were maintained atfollow-up. No other significant differences between the effects of any of the treatments and the waiting-listcontrol condition were demonstrated at post-treatment or at follow-up on any of the cognitive variables.Only the combined treatment resulted in significantly larger reductions in the severity of depression, Theeffects were maintained for the follow-up period of three months. Compared to the waiting-list control condition, the combined treatment resulted in improvement over abroader spectrum of social phobia symptomatology than exposure only at post-treatment and follow-up.The two treatments were also directly compared in terms of their effects on each of the dependentvariables and the differences were largely insignificant at both post-treatment and follow-up. Only in termsof thought functionality tentative indications of a possible larger effect for the combined treatment werefound. However, if this was the case, the differences were cancelled out at follow-up.It seems that both the combined treatment and exposure only were effective treatments for social phobiaand that the combined treatment might have demonstrated slightly better results. These findings supportthe emerging view that the most important cognitive-behavioral treatments of social phobia do not differgreatly in terms of efficacy. It also offer support for the view of prominent researchers on social phobiaoutcome, namely that treatment effects are less dependent on procedural variations than on other criticalelements, such as the length and frequency of treatment sessions, and exposure to the critical elementsof patients' social fears.

[发布机构] Stellenbosch University