Introduction
In this research paper, several aspects of Cognitive behavioural therapy are going to be reviewed and how social phobia is treated through the cognitive behavioural therapy plan. A brief overview of social phobia will be discussed and how it affects the individual capability in social settings. Secondly, the plan of cognitive behavioural therapy will be discussed and the efficacy of those techniques to control the social anxiety. Lastly, there is discussion about the unique situation that would influence the efficacy of the treatment or hinder the application of cognitive behavioural therapy.
Social phobia
The main psychopathology in social phobia is demonstrated as a fear that makes an individual avoid evaluations in performance and social situations. This is the fear of feeling ashamed and overlaps with the notion of shame. Social phobia leads to the avoidance of other situations such as meetings, public speaking, talking to a group, drinking or eating in public, writing, or working when being observed, parties, telephone calls, dating, and intimacy. Peers of the same age are more likely to be anxious than older generations. For heterosexual peers, individuals of opposite gender are more anxiety provoking than the peers of the same gender.
Those individuals in authority especially in working places are more anxiety provoking than those individuals who are at the same level (David 2003).
There are two types of social phobia, which includes the generalised, and non-generalised. In generalised phobia, it is more disabling and involves a range of feared stimuli. The patients who are affected by this social phobia demonstrate avoidance personality disorder, which has worse prognosis. On the other category of non-generalised phobia, the patients are characterised with avoidance of some limited range of interaction or performance situation (David 2003).Those interactions are public speaking, and sexual dysfunction brought by performance anxiety. In non-generalised phobia is easier to treat than the generalised with better prognosis. Therefore, a person who is afraid of speaking in public would not be diagnosed with social phobia if the person was not distressed about it and if there is lesser account of public speaking and not a routine to that individual. Social phobia diagnosis is warranted by the degree of impairment and distress encountered by an individual. Hence, the possible indicators ought to be considered in the actual and appropriate context. (Davidson, Richichi & Potts 1991).
Historical, theoretical, and technical aspects of CBT
There are many types of psychotherapy, however when directly compared its only a very few approaches that deemed to be effective in treating the kinds of problems the clients seek to be assisted. Cognitive behavioural therapy is regarded as a “gold standard” for its efficiency in its therapy strategies in combating anxiety, depression, stress and phobia related problems. Since 1977 out of 375 clinical trials has supported that CBT is the best type of therapy in overcoming social phobia. It has been very effective to individual of all ages from children to older adults, people with different education levels and various income and cultural backgrounds (Heimberg 2002).
Cognitive Behavioural Therapy is a non-pharmacologic approach in treating social phobia. It is the most recognised approach and its successes in treating social anxiety disorder have been demonstrated in many investigations. This approach is a time limited and present-oriented approach to the psychotherapy that enlightens the patients about the behavioural and cognitive competences required to allow them adapt in their intrapersonal and interpersonal worlds. This approach is a joint effort between the patient and the therapist. They form a collaborative team to discuss and address the patient’s concerns.
One the characteristic of cognitive behaviour therapy is its emphasis on empirical demonstration and its application in the controlled research (Heimberg 2002). When this approach is administered into a group, it is known as cognitive behavioural group therapy. The main components of this approach in treating social anxiety are cognitive restructuring, psycho-education, exposure, and homework. In psycho-education, it involves educating and teaching the patient about the existence of the relationship between emotions, physiological reactions, and thoughts. Cognitive restructuring encompasses the correcting of inaccurate and negative cognitions. This is based upon the premises that those clients who are socially anxious have incorrect beliefs. They also believe that social situations poses danger and they have a false prediction about the outcome of those situations.
According to Heimberg (2002), those individuals demonstrate biased and inaccurate processing when they are in the social situations. In the stage of exposure, it comprises of role praying activities, which are designed to get out of the feared situations. During this activity, the client is supposed to remain focussed on the situation and avoid safety behaviours for instance distraction. This helps the client’s anxiety reduce over a time. Initially the client anxiety may be heightened as the physiological arousal connected with the anxiety is finite but eventually it reduces with time (Heimberg 2002). In the stage of homework, the client is assisted in identifying the distorted thoughts when they usually occur naturally. The client is assigned exposure exercises, which they can perform on their own. Those assignments are designed and towards an individual who are likely to experience different scale of anxiety.
Efficacy of Cognitive Behavioural Therapy
In all the different modalities of psychotherapy, CBT is one of the most efficacious modes of treatment for social phobia (Butler, Chapman, Forman & Beck 2006). However, there is limitation in extant research. In various studies and assessment it is evident that many patients under this therapy do not meet the diagnostic criteria for the social phobia. Those clients however experiences fundamental difficulties in the social situations and settings considered as subsyndromic manifestations of the social phobia.
