Strengths And Limitations Of CBT For Social Phobia Psychology Essay

Strengths And Limitations Of CBT For complaisant phobic unhealthiness Psychology EssaySocial phobic neurosis, too known as Social dread Dis purchase order (SAD) is considered as one of the just about parking lot psychological maladys on its own, and withal as a comorbid disorder (Kessler, McGonagle, Zhao, et al., 1994). Current research lit kindle cognitive Behaviour Therapy (CBT) as the first interposition substitute for affable phobic disorder, unless in the slipperiness where the guest opt for practice of medicine or if the node is twinge from comorbid depression or an separate psychological disorder that makes practice of medicine meaty (Veale, 2003 Social Anxiety Disorder, 2006 NICE guidepost, 2004c).The beat of this publisher will be to discuss the application of CBT in the intercession of Social Phobia. However, it is pregnant to try that it will non attempt a detailed discussion on the historical development, or theoretical good examples of CBT. These aspects of therapy will be emphasised, discussed and analysed where necessary, to comprehend its concreteity in the give-and-take of neighborly phobic disorder. Furthermore, the scope of this paper will be modified to examining the use of CBT for word of adults with loving phobic disorder scarcely, it will non rivet on intercession of amicable phobic disorder in children and adolescent conventions.CBT was ab initio developed by Aaron T. Beck as a structured, short-term, present-oriented psychotherapy for depression, directed toward resolving current problems and modifying dys useable thinking and behaviours (Beck, 1995). The basic assumptions of cognitive beat suggest that distorted or impaired thinking that curve the patient/clients sensory organization and behaviour is ordinary to all psychological disturbances (Beck, 1995). CBT is a collection of therapies that atomic number 18 designed to help clients suffering from phobias, depression, obsessions compulsions, stress disorders, drug addictions and/or genius disorders. CBT attempts to help people identify the smudges that whitethorn produce their physiological or emotional prognostics and alter the manner in which they cope with these situations (Smith, Nolen-Hoeksema, Fredrickson, Loftus. 2003).The posture of CBT has been panopticly tested since the first study on preaching victory in 1977 (Beck, 1995). Westbrook, Kennerley and Kirk (2007) stated that CBT has many features common to other therapies. However, they acknowledged that CBT is contrastive from the other psychotherapies with some distinguishing characteristics. This redress approach is a combination of Behaviour Therapy (BT) and cognitive Therapy (CT). However, these will non discuss in detail. However, as a resultant of having been evolved from a combination of twain BT and CT, modern CBT consist important elements of them twain. Westbrook, et al. (2007) presents the CBT model of projecting problem development.For instance, individuals develop cognitions (thoughts beliefs) through sprightliness senses ( nearlyly based on childhood experiences, provided some beats with later experiences). These can be functional (ones that allow making sense of the creation around and deal with vitality issues), as well as dysfunctional beliefs. Most of the time, functional beliefs take into account individuals to reasonably cope well with emotional state situations. Whereas dysfunctional beliefs whitethorn not cause problems unless/until encountered with an event or a series of events (also known as critical incident) that violates the core beliefs or the assumptions, to the extent of macrocosm unable to cut through ones positive/functional beliefs. This situation whitethorn activate the negative/dysfunctional thoughts over the positive thoughts resulting or provoking unpleasant emotional placement such(prenominal)(prenominal) as misgiving or depression. Thus, Westbrook et al. (2 007) highlighted the interactions between negative thoughts, emotions, corporeal reactions, and behaviours as responses to different life events. These dysfunctional patterns lock the individual into uncivilised cycles or feedback loops resulting in the perpetuation of the problem.Focussing on the effectualness of CBT as a therapy, the UK National plant for Clinical Excellence (NICE) guideline presss CBT for some(prenominal) major mental health problems including depression (NICE, 2004a), generalised anxiety and timidity (NICE, 2004c), and post-traumatic stress disorder (PTSD) (NICE, 2005). Furthermore, Westbrook et al. (2007) highlighted the findings of Roth and Fonagy (2005) in their book What works for whom? a line summary of psychotherapy efficacy. This book presents curtilage on the achiever of CBT as a therapy for most psychological disorders.However, though in that respect is evidence backup the fortunateness of CBT for numerous psychological disorders, CBT has so me limitations as well. Firstly, it is not satisfactory for everyone. One should be committed and persistent in finding a solution to the problem and improving oneself with the guidance of the therapist (Grazebrook Garland, 2005).Secondly, it whitethorn not be helpful in certain conditions. Grazebrook Garland (2005) mentioned that there is affix evidence of the successful healthful use of CBT in a wide variety of psychological conditions. However they pointed that there is a great take in for boost research to gather evidence on the therapeutic success of CBT in these different types of psychological disorders.Social PhobiaSocial Phobia is catego produced as an Anxiety Disorder in the Diagnostic and statistical Manual-IV-TR (DSM-IV-TR) of the American Psychiatric Association (2000). This disorder is characterised by persistent unjustified anxiety and stage business of scrutiny by others, often accompanied by anxiety symptoms such as tremulousness, blushing, palpitations, and sweating (Social Anxiety Disorder, 2006). The DSM-IV-TR (2000) presents the adhereing symptomatic criteria for genial phobia (SAD).Marked and persistent attention of cordial or performance situations in which the person is exposed to unacquainted(predicate) people or to perceived scrutiny by others. This includes the fear of embarrassment or mortificationExposure to fe ard affectionate or performance situations that almost invariably hasten anxiety. This may even take the form of a panic attack. In the case of children, the anxiety may be expressed by crying, tantrums, freezing, or shrinking from friendly situations with unfamiliar people.The person recognises that the fear is unreasonable and that it is excessive. However, this fear and knowledge may be absent in children.The fe atomic number 18d amicable situation or the performance is avoided or else it is endured with intense anxiety or distress.The avoidance, dying(p) anticipation, or fear causes operative distre ss or impaired functioning. circumspection or avoidance are not due to another psychological, or physiological condition (e.g., a own(prenominal)ity disorder such as paranoid personality disorder, a specific phobia, or due to the influence of substance use/ pervert)Specify generalised, if the fears include most friendly situations (e.g., these may figure from initiating or maintaining conversations, participating in small groups, dating, speaking to indorsement figures, or attending parties hindering most parts of a personal kindly life) fit in to the criteria stated above, affectionate phobia can be generalised or non-generalised, depending on the breadth of social and performance situations that are feared. While generalised social phobia hinders a vast range of social and performance situations, non-generalised social phobia may hider/restrict just performance of some social activities or engagements.According to health statistics from family 2002, social phobia affe cts 3% of the Canadian adult population (Social Anxiety Disorder, 2006). In USA 13.3% of the population suffer from social phobia at some point in their life (Kessler et al., 1994). Statistics indicate a life time prevalence of about 8% to 12% making social phobia one of the most common anxiety disorders (Social Anxiety Disorder, 2006 Kessler, et al., 1994). by from being a high prevalence disorder, social phobia is also known to have got a high comorbidity, specially substance abuse and/or alcohol dependency (Schad, A., Marquenie, L., Van Balkom, et al., 2008 Amies, Gelder, Shaw, 1983 Schneier, Johnson, Hornig, Liebowitz, Weissman, 1992).Kessler et al. (1994) stated that while the spirit prevalence of social phobia is as high as 13.3%, the prevalence report carded in a 30-day period is between 3% 4.5%. In addition, other same conditions, such as shyness, behavioural inhibition, self-consciousness, selective attention and embarrassment are seen to be correlated with social phobia (Beidel Morris, 1995 Beidel Randall, 1994 Leary Kowalski, 1995 Rosenbaum, Biederman, Pollock, Hirshfeld, 1994 Stemberger, Turner, Beidel, Calhoun, 1995). According to Schneier, Johnson, Hornig, et al. (1992), comorbidity of twain or more psychological disorders, is also fairly common with social phobia. Research has also indicated that social phobia is also characterised with a higher frequency of suicide attempts (Schneier et al., 1992). focal point on the impact of the disorder on the reference of life, social phobia is describe as an disease of missed opportunities, because its early onset hinders future social progression such as marital success and career growth (Social Anxiety Disorder, 2006). The authors of this word stated that these individuals were less likely to be well educated, belong to demean socioeconomic status, and are possibly unmarried. In addition, they also suffer great functional, health, and physical impairments than individuals without soci al phobia (Social Anxiety Disorder, 2006). Thus the disorder has a significant impact on the quality of life, in particular, socially and emotionally. Emphasising on this point, the authors of this article highlighted that in a community health survey in Canada, people with social phobia were in two ways as likely to report at least one disability day in the past tense two weeks, compared to people without social phobia (Social Anxiety Disorder, 2006).Aetiology of social phobia can be traced to Bio-Psycho-Social factors (Smith, Hoeksema, Fredrickson, et al., 2003). Looking at the neuro-biologic factors, research info up to date, provides evidence of dopaminergic, serotonergic, and noradrenergic systems (Stein, Tancer, Uhde, 19992 Tancer, Stein, Uhde, 1993 Yeragani, Blalon, Pohl, 1990). However, Stein, Tancer, Uhde (1995) stated that the evidence for these neuro-biological factors in the predisposition, precipitation, and perpetuation is outlying(prenominal) from clear. The aut hors also present the same regarding the effect of antidepressants on social phobia stating that further work is warranted, although preliminary evidence indicates that antidepressants are not all effective on social phobia.From a cognitive-behavioural perspective, a person with social phobia develops a series of negative assumptions about themselves and their social world based on some negative experience (Kessler, et al., 1994). These assumptions of behaving inappropriately and being evaluated negatively