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.