REBT Applied to Patients With Social Anxiety Disorder

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    Dr.PamGarcy

    REBTAppliedtoPatientswithSocial

    AnxietyDisorder(SocialPhobia)

    Introduction

    Psychologist&lifecoachinpractice17years

    Majorityofmypracticeishelpingadultswith

    depression,socialanxietyandmaritalproblems.

    Irun4groups(SMART,Fearless,REBT/CBT,and

    SocialMastery)&conduct3workshopsayear

    Irunamixedgendersocialmasterygroupfor

    adultswith

    social

    anxietylast

    members

    just

    graduated&anothergroupisforming

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    MarriedtoRoger23years

    Ourkids

    (2

    years

    ago)

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    Overview

    Symptomsofsocialanxiety,howitisa

    problem,comorbidity

    Usingresearchtoinformtreatment

    REBTconceptsandtechniquestouse

    Demonstrationiftherestime

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    SymptomsofSocialAnxiety

    Persistentfearofoneormoresocialsituations

    Fearofhumiliation/embarrassment/negativeevaluationinthese

    Anxietyorpanicinresponsetothesocialsituation

    Avoidanceorendurancew/distress

    Significantinterferencew/normalroutine,

    occupation,academics,

    relationships

    OR

    markeddistressabouthavingtheanxiety

    ProblematicPerformance

    Situationgs

    Publicspeaking

    Writinginfrontofothers

    Eatinginfrontofothers

    Playinganinstrument/sport

    Enteringaroomofpeople

    Usingapublic

    restroom

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    ProblematicSocialSituations

    Socializing,smalltalk,eatingw/others

    Initiatingormaintaing aconversation

    Askingfordirections,help,instructions,

    clarification(atschool,work,instores,etc.)

    ComorbidDisorders

    Mostcommonlyrunswith

    Depression

    SubstanceAbuseorDependence

    EatingDisorders

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    CognitiveModelforSocialAnxiety

    Thecognitivemodelappliedtosocialanxietyandsocialphobiaproposesthatpatientsfocustheirattentionontheimagetheybelievethatothershaveofthemandtheirperformanceandontheirsubjectivesensationsinsociallyevaluativesituations.Asaresult,theybecomeoblivioustoobjectivesocialcues.

    Researchhasconfirmedthatthesepatientsnegativelydistorttheiractualevaluationbyothersandthattheirrecollectionofsocialexperiencesisalsonegativelybiased.Furthermore,thepatients anxietyincreasesandtheirobjectiveperformancedecreaseswhentheyperceive

    negative,

    as

    opposed

    to

    neutral,

    images

    during

    exposure

    to

    sociallythreateningsituations.Beck,ArchGenPsychiatry.2005;62:9539

    IndividualizedTreatmentPlanningin

    theContextofEmpiricalSupport

    focustheirattentionontheimagetheybelievethatothershaveofthem: Challengetheirideaoftheimageothershaveofthem

    andontheirsubjectivesensationsinsocialsituations: Helpthemtoreevaluateandcopewiththesesensations

    oblivious

    to

    objective

    social

    cues:

    Work

    on

    thempayingattentiontosocialcuesthatare(1)positive(2)comfortenhancing

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    (applicationexamples,continued)

    negativelydistorttheiractualevaluationbyothers: getthemtorecordtheirevaluationsandlookforcontraryevidence

    recollectionofsocialexperiencesisalso

    negativelybiased:getthemtorecordandrereadpositivesocialexperience;increaseawarenessoftheirbias

    patients anxietyincreasesandtheirobjective

    performancedecreases:

    help

    them

    search

    for

    examplesofthistoenhancemotivation

    CBT+Transdiagnostic modelfor

    anxiety Patientssufferingfromanxietydisordersshowedthemost

    improvementwhentreatedwithcognitivebehavioraltherapy(CBT)inconjunctionwitha"transdiagnostic"approachamodelthatallowstherapiststoapplyonesetofprinciplesacrossanxietydisorders.

    Thefindingsaretheresultofadecadeofresearch,fourseparateclinicaltrialsandthecompletionofafiveyeargrantfundedbytheNationalInstituteofMentalHealth.

    UniversityofHouston(NortoninterviewScienceDaily,

    2012,June

    28).

    Cognitive

    behavioral

    therapy

    effective

    in

    combatinganxietydisorders,studysuggests.

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    CompensatingforaMisregulating

    BrainThroughExposure Functionalmagneticresonancetomographywasusedtomeasurethe

    changesinthebrainactivityofsociallyphobicpatientsandhealthytestsubjectswhiletheywerelookingatfaces(confrontationsimulation).

    Permanentconfrontationhasadiminishingeffectonanxiety

    "Thestudydemonstratedthatpeoplewithsocialphobiainitiallyexhibitgreateractivityintheamygdala andinthemedial,prefrontalcortexofthebrain,howeverafterafewfacesthisactivityrecedes.

    Ledtoasolutiontothe"problem"beingfoundmorequicklyinthebrain&brainbypassedthenormalanxietycircuit,includingpartsthatareusuallyoverstimulated,acharacteristic typicalofanxiety.

