Advances and Controversies in the Application of a Modified Version of Cognitive Behavior Therapy for Social Anxiety Disorder

Abstract

In their comprehensive case study, Jensen, Hougaard, and Fishman (2013) examined the microlevel mechanisms of change for a socially anxious client who underwent one-week of intensive group-based cognitive behavioral therapy (CBT) and experienced rapid symptom improvement. Our commentary focuses on two key components in the cognitive model of social anxiety, which this study highlights -the role of safety behaviors and interrogating the social environment, as well two topics that are applicable to anxiety treatments in general -integrating acceptance-based strategies into CBT and novel approaches in treatment delivery. We highlight what can be learned from Jensen and colleagues' case study by incorporating both empirical research and our own clinical anecdotes.Key words: cognitive behavior therapy; social anxiety disorder; mechanisms of change; exposure therapy; anxiety; case studies; clinical case studies; case series ______________________________________________________________________________We thoroughly enjoyed reading Jensen, Hougaard, and Fishman's (2013) case study of the mechanisms of change in a social phobia client following intensive group-based cognitive behavioral therapy (CBT). This article described Sara, a woman diagnosed with Social Anxiety Disorder who suffered from a primary fear of blushing, and explored mechanisms of change related to her rapid recovery following a brief, intensive treatment. This treatment was based primarily on the work of David Clark and colleagues and comprised of three individual weekly treatment sessions, followed by one week of 5-hour intensive daily group treatment, and five weekly individual follow-up sessions largely for consolidation of treatment gains. Although we're quite familiar with this treatment model and have utilized it with numerous clients individually in our own clinical practices, the authors of this article provide a novel approach for delivering this treatment -in terms of both format and frequency. Being zealous cognitive behavior therapists, we were intrigued by this approach and will focus this commentary on

Improvement in therapist skills over sessions in brief motivational interventions predicts client language and alcohol use outcomes.

“…Therefore, to control for possible distribution of practice/training effects, which have been shown to impact retention of new skills and information learned (e.g., Miller & Binder, 2002), we also controlled for within-therapist session density (i.e., mean number of sessions per month). That is, past work has indicated that either more concentrated learning (Tsao & Craske, 2000) or distributed learning (i.e., the same content, but presented and practiced over a longer, more spaced out period of time; Rogojanski & Rego, 2013; Storch et al, 2008) can improve memory consolidation and skills retention. To account for potential variability among therapists in the effect of time, we also included the random slopes for time (i.e., within-therapist session number) in all analyses.…”