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Social Mishap Exposures for Social Anxiety Disorder: An Important Treatment Ingredient.

ABSTRACT: Conventional cognitive-behavioral therapy for social anxiety disorder, which is closely based on the treatment for depression, has been shown to be effective in numerous randomized placebo-controlled trials. Although this intervention is more effective than waitlist control group and placebo conditions, a considerable number of clients do not respond to this approach. Newer approaches include techniques specifically tailored to this particular population. One of these techniques, social mishap exposure practice, is associated with significant improvement in treatment gains. We will describe here the theoretical framework for social mishap exposures that addresses the client's exaggerated estimation of social cost. We will then present clinical observations and outcome data of a client who underwent treatment that included such social mishap exposures. Findings are discussed in the context of treatment implications and directions for future research.

SUBMITTER: Fang A

PROVIDER: S-EPMC4238930 | biostudies-literature | 2013 May

REPOSITORIES: biostudies-literature

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Social Mishap Exposures for Social Anxiety Disorder: An Important Treatment Ingredient.

Fang Angela A Sawyer Alice T AT Asnaani Anu A Hofmann Stefan S

Cognitive and behavioral practice 20130501 2

Conventional cognitive-behavioral therapy for social anxiety disorder, which is closely based on the treatment for depression, has been shown to be effective in numerous randomized placebo-controlled trials. Although this intervention is more effective than waitlist control group and placebo conditions, a considerable number of clients do not respond to this approach. Newer approaches include techniques specifically tailored to this particular population. One of these techniques, social mishap e ...[more]

PMID: 25419100

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Project description:ContextCurrent behavioral measures poorly predict treatment outcome in social anxiety disorder (SAD). To our knowledge, this is the first study to examine neuroimaging-based treatment prediction in SAD.ObjectiveTo measure brain activation in patients with SAD as a biomarker to predict subsequent response to cognitive behavioral therapy (CBT).DesignFunctional magnetic resonance imaging (fMRI) data were collected prior to CBT intervention. Changes in clinical status were regressed on brain responses and tested for selectivity for social stimuli.SettingPatients were treated with protocol-based CBT at anxiety disorder programs at Boston University or Massachusetts General Hospital and underwent neuroimaging data collection at Massachusetts Institute of Technology.PatientsThirty-nine medication-free patients meeting DSM-IV criteria for the generalized subtype of SAD.InterventionsBrain responses to angry vs neutral faces or emotional vs neutral scenes were examined with fMRI prior to initiation of CBT.Main outcome measuresWhole-brain regression analyses with differential fMRI responses for angry vs neutral faces and changes in Liebowitz Social Anxiety Scale score as the treatment outcome measure.ResultsPretreatment responses significantly predicted subsequent treatment outcome of patients selectively for social stimuli and particularly in regions of higher-order visual cortex. Combining the brain measures with information on clinical severity accounted for more than 40% of the variance in treatment response and substantially exceeded predictions based on clinical measures at baseline. Prediction success was unaffected by testing for potential confounding factors such as depression severity at baseline.ConclusionsThe results suggest that brain imaging can provide biomarkers that substantially improve predictions for the success of cognitive behavioral interventions and more generally suggest that such biomarkers may offer evidence-based, personalized medicine approaches for optimally selecting among treatment options for a patient.

Dataset Information

Social Mishap Exposures for Social Anxiety Disorder: An Important Treatment Ingredient.

Publications

Social Mishap Exposures for Social Anxiety Disorder: An Important Treatment Ingredient.

Similar Datasets

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