and/or being humiliated will give rise to anticipatory anxiety that precedes the social situation adding an extra source of concern and perceived danger. Preoccupied with these fears, clients with social phobia have difficulty guidance their attention on the social cues or their own strengths that help them to effectively cope in the phobic situations. In addition, biased memory and focused attention towards negative signs will prevent the individual from perceiving the positi ve signs (e.g., acceptance, success, admiration) prominent rise to performance deficiencies. These may contribute towards producing patterns of negative interactions that may further contribute to the perpetuation of the phobic condition experienced at the time (Elting Hope, 1995). These explanations are similar to the generic CBT model, of problem development. Thus the research by Kessler et al (1994) has provided supporting evidence to the general CBT explanation and theoretical framework of problem understanding, assessment and treatment.Another dimension of the aetiology of social phobia is the lack of social skills and/or the lack of awareness of ones own social skills. According to Hill (1989), clients with social phobia vary astray in their knowledge of socially appropriate behaviour skills. Many of these individuals seem to have adequate social skills when assessed in a non-threatening environment such as the clinicians office, but they fail to use these skills when laden with anxiety in an unfamiliar social situation that is perceived as threatening. Hill (1989) further described that there is another group of individuals suffering with social phobia who may be unaware of socially appropriate behaviours in certain situations and hence encounter repeated failures and disappointments. Thus, Hill (1989) suggest that apart from practice of medicine and/or conventional CBT, individuals in this group will benefit more from specific training in social skills either through role playing or modelling as appropriate.In addition to the above dimensions, there are developmental and psychodynamic issues associated with the aetiology of social phobia as well. In this view, children who are rejected, belittled, and censured by their parents, teachers or peers may develop feelings of low egotism and social alienation (Arrindell, kwee, Methorst, 1989). The authors of this article further stated that clients with social phobia tend to report, having had hypercr itical parents. The article further examine the condition of social phobia from a psychodynamic perspective hypothesising that avoidant behaviour may be caused by an exaggerated desire for acceptance, an intolerance of criticism, or a willingness to constrict ones life to maintain a sense of control. Furthermore, they claim that traumatic embarrassing events may lead to loss of self-confidence, increased anxiety, and subsequent poor performance, resulting in a vicious circle that progress to social phobia.Concentrating on treatment seek behaviours for social phobia, Hill (1989) highlighted that clients rarely see a physician for symptoms relating to social anxiety. More often seeking help will be for conditions such as substance abuse, depression or any other anxiety disorder (e.g. panic attack).Treatment for Social PhobiaAs mentioned above, social phobia is the result of biopsychosocial factors. Thus, the treatment natural selections may also vary which may include pharmacotherap y, and/or different types of psychotherapy. Veale (2003) stated that treatment choice for social phobia is up to the client to decide. Medication is indicated if it is the clients first choice, or if CBT has failed or if there is a long waiting list for CBT. connaturally, pharmacotherapy becomes the choice of treatment when social phobia is comorbid with depression (Veale, 2003). Considering the first treatment choice, UK National imbed for Clinical Excellence (NICE) does not have a specific guideline specific for social phobia. However, in its guidelines for anxiety disorders (NICE, 2004), it pep ups pharmacotherapy as treatment if the client opts for medication, or if the client opts for psychological treatment, CBT is given as the first choice of therapy. NICE guidelines (2004) too recommend CBT as the first choice of psychological therapy for generalised anxiety disorder and other anxiety disorders. The National Institute for Clinical Excellence provides evidence that CBT is more effective than no hindrance and that CBT has been found to maintain its effectiveness when examined after long term follow up of eight to fourteen years. This can be used as a cost and time effective therapeutic intervention in group stage settings and most clients have maintained treatment gains at interminable terms (NICE 2004). It further stated that CBT is more effective than psychodynamic therapy and non-specific treatments. Apart from CBT, clients who assemble anxiety management training, simplicity and breathing therapy have been proven to be effective compared to having no intervention.Apart from CBT, Veale (2003) also discusses Graded self- exposure as a psychological therapy for social phobia. This therapeutic intervention which is based on the acquire theory hypotheses has been the treatment of choice for social phobia for many years. However, as this method of therapy using exposure to previously avoided situations in a judge manner until habituation occurs w as except successful with limited amount of clients, alternative approaches such as CBT have become a more everyday therapy choice.NICE guidelines (2006) on computerised cognitive behaviour therapy (CCBT) for depression and anxiety recommend CCBT