    Sladky (researcher):"Wethereforeconcludedthattherearefunctionalcontrolstrategiesevenintheemotionalcircuitsofpeoplewithsocialphobia,althoughthemechanismstakelongertotakeeffectintheseindividuals.

    MedicalUniversityofVienna(2013,January30).Eventhebrainsofpeoplewithanxietystatescangetusedtofear.ScienceDaily.

    RationalEmotive

    Behavior

    Therapy

    FoundedbyDr.AlbertEllisin1955

    PrecededCognitiveTherapy,whichfollowedin

    1960s,foundingbyAaronBeck

    Ellistaughtthatitiswhatweallowourselves

    tobelievewithoutquestionthatleadsusto

    unhealthy

    negative

    emotions

    and

    maladaptive

    behaviors

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    ABCTheoryofEmotion

    A=ActivatingEventorAdversity

    B=BeliefsaboutA

    C=Consequences(emotionalandbehavioral)

    FollowingtheidentificationoftheABCs,wecan

    usecognitiverestructuringtohelpthepatient

    tothinkscientificallyabouttheirthinking.

    This

    is

    called

    D

    or

    disputation.

    CoreBeliefs

    of

    Social

    Anxiety

    EllisandBeckbothtalkaboutCoreBeliefs.

    Ellissaysthattherearethreebasicmuststhat

    leadtoallpsychopathologyandthisincludes

    socialanxiety.

    Mustsontheself,others,lifeconditions

    Imust

    perform

    perfectly

    Youmustloveme

    Lifemustbehasslefree

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    DisputationQuestions

    Wecanhelpourpatientstoquestionanybeliefsthataregettingintheway,oneatatime: surfaceorcorebeliefs

    Askquestionstochallenge(1)thevalidityofthebelief(2)theutilityofthebelief(3)thelogicofthebelief

    Whatistheevidencefor/against?

    Howsthis

    idea

    working

    for

    you/against

    you?

    Whatisanalternativeview?

    EffectiveNew

    Ways

    of

    Thinking

    Iftheclientisabletoanswerthese

    disputationquestions,theymaybereadyto

    developaneffectivenewwayofthinking

    abouttheirsituation

    Example: Itisuncomfortabletoeatinfrontof

    others,butIcanstandit,itisnttheworst

    thingin

    the

    world,

    and

    others

    are

    probably

    focusedmoreontheirfoodthanonme.

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    ShameAttacking

    ThisisaninvivoexposureexercisedevelopedbyEllis. Thepersonattackstheirshamethroughcognitivebehavioralflooding.

    Hugebenefitifthepatientiswilling

    Askthepatienttodosomethingthatisnotillegalorimmoral,butthatwillbeshamefultohim/her

    Askthe

    patient

    to

    talk

    him/herself

    out

    of

    the

    shameuntilthepatientfeelsunashamed

    StrengthBombardment

    Havepatientswritealistoftheirsocial

    strengths

    Youcanalsodothis

    Gooveritwiththem

    Evenmorepowerfulingroups

    Haveeach

    person

    talk

    about

    successes

    while

    otherswritedownpositives&laterreadback.

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    Mirrorwork: Buildingselfacceptance

    SocialSkills

    Training

    +Feedback

    Askthepatientwhatareastheyhavea

    difficulttimewithsocially

    Teachtheskillsthatarelacking

    Examples: eyecontact,smiling,introductions,

    usingpeoplesnames,smalltalk,personal

    space,

    handshakes,

    asking

    questions,

    inviting,

    acceptingno,sayingno,etc.

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    RelaxationTraining

    Teachpatientstousediaphragmaticbreathing

    toreducesympatheticactivationand

    encourageparasympatheticresponse

    Helpfultodothispriortoimaginal exposure&

    duringthisexposuretohelpthepatient

    desensitizeimaginally

    GroupTherapy

    Offersmultipleadvantagesincluding

    Exposure

    Practice

    Feedback

    Skilltraining&learningthroughmodeling

    Affirmation&

    connection

    Ideasfromotherswhoareintheirshoes

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    Challengeofsocialanxietygroups

    Thebiggestchallengeisavoidanceofexposureto

    fearedsituationsindividualtherapyisoften

    requiredtoprepareforandsupportgroupwork

    Thisisahugechallenge&soitisoftendifficultto

    getagrouptogether

    Havememberssignacommitmenttoparticipate

    foratleast8sessionsandhavethemprepayhalf

    atthe

    beginning

    of

    each

    4session

    cluster

    to

    diminishavoidance

    WhentoRefertoaPsychologistwho

    specializesinREBT&SocialAnxiety

    Whenyouhavesomeonewhohasimpairmentthatiscausingdistress who

    1. Wantstolearnandpracticeskills

    2. Patientswithpoorresponsetoantidepressantswhoalsowanttoavoidorlimituseofanxiolyticsthroughskillacquisition

    3. Patientswithpersistentbeliefswhoneed

    additionalsupport

    in

    challenging

    these

    4. Patientswithcomorbid diagnoseswhowouldbenefitfromREBTorCTapproachestotherapy

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    Questions/contactinfo

    Dr.PamGarcy

    ClinicalPsychologist+LifeCoach

    [email protected]

    (972)2483861


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