Treatment plan for social phobia
In treating social phobia also known as social anxiety disorder, the CBT is introduced. This therapy is educational and uses a focused approach. The therapist uses practical discussions, which are performed in the sessions and during homework assignments. The treatment of the social phobia is an active and collaborative role of the therapist. This session may take from 12 to 16 weekly sessions, which are believed to reduce the symptoms (David 2003). Treatment response may depend upon the severity of symptoms and number of comorbidities, which may lengthen the treatment period and limited results.
Exposure
Those exposure techniques are designed to assist the patient in facing those situations they fear and hence they are able to stay psychologically engaged to enhance those conditions, which are involved in reducing fear to occur. Initially the therapist develops a list with ranks of anxiety provoking situations. The client is supposed to start working on those least feared situations and they continues approaching those difficult situations. This brings sense of mastery in the lesser situations and therefore building confidence in tackling the difficult situations. The therapist can administer this in various ways. The first one can be either by imagination where the therapist narrates the scenes to the patient to imagine, role-play, or by confronting those feared situation outside the session. However, the therapist can combine all the three ways and the client is directed to engage in the situation and make continuation until the anxiety is naturally gone or it start to subside.
CBT variations use exposure as the central component. The exposure technique is effectively implemented when the patient allow themselves to be engaged fully to the feared situation. This allows them to have full attention to the situation, and experience it fully and tolerate the inevitable rush of arousal and anxiety to occur. Those anxious patients may find this hard to occur then they should engage in maladaptive efforts in a well intentioned way to manage their anxiety situations and experiences. For instance, the patients may distract themselves, which will distract them from paying attention to the details of the feared situation. The patient may also try to think other things, which depict them in danger rather than concentrating what is currently going around them. The instructions to maintain ones focus on the situation that is feared will increase the efficacy of the technique being exposed (Wells and Papageorgiou 1998).
Constructive restructuring
In constructive restructuring, it assists the patients to examine their thoughts in the feared situations and the underlying beliefs around them. The social phobia is believed to rise from inaccurate beliefs about the potential dangers that are posed by negative prediction on social outcome, and the biased processing of activities that happen during social situations. In this constructive reconstruction, individuals are taught to identify the negative thoughts that take place during, before, or after the situations that provoke anxiety (Heimberg 2002).
Secondly the patient are required to evaluate their thoughts accuracy through the data collected from Socratic questioning, also known as behavioural experiment. In the third stage, the patient derives the rational alternative thoughts, which are based on the information acquired. In this method, there is presence of substantive exposure component and the focus is based on the exposure on the collected information. This will allows the patient to revise the judgement they make about the degree of risk they are exposed in the feared situations.
Those behavioural experiments are assigned to the patient and they are supposed to engage in the activities that will not enhance their beliefs. This will not make them aware on how to behave in a particular situation. For example, a patient who believes that he must be very witty for his argument to be accepted by others may be made to eavesdrop on other conversation during lunch break and requested to report back their ordinary discussion.
Another strategy may be a patient who is not able to break silences on his conversation may be requested to do so artificially during his conversation. The patient may also be requested to enter into a feared situation without the engagement of safety behaviour. The safety behaviour is that action that a patient falsely believes that will enable him to manage their anxiety in a successful manner. Nevertheless, contrary to that, those behaviours will prevent the patient from learning they have flourished and survived without those efforts. Therefore, the patients should be instructed to drop those safety behaviours when they are exposed to enhance the treatment (Davidson, Richichi & Potts 1991).
Relaxation training
In the feared events, the patient is assisted by relaxation training to attend to and control the extent and of physiological arousal experienced. The patients are made to relax through exercises that involve groups of different muscles. This is usually done in sessions and then the patient is given homework to do later. The patient are instructed to focus on the a particular group of muscles tense them for five to ten seconds and then release the tension, observing the difference between the relaxation and feeling of tension. In addition, the patient is focussing on the sensations, which accompany the relaxation for example heaviness and warmth.
In this training, the patient begins with 16 muscle groups and as time goes by the focus is shifted to larger groups of muscles, which enhances rapid relaxation (Butler , Chapman, Forman & Beck 2006). The patients continue to learn on how to scan their body for tensions on the muscle and be able to release any tension by remembering how those muscles experienced when they were relaxed. The patients are also taught others relaxation methods known as cue-controlled relaxation. In relaxation training method, the therapist repeatedly combines the word relax with a relaxed state and then they are used as a cue to start the process of relaxing rapidly during daily activities.
This approach of relaxing social anxiety disorder may not be effective unless it is applied. When it is applied, the patients will first learn on how to attend to physiological anxiety sensations. They then learn on how to relax quickly in their daily activities. In those anxiety-provoking situations the patients are taught to apply relaxation skills hence they are able to cope with those situations that are anxiety provoking (Wells and Papageorgiou 1998).
