Cognitive therapy versus exposure and applied relaxation in social phobia: A randomized controlled trial.

Abstract

A new cognitive therapy (CT) program was compared with an established behavioral treatment. Sixty-two patients meeting Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) criteria for social phobia were randomly assigned to CT, exposure plus applied relaxation (EXP = AR), or wait-list (WAIT). CT and EXP = AR were superior to WAIT on all measures. On measures of social phobia, CT led to greater improvement than did EXP = AR. Percentages of patients who no longer met diagnostic criteria for social phobia at posttreatment-wait were as follows: 84% in CT, 42% in EXP = AR, and 0% in WAIT. At the 1-year follow-up, differences in outcome persisted. In addition, patients in EXP = AR were more likely to have sought additional treatment. Therapist effects were small and nonsignificant. CT appears to be superior to EXP = AR in the treatment of social phobia.

Pathways to change in one-session exposure with and without cognitive intervention: An exploratory study in spider phobia

“…This explanation is in line with Clark et al (2006), who suggested that treatment effects will be stronger if the crucial mechanisms which maintain anxiety (i.e., maladaptive cognitions) are targeted directly.…”

“…Furthermore, some authors argue that if the mechanism of change (i.e., change in cognitions) is directly targeted (i.e., through cognitive interventions), treatment effects will be larger (Clark, 1999;Rachman, 1997). Several empirical studies confirm that the use of cognitive interventions (slightly) enhances treatment outcome (Bryant et al, 2008;Clark et al, 2006;Mattick, Peters, & Clarke, 1989;McMillan & Lee, 2010;Salkovskis, Hackman, Wells, Gelder, & Clark, 2007). Other studies, by contrast, have not found enhanced treatment effects when cognitive interventions were added to a behavioral treatment (Feske & Chambless, 1995;Koch, Spates, & Himble, 2004;Whittal, Thordarson, & McLean, 2005).…”

Affect labeling enhances exposure effectiveness for public speaking anxiety

“…Although behavioral treatments for anxiety disorders are highly effective in reducing symptoms of anxiety (Butler, Chapman, Forman, & Beck, 2006;Hofmann & Smits, 2008;Tolin, 2010), many patients do not improve, drop out of treatment, or relapse (Arch & Craske, 2009;Clark et al, 2006;Davidson et al, 2004). Given the need to improve treatments, the goal of the current project is to translate neuroscience research to enhancing the effectiveness of exposure therapy for public speaking anxiety.…”

Cognitive versus exposure therapy for problem gambling: Randomised controlled trial

“…Comparable patterns of improvement in short to mid-term follow-up have also been shown in the treatment of anxiety disorders using CBT (Clark et al, 2006;Marks, Lovell, Noshirvani, Livanou, & Thrasher, 1998) where mechanisms of psychological and physiological (arousal) components in response to environmental triggers or cues are analogous to those in problem gambling .…”