Cognitive-Behavioral Treatment of Social Anxiety Disorder and Comorbid Paranoid Schizophrenia

Abstract

We report on the cognitive-behavioral treatment (CBT) of a patient with comorbid social anxiety disorder (SAD), schizophrenia, and major depressive disorder, complicated by alcohol abuse. Symptoms included auditory hallucinations that commented on the patient's behavior and paranoid thoughts. The paranoid symptoms affected his social interactions as this included the fear that his thoughts may be heard and judged by others. Therapeutic activities raised awareness as to how avoidance interferes with and perpetuates the cycle of depression and psychosis while maintaining symptoms of SAD. Psychoeducation was provided about factors that maintain social anxiety and increase social isolation. New skills were obtained by helping the patient discover alternative ways to view social situations, experimentation, and real-world application to disprove notions about others' predicted behavior. Treatment led to a great reduction in social anxiety, depression, and suspicious thinking. This case study demonstrates that SAD symptoms in a patient experiencing psychosis can be effectively treated using CBT.

Cognitive Restructuring and Graded Behavioral Exposure for Persecutory Paranoia and Agoraphobic Anxiety in Complex Psychosis

“…For instance, cognitive restructuring was shown to produce a desirable reduction in clinical symptomatology among individuals with psychosis and comorbid PTSD (post-traumatic stress disorder; Marcello, Hilton-Lerro, & Mueser, 2009). Likewise, the utilization of psychoeducation, cognitive restructuring, and behavioral experimentation was demonstrated to increase cognitive flexibility, reduce suspiciousness, and decrease associated emotional distress in a comorbid presentation of psychosis, social anxiety, and depression, complicated by excessive alcohol use (Williams, Capozzoli, Buckner, & Yusko, 2014). Furthermore, while the applicability of CBTp in chronic and comorbid presentation of psychosis involving distressing persecutory auditory hallucinations, paranoid delusions, and associated symptoms of anxiety and depression was illustrated by Hatzipetrou and Oei (2010), the importance of addressing the underlying dysfunctional core beliefs in achieving a sustained reduction in the levels of emotional distress associated with mood disorders comorbid to psychosis was emphasized by Prisciandaro and Roberts (2009).…”

Dealing with Rejection: Post-Event Processing in Social Anxiety and Paranoia

“…Additionally, CBT for paranoia may benefit from inclusion of cognitive strategies specific to CBT treatments for social anxiety. As evidenced in the case study(Williams et al, 2014), CBT treatment for SAD was successful in lowering paranoia symptoms for a client with comorbid SAD and paranoia. Thus, CBT treatments for paranoia might benefit from inclusion of social anxiety-specific CBT strategies, especially for clients with co-occurring SAD and paranoia.…”

“…These noted similarities have led some researchers to hypothesize that paranoia may represent a subtype of anxious fear (Freeman, Gittins, Pugh, Antley, & Dunn, 2008). A case study reported by M. Williams, Capozzoli, Buckner, and Yusko (2014) provides further insight into the co-occurrence of SAD and persecutory delusions. In this case study, the client believed that others could hear his thoughts and would negatively evaluate him based on the content of these thoughts.…”

“…Furthermore, he experienced information processing biases also noted in SAD, as he would interpret social situations as dangerous, which triggered his persecutory delusions. His fear of negative evaluation led to increased self-focused attention, which further exacerbated his persecutory delusions (M. Williams et al, 2014). The client made significant progress over the course of cognitive-behavioral treatment, utilizing strategies for managing his social anxiety.…”

Social anxiety disorder co-morbid with schizophrenia: a cross-sectional study from India

“…Original Research Article International Journal of Medical Research and Review Available online at: www.ijmrr.in 1956 | P a g e as specific serotonin-reuptake inhibitors [17], oxytocin [18] and psychosocial therapies such as cognitive behavioural therapy [19,20] have been used with success.…”