Psychotherapy for Social Phobia and Depression

There is good evidence for the effectiveness of exposure-based strategies of cognitivebehavioural therapy in social anxiety disorders. The three principal forms of treatment that have been found useful in SP patients are desensitisation (in vivo or by imaginable exposure), social skills training, and cognitive restructuring. Behavioural strategies are designed to directly address avoidance behaviour and eliminate emotional or anxious arousal, whereas cognitive-behavioural strategies seek to change the way patients perceive and respond to threatening or fear-producing stimuli or thoughts. From a cognitive perspective, ‘‘catastrophic cognition’’ is believed to be an important element of SP, independently of the anxious emotional arousal.

It has been hypothesised that exposure plus cognitive restructuring would be a particularly effective combination, and several methodologically sound studies have examined this combination. Recently two programmes of cognitive-behavioural therapy have developed: cognitive-behavioural group therapy and social effectiveness therapy. These treatments both involve exposure, which is the key element that influences therapy outcome. The difference is that the cognitive-behavioural group therapy (CBGT) focuses on cognitive restructuring whereas social effectiveness training (SET) is based on exposure plus social skills training.

Overall, the clinical observation suggests that an initially effective treatment for SP, regardless of the form, may trigger a positive process of improvement in most patients: the reduction of the fears and of the anticipation of failure usually renders the subjects more willing to face situations that were formerly avoided. This, in turn, brings a sort of automatic self-exposure, which has further positive therapeutic value.

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