CBT Reduces Shame in Individuals with Social Anxiety Disorder

According to a recent study published in Plos One, cognitive behavior therapy (CBT) may help reduce experiences of shame (specifically associated with how individuals judge themselves) among patients diagnosed with social anxiety disorder (SAD.) Participants (n= 161) in the current study were initially evaluated for experiences of shame, guilt, depression, and social anxiety. Participants diagnosed with SAD (n=67) were assigned to a CBT treatment condition; the remaining participants (n=94) were assigned to two samples of healthy controls. According to results, shame, social anxiety, and depressive symptoms were each associated in participants with SAD. Further, shame was shown to be elevated among SAD patients compared to the main healthy control. Following treatment, shame significantly reduced among participants with SAD. These findings suggest that shame and social anxiety are associated, that socially anxious patients may be more likely to experience shame than patients without social anxiety, and that CBT treatment can help reduce shame among individuals with SAD.

Hedman, E., Strom, P., Stunkel, A., & Mortberg, E. (April 19, 2013). Shame and Guilt in Social Anxiety Disorder: Effects of Cognitive Behavior Therapy and Association with Social Anxiety and Depressive Symptoms. Plos One, 8, 4.

The Shift of EEG Activity in SAD Patients Treated with CBT

Researchers are investigating the neurological effects of therapeutic interventions on patients with a variety of disorders, including PTSD, but few studies have focused on the neurological effects of CBT on patients with Social Anxiety Disorder (SAD).  Emotional processing occurs in both sides of the frontal brain.  The right area of the frontal brain is associated with negative emotions and the left area with positive emotions.  The present study uses this frontal brain asymmetry in hopes of observing the effects of cognitive behavior therapy on the neural mechanisms of patients with SAD.   Researchers believe that patients with SAD should have more EEG activity in the right frontal pretreatment, which would shift to the left frontal brain post treatment.

23 outpatients with SAD were recruited to participate in this study.  All participants underwent 12, two-hour long group CBT sessions.  Each group had 7 to 9 patients and 2 to 3 qualified therapists following a protocol manual.  About two weeks before the first session and again after the last session, participants underwent a 6 minute EEG assessment.  At each assessment, participants were also asked to complete the Social Phobia Inventory (SPIN) and the Beck Depression Inventory (BDI-II).

The results indicated a significant decrease in SAD severity, as well as decreased self-reported measures of the SPIN and BDI-II post treatment.  The study also yielded a shift in the EEG activity from the right side of the frontal brain to the left, demonstrating a shift of emotional processing from the negative to the positive.  Moscovitch et al noted that higher activity in the left frontal brain pretreatment correlated with lower social anxiety and depression scores post treatment.  These findings suggest that the effects of CBT can be measure biologically.  Future studies may also find EEG assessments useful in predicting a patient’s response to CBT.

Moscovitch, D. A., Santesso, D. L., Miskovic, V., McCabe, R.E., Antony, M.M., & Schmidt, L. A.  (2011). Frontal EEG asymmetry and symptom response to cognitive behavioral therapy in patients with social anxiety disorder.  Biological Psychology.  (in press)

From Kafka to Cognitive Behavioral Therapy: Using Trial-Based Thought Records on Patients with Social Anxiety Disorder

A recent study investigated the efficacy of Trial-Based Thought Records (TBTR) as an alternative to conventional Cognitive Therapy in the treatment of patients with generalized Social Anxiety Disorder (SAD).  SAD is the most common form of anxiety disorder and an important target of therapy is the modification of patients’ negative core beliefs.  Based on the idea of “self-accusation” suggested in Kafka’s The Trial, Dr. Irismar Reis de Oliveira devised the TBTR intervention in which patients become their own prosecutor and defender in a trial against their negative core beliefs.  TBTR mimics a trial and one technique involves asking patients to report evidence supporting their negative core beliefs, then form an argument against them, and then repeat the process with new evidence. 

The present pilot study looks at the efficacy of TBTR in a randomized population of people with generalized Social Anxiety Disorder.  36 patients with SAD were randomly assigned to either the conventional CT treatment (control group) or the TBTR treatment (experimental group).  Five trained CT-therapists conducted 12, one hour long sessions in a period of 14 weeks following either CT or TBTR manuals.  Patients were asked to fill out a series of self-report measures throughout the treatment and during a 12 month follow-up.  The study showed that TBTR is at least as efficacious as traditional CT; however, patients that underwent TBTR scored lower on the Fear of Negative Evaluation scale than patients with regular CT. 

Alternative and supplementary treatment models are needed to increase the effectiveness of CT for SAD.  This study suggests the advisability of further investigation of Trial-Based Cognitive Therapy and the Trial-Based Thought Record.

De Oliveira, I.  (2011). Kafka’s trial dilemma: Proposal of a practical solution to Joseph K.’s unknown accusation.  Medical Hypotheses. (in press).

De Oliveira, I. R., Powell, V. B., Wenzel, A., Caldas, M., Seixas, C., Almeida, C., Bonfim, T., Grangeon, M. C., Castro, M., Galvao, A., Moraes, R., & Sudak, D.  (2011).  Efficacy of the trial-based thought record, a new cognitive therapy strategy designed to change core beliefs, in social phobia: A randomized controlled study.  Journal of Clinical Pharmacy and Therapeutics.