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Person-Centred/Experiential Approaches to Social Anxiety: Initial outcome results

Person-Centred/Experiential Approaches to Social Anxiety: Initial outcome results. Robert Elliott & Brian Rodgers University of Strathclyde. Why Study Social Anxiety (SA)?. Some research on PTSD/trauma and Generalized Anxiety, but social anxiety neglected

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Person-Centred/Experiential Approaches to Social Anxiety: Initial outcome results

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  1. Person-Centred/Experiential Approaches to Social Anxiety: Initial outcome results Robert Elliott & Brian Rodgers University of Strathclyde

  2. Why Study Social Anxiety (SA)? • Some research on PTSD/trauma and Generalized Anxiety, but social anxiety neglected • Common but debilitating problem, affects social adjustment, work functioning • Relevance to government initiatives targetting anxiety/depression in chronic unemployment • Risk factor for depression, substance misuse (self-medication)

  3. What is Social Anxiety?(DSM-IV) • A. Marked and persistent fear • One or more social or performance situations • The individual fears that he or she will act in a humiliating or embarrassing way • B. Consistency: Exposure to feared social situation almost invariably provokes anxiety • C. Recognition: Person experience fear as excessive or unreasonable • D. Avoidance, or endurance with intense distress • E. Interference: interferes significantly with functioning or wellbeing

  4. Why Person-Centred-Experiential (PCE) Therapies for Social Anxiety? • This client group has been virtually ignored by humanistic psychotherapies • PCEs shown to be effective with Major Depression • SA Commonly accompanied with clinical depression, substance abuse, employment problems • Resonance with key theoretical formulations: • Standard Person-Centred Therapy: Conditions of worth • Emotion-Focused Therapy: Anxiety splits: externalized inner critic

  5. SA: Driven by Powerful Emotion Processes • Key emotions: primary maladaptive (overgeneralized) shame and fear • Organized by core emotion schemes: • Self as socially defective • Others as harshly judging/rejecting (=internalized critic) • SA organized around core emotion scheme of Self as socially defective • Basis of SA: Fear that this core defective self will be seen & negatively judged by others

  6. Core Defective Self-scheme • Socially Defective Self (Experiencer) • Typically grounded in early physical/emotional/sexual abuse or rejection/bullying • Organized around primary maladaptive shame/fear • Symbolized by one or more key phrases/images, e.g., “rubbish”, “crazy”, “stupid”, “ugly”, “a freak”

  7. Shaming Internalized Critic Scheme • Complementary emotion scheme: • Harsh, shaming internal Critic • Introject of early rejection/abuse • Emotion scheme primes monitoring for social dangers • Attribution to current others • But: also has protective function (prevent social rejection) • Motivates social withdrawal/avoidance & emotional avoidance

  8. Strathclyde PCE Therapy for Social Anxiety Project • Therapy development/ Pilot study • Open clinical trial • In progress; n = 19 completers to date • Two arms of study (non-randomized but unsystematic): • Standard Person-centred (PCT) • Including nondirective & broader relational versions • Emotion-focused therapy (EFT) • PCT + active tasks: Focusing, Unfolding, Chairwork

  9. Method: Clients • Community sample • Brief telephone screening • Face-to-face diagnostic assessment (2 X 2 hrs): • SCID-IV • Personality Disorders Questionnaire (PDQ) • Create Personal Questionnaire • Inclusion criteria: • Consider self to have problem with social anxiety • Meet DSM-IV criteria for social anxiety • Willingness to be recorded, fill out forms

  10. Method: Clients • Specific SA (one specific situation: public speaking): 49% • Generalized (multiple situations): 51% • Axis 2: mean 3.3 Axis 2 diagnoses • Avoidant Personality pattern: 92% • Borderline: 35%

  11. Mean Problem Duration Ratings of Personal Questionnaire Items • “6.2”: somewhat more than 6 to 10 years • Client presenting problems = chronic

  12. Method: Therapy & Research Parameters • Up to 20 sessions; less if client feels finished • Assessments/data collection at: • Pre • Mid: After session 8 • Post (end of therapy) • 6- & 18-mo follow-ups

  13. Method: Outcome measures • 1. Personal Questionnaire(PQ): Individualized/weekly problem distress; used for progress monitoring • 2. CORE-Outcome Measure (CORE): General problem distress • 3. Social Phobia Inventory (SPIN): Problem specific • 4. Inventory of Interpersonal Problems (IIP): Interpersonal problem distress • 5. Strathclyde Inventory (Strath): Person-centred outcome measure • 6. Self-relationship Scale (SR): EFT Outcome measure (Self-attack, Self-affiliation, Self-neglect) • Qualitative: Change Interview (used in case studies)

  14. Results: Post-therapy Outcome for Combined Sample

  15. Clients Showing Reliable Change X Measures

  16. Results: SPIN Outcome Benchmarking

  17. Results: SPIN Subscale Analyses (w Benchmarking)

  18. PCT vs. EFT Pre-post Effect Sizes

  19. Worse than expected Better than expected

  20. Results: Analysis of Drop-out Patterns

  21. Late Drop-outs • Quit before indicating they were done with therapy or finishing