The Case Of Vumile: Breathing Life Into a Manual and Model

Abstract

Vumile represents an individual with social phobia who experienced a successful outcome after being treated with a manualized treatment based on Clark and Wells' (1995) theoretical model (Edwards & Kannan, 2006). This commentary reviews issues in the debate regarding manualized treatments, with an emphasis on how the case of Vumile represents the best of what manualized treatments and empirically based approaches to clinical practice have to offer. Additionally, the fit of the case of Vumile with Clark and Wells' (1995) theoretical model is considered.Key words: social phobia; manualized treatment; evidence based practice; randomized control trials (RCTs) ______________________________________________________________________ A large body of research supports the efficacy of cognitive behavioral treatments for social phobia (see Rowa & Antony, 2005 for a recent review). Clark's (1997) version of cognitive behavioral treatment for social phobia has yielded large effect sizes and appears promising Stangier, Heidenreich, Peitz, Lauterbach, & Clark, 2003). Clark's (1997) protocol includes cognitive restructuring and exposure elements like most efficacious treatments for social phobia. However, his treatment also emphasizes procedures derived from his theoretical work and basic research such as identification of safety behaviors, shifting focus of attention away from the self (to the social situation), behavioral experiments in which safety behaviors are dropped, and video feedback on social performance. Edwards and Kannan (2006) present an application of Clark's (1997) manualized treatment for social phobia to the case of Vumile. This commentary will tie elements of Vumile's case into issues involving manualized treatments and theoretical models of social phobia.

How the Case of Vumile Contributes to the Evidence Base for Cognitive Therapy with Social Phobia as an Empirically Grounded Clinical Intervention

“…The role of group cohesion relates to another point raised by Turk (2006). Our approach is entirely in line with her observation that "even when a treatment manual is used, successful treatment is characterized by an integration of the case conceptualization, the treatment techniques, the unique characteristics of the patient, and the therapeutic relationship."…”

“…S. Fishman (2006) and Turk (2006) both raise the concern that we did not use some of the widely used standardized quantitative measures of social phobic thinking and behavior in our work with Vumile and his group. As S. Fishman and Turk point out, the use of such measures would have facilitated comparison with data from other studies.…”

“…Finally Turk (2006) asks whether we would propose any modifications to the treatment as a result of our program evaluation. Our project was a formative one.…”

“…Fishman (2006) and Turk (2006) both observe that clinicians do not necessarily adopt treatments shown to be effective in randomized controlled trials because of concerns about their generalization to a more complex patient population where co-morbidity is common. This problem could be addressed by giving greater emphasis to case formulation and the development of manuals that are flexible in this regard.…”

“…Similarly, as the program continued, if Vumile had had significant concerns about being physically or emotionally abused, these would surely have come to light. Nevertheless, as Turk (2006) points out, even without a diagnosis of PTSD, traumatic events such as being bullied can play a role in predisposing individuals to social phobia, and the kind of processes that maintain PTSD can play a role in social phobia too. Clark and Wells' cognitive therapy for social phobia (CTSP) can easily be extended to incorporate this kind of new information.…”