Social skill training
Social skill training in treating social phobia is anchored on the idea that patients that are socially anxious exhibit behavioural deficiencies. Those deficiencies are poor conversation skills and poor eye contact. Those deficiencies will elicit reactions, which are negative from the others and those social interactions causes punishment to the patient and provoking anxiety. The social training techniques include behavioural rehearsal, therapist modelling, homework assignments, corrective feedback, and social reinforcement. If these techniques reduce anxiety, it is not necessarily because of the patients deficiencies through the social skill that has been rectified but this is most certainly the case. In the social skills training, the benefits are provided because of the training aspects (Wells and Papageorgiou 1998).
The technique has repeated practice of the feared social behaviour, and the exposure aspects, which includes confrontation of the feared situation. In addition, the social skill training considers the cognitive elements that are inherent in the procedures, which includes corrective feedback of the individual’s social behaviour. Social skills training are also combined with other techniques such as exposure and cognitive restructuring. Social effectiveness training is a treatment package with multi component that combines social skills training with exposure and education in a mixture of individual and group formats.
Situation that would influence or undermine the efficacy of the treatment
In the CBT implementation there are unique situation that would influence the efficacy of the treatment or result as a barriers to its application. However, there is limitation in extant research. In various studies and assessment it is evident that many patients under this therapy do not meet the diagnostic criteria for the social phobia. Those clients however experiences fundamental difficulties in the social situations and settings considered as subsyndromic manifestations of the social phobia.
The other barrier to the CBT application demonstrated if the individual affected do not necessarily find it disturbing for example, person who is afraid of speaking in public would not be diagnosed with social phobia if the person was not distressed about it and if there is lesser account of public speaking and not a routine to that individual. Social phobia diagnosis is only warranted if there is high degree of impairment and distress encountered by an individual (Davidson, Richichi & Potts 1991). Individual situation also enhances the treatment of social phobia through the cognitive behavioural therapy. Those individuals who are able to interact with their peers and they fear doing things alone are randomly chosen to participate in the role-playing in front of other groups.
The client are given the autonomy of choosing a potential role play hence making the client elicit amount of anxiety which will not hinder them to participate. Therefore, through that unique situation the patients are able to have control of their situations even when the therapist is not there. Patients with generalised social phobia, which runs a course that is long lasting is often associated with the comorbidity disorder, will require individual therapy. For those patients a combined treatment with pharmacotherapy will not be sufficient for an ultimate resolution of symptoms since an outcome condition may remain and ease recurrences. Therefore, the use of various efficacious therapy techniques comes in handy when empirical supported treatment is not able to produce responses, which are satisfactory.
Young children who have social phobia can be identified by CBT and this will allow for the prevention of social phobia in their childhood and adolescence.
According to David (2003), Cognitive Behavioural Therapy will be more efficient if the individual involved if there is a good relationship with the therapist. The patient should always put into consideration all the steps that are indicated in the therapy. Patients should do their homework well and assume as if the therapist is together with them even when they are alone at home. The motivation to change their behaviour and lessen the social phobia should be intrinsic motivated. The efficacy of the treatment also works well when the patients are given the sessions when they are together. They are able to role-play amongst themselves and this will assist them to build confidence and enhance self-esteem. In our case, Anxious Alex should be allowed to interact with the member of different gender and do role praying in their groups. This will allow Alex to improve eye contacts with women and he will be able to talk to them and share ideas.
In conclusion, Cognitive Behavioural Therapy is a non-pharmacologic approach in treating social phobia. It is the most recognised approach and its successes in treating social anxiety disorder have been demonstrated in many investigations. The main components of Cognitive Behavioural Therapy in treating social anxiety are cognitive restructuring, psycho-education, exposure, and homework. CBT use exposure as the central component. The exposure technique is effectively implemented when the patient allow themselves to be engaged fully to the feared situation. Therefore, CBT can also be combined with other methods in combating social phobia for instance medication as a future directions.
References
Butler AC, Chapman JE, Forman EM, Beck AT. (2006). The empirical status of cognitive-behavioural therapy: a review of meta-analyses. Clin Psychol Rev. 26(1):17-31.
David Veale (2003), Treatment of social phobia. Advances in Psychiatric Treatment, 9, 258–264.
Davidson, J. R. T., Potts, N. L. S., & Richichi, E. A., et al (1991), The Brief Social Phobia Scale. Journal of Clinical Psychiatry, 52, 48–51.
Heimberg, R.G. (2002). Cognitive-behavioral therapy for social anxiety disorder: Current status and future directions. Biological Psychiatry, 51, 101-108.
Wells A, Papageorgiou C (1998) Social phobia: Effects of external attention on anxiety,
negative beliefs, and perspective taking. Behav Ther 29:357–370.
Order an Essay Now & Get These Features For Free:
Turnitin Report
Formatting
Title Page
Citation
Outline