for mild depressions and anxiety disorders, including social phobia. With reference to two Randomised Controlled Trials (RCTs) and two non-RCTs comparing CCBT (programme for panic/phobic disorders FearFighter) with therapist led CBT (TCBT) the NICE guidelines recommend the use of CCBT for mild phobic/panic disorders. When results of CCBT and TCBT were compared after a terce month period of therapy for global phobia, both groups showed statistically significant improvement. Similar results were shown in two non-RCT studies too. When these scores were compared with a group who received rest period techniques as therapy, this third group did not show statistically significant improvement while the other two groups (CCBT TCBT) did. Howeve r, it must be note that the RCT and the non-RCT studies does not report clinically significant improvement. Nevertherless, the dropout rate of FearFighter group was twice as many as the TCBT dropout rate. However, from a positive point of view on the practicality of CCBT on phobias, de passry of FearFighter programme at the clinical setting for one group, and the other group having access to the programme at rest home over a 12 week period showed that both groups showed statistically significant improvement in all measures (NICE guidelines, 2006). In terms of client satisfaction too there was no statistically significant fight between TCBT and CCBT (NICE guidelines, 2006). Thus, though further research is warranted to evaluate the clinical deduction of CCBT for social phobia specifically, the NICE guidelines recommend CCBT as a choice of therapy for mild levels of depression and anxiety disorders. In addition to the observed effectiveness of CCBT, NICE guidelines also recommend it as a cost effective therapy alternative. Thus, CCBT for social phobia at mild levels could be useful at a practical level too.In a study by Rosser, Erskine Crino (2004), the researchers studied the treatment success of CBT with antidepressants and CBT on its own as treatment for social phobia. The results did not show a statistically significant dissimilarity in the treatment progress between the two groups allowing the researchers to conclude that be use of antidepressants did not enhance or detract from the positive treatment consequence of a structured, group-based CBT programme for social phobia. Application of medication and CBT is common practice in treatment for social phobia (Rosser et al., 2004). Yet, there are not many studies that have studied the combine effectiveness for social phobia. Citing Heimberg (2002) Rosser et al., (2004) describe that there are three possible outcomes from combine medication and CBT. Combined treatment may produce a better outcome than each treatment merely, by potentiating the gains achieved by CBT and also reducing retrovert rates following the discontinuation of medication. Alternatively, there may be no difference between the combined approach and each approach individually, if both therapies (pharmacotherapy and CBT) are sufficiently powerful on their own. Also, depending on how individual clients delegate treatment success, effectiveness of CBT might be detracted by medication in a combined approach of treatment. Referring to literature on treatment success for social phobia Rosser et al., (2004) highlighted that combination treatment (CBT and pharmacotherapy) or pharmacotherapy alone has not been found to be of significant advantage. CBT has mostly been successful in overcoming symptoms, minimising relapses and also effective in terms of cost minimisation (Rosser et al., 2004). Focussing on the conclusions Rosser et al. (2004), there were no significant differences between the combination treatment (CBT antidepressants) and CBT alone could be interpreted in different ways. It is possible that since antidepressants and CBT are both reasonably powerful treatments individually, and thus a combination of the two did not contribute to a significantly to improve the outcome. Alternatively it may be that the group who were already taking antidepressants may have been prescribed with the medication because they were more severe in terms of social phobic or depressive symptoms prior to commencing treatment programme. Thus, it may be possible to argue that the combined therapy may not have contributed to a significant improvement compared to the group that that only received CBT, because there was a difference in symptom severity between the two groups. In addition there was no control in allocating (randomly) participants and or having a control over the medication dosage. Thus, the research findings of the study are subjected to the limitations of these variables that were out of the rese archers control. However, it has to be noted that it does not devalue the comparative treatment success on the CBT (alone) group. The researchers of this study wherefore emphasise the need for further research on combined therapy for social phobia as in real life clinical settings most clients are on medication while receiving CBT.Moreover, Rodebaugh Heimberg (2005) recommends CBT combined with medication as a widely used successful treatment method for social phobia. However, while recommending the above, they also emphasise the need for further research in this regard as the current data reveals mixed results. According to unattached evidence and theoretical considerations they suggested that some methods of combination could provide short-term benefits, but long-term decreases in efficacy compared to either treatment alone. In this paper Rodebaugh Heimberg (2005) emphasised that most research on the effects of CBT combined with medication had the common