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Cognitive Therapy and Research

, Volume 14, Issue 1, pp 1–23 | Cite as

Cognitive behavioral group treatment for social phobia: Comparison with a credible placebo control

  • Richard G. Heimberg
  • Cynthia S. Dodge
  • Debra A. Hope
  • Charles R. Kennedy
  • Linda J. Zollo
  • Robert E. Becker
Article

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.

Key words

social phobia cognitive-behavioral group treatment social anxiety group treatment anxiety disorders 

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References

  1. American Psychiatric Association. (1980).Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: Author.Google Scholar
  2. American Psychiatric Association. (1987).Diagnostic and statistical manual of mental disorders (3rd ed., rev.). Washington, DC: Author.Google Scholar
  3. Amies, P. L., Gelder, M. G., & Shaw, P. M. (1983). Social phobia: A comparative clinical study.British Journal of Psychiatry, 142 174–179.PubMedGoogle Scholar
  4. Arnkoff, D. B., & Glass, C. R. (1989). Cognitive assessment in social anxiety and social phobia.Clinical Psychology Review, 9 61–74.Google Scholar
  5. 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: ErlbaumGoogle Scholar
  6. 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.Google Scholar
  7. Barlow, D. H., O'Brien, G. T., & Last, C. G. (1984). Couples treatment of agoraphobia.Behavior Therapy, 15 41–58.Google Scholar
  8. 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.PubMedGoogle Scholar
  9. 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.PubMedGoogle Scholar
  10. Borkovec, T. D., & Nau, S. D. (1972). Credibility of analogue therapy rationales.Journal of Behavior Therapy and Experimental Psychiatry, 3 257–260.Google Scholar
  11. Burns, D. D. (1980)Feeling good: The new mood therapy. New York: William Morrow.Google Scholar
  12. Butler, G. (1985). Exposure as a treatment for social phobia: Some instructive difficulties.Behaviour Research and Therapy, 23 651–657.PubMedGoogle Scholar
  13. 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.PubMedGoogle Scholar
  14. 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.Google Scholar
  15. 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.Google Scholar
  16. 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.Google Scholar
  17. 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.PubMedGoogle Scholar
  18. 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.Google Scholar
  19. Emmelkamp, P. M. G. (1982).Phobic and obsessive-compulsive disorders: Theory, research and practice. New York: Plenum Press.Google Scholar
  20. 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.PubMedGoogle Scholar
  21. Glass, C. R., & Furlong, M. (in press). Cognitive assessment of social anxiety: Affective and behavioral correlates.Cognitive Therapy and Research. Google Scholar
  22. 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.Google Scholar
  23. Hamilton, M. (1960). A rating scale for depression.Journal of Neurology, Neurosurgery, and Psychiatry, 23 56–62.Google Scholar
  24. Heimberg, R. G. (1989). Cognitive and behavioral treatments for social phobia: A critical analysis.Clinical Psychology Review, 9 107–128.Google Scholar
  25. Heimberg, R. G., Acerra, M., & Holstein, A. (1985). Partner similarity mediates interpersonal anxiety.Cognitive Therapy and Research, 9 436–445.Google Scholar
  26. Heimberg, R. G., & Barlow, D. H. (1988). Psychosocial treatments for social phobia.Psychosomatics, 29 27–37.PubMedGoogle Scholar
  27. 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.PubMedGoogle Scholar
  28. 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.Google Scholar
  29. 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.Google Scholar
  30. 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.Google Scholar
  31. Jacobson, N. S., & Revenstorf, D. (1988). Statistics for assessing clinical significance of psychotherapy techniques: Issues, problems, and new developments.Behavioral Assessment, 10 133–145.Google Scholar
  32. 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.PubMedGoogle Scholar
  33. 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.Google Scholar
  34. 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.Google Scholar
  35. Kendall, P. C., & Korgeski, G. P. (1979). Assessment and cognitive-behavioral interventions.Cognitive Therapy and Research, 3 1–21.Google Scholar
  36. 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.Google Scholar
  37. 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.Google Scholar
  38. 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.PubMedGoogle Scholar
  39. Marks, I. M., & Mathews, A. M. (1979). Brief standard self-rating for phobic patients.Behaviour Research and Therapy, 17 263–267.PubMedGoogle Scholar
  40. 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.PubMedGoogle Scholar
  41. 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.Google Scholar
  42. 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.PubMedGoogle Scholar
  43. 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.Google Scholar
  44. Paul G. L. (1966).Insight vs. desensitization in psychotherapy. Stanford, CA: Stanford University Press.Google Scholar
  45. Sank, L. I., & Shaffer, C. S. (1984).A therapist's manual for cognitive behavior therapy in groups. New York: Plenum.Google Scholar
  46. 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.Google Scholar
  47. 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.PubMedGoogle Scholar
  48. Watson, D., & Friend, R. (1969). Measurement of social-evaluative anxiety.Journal of Consulting and Clinical Psychology, 33 448–457.PubMedGoogle Scholar
  49. Watson, J. P., & Marks, I. M. (1971). Relevant and irrelevant fear in flooding—A crossover study of phobic patients.Behavior Therapy, 2 275–293.Google Scholar
  50. Wolpe, J., & Lazarus, A. A. (1966).Behavior therapy techniques: A guide to the treatment of neuroses. Oxford: Pergamon.Google Scholar

Copyright information

© Plenum Publishing Corporation 1990

Authors and Affiliations

  • Richard G. Heimberg
    • 1
  • Cynthia S. Dodge
    • 1
  • Debra A. Hope
    • 1
  • Charles R. Kennedy
    • 1
  • Linda J. Zollo
    • 1
  • Robert E. Becker
    • 2
  1. 1.Center for Stress and Anxiety Disorders, Department of PsychologyUniversity at Albany, State University of New YorkAlbanyUSA
  2. 2.Medical College of Pennsylvania at EPPIUSA

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