research gap of failin g to control the medication pane of glass and the allocation of participants in to random samples. However, the authors of this paper emphasised that in most studies combined therapy for social phobia had not shown significant evidence of treatment success compared to either pharmacotherapy or CBT.Rodebaugh Heimberg (2005) highlighted that there is supporting evidence to the treatment success of combining CBT with relaxation training. While mentioning this, they also noted that relaxation training alone has not proven to have any clinically significant benefit for the clients. Thus, it is when combined with CBT that clients have had a successful experience with relaxation training. Rodebaugh Heimberg (2005) stated that all forms of CBT aim to reduce the experience of fear through modification of avoidance and other maladaptive behaviours, thoughts, and beliefs (e.g. through exposure with cognitive restructuring). Thus, in the process of therapy most clients may experience an incr ease in stress and negative affect and distress in the short-term, but the modification of these earlier components of these earlier components of a behavioural-emotional chain leads to reduction of symptoms over time.In regard to combining treatment methods with CBT as treatment for social phobia, Rodebaugh Heimberg (2005) highlighted the fact that all treatment methods have its own limitations and strengths. Thus when combining two therapies (either pharmacological and CBT or CBT with another psychotherapy), the strengths as well as the weaknesses of the two approaches could be magnified, depending on the nature of the combination. Hence, Rodebaugh Heimberg (2005) stated that an empirically support method of combining medication and CBT for social anxiety disorder is save to be established, although under varied circumstances clinicians use different combinations of CBT on with other psychotherapies and medication to maximise effectiveness on a case by case level.Concluding Re marksAs discussed in this paper, social phobia may literally be a common mental disorder and it is categorised as an anxiety disorder under the DSM-IV classification system (DSM-IV-TR, 2000). While being highly prevalent, it is also a disorder that may have a large impact on a persons quality of life, hindering opportunities for personal growth and/or social interaction/relationships. Therefore, it is an important area of study and clinical practice in mental health, which has the aim of improving the lives of people suffering from this disorder, and minimising its effect on the society.Research literature on social phobia recommends certain types of medication, and CBT as a releasing intervention as the first choice of treatment for this debilitating condition. As it is out of our scope, this paper did not pay detailed attention to the types of pharmacotheraputic interventions that may successfully be used to control symptoms of this disorder and enable clients live a healthy life .From a psychological perspective, CBT is widely recommended through evidence based research as the first choice of psychotherapeutic treatment for social phobia. As discussed in this paper, evidence on the successful combinations of therapeutic methods at present denotes the need for further research in order to determine the best combinations for successful treatment. Another area that needs similar attention is combining different types of psychotherapies with CBT as treatment for social phobia.Focusing on CBT for social phobia, although there is supporting evidence for therapy success, and though it is widely considered as the first choice of psychotherapy for this disorder, it is not always successful with all individuals. Thus, form a practical point of view, it is important that clinicians are able to tailor and combine different therapeutic methods (pharmacotherapy and psychotherapy), not only to maximise treatment success, but also to make it useful with different types of clients/clients from different background and life-experiences. Furthermore, although CBT is recommended as the first therapy choice, there are practical issues regarding meeting the demand for services. This becomes an issue in terms of finance as well as in terms of the limited amount of professionals open to deliver treatment. Some successful methods of overcoming these difficulties would be Group CBT for social phobia and CCBT.However, it must be emphasised that these issues become a much etch problem in countries where psychotherapists trained in CBT are rare, and even methods such as CCBT could be unaffordable and inaccessible for certain groups. In addition, there are also limitations in being able to use programmes such as CCBT in countries where English is not used, or it not the first language. Thus, from a global perspective, the use of CBT as a therapy choice is practically challenged due to limitations of resources and trained personals, leavening pharmacotherapy as t he most practical mode of therapy for a large numbers of people suffering from social phobia.To conclude, it must be stated that continued research on the successful use of CBT as a therapeutic tool for social phobia and other disorders should be continued as it proves to be a successful therapy for many psychological disorders (Westbrook et al., 2007). Thus, it can be stated that CBT is a useful and successful therapeutic intervention for social phobia. The practical use of it could be further meliorate through continued research, and through therapist training programmes to meet the demands for therapy, as it would further increase the effectiveness of CBT as a therapy for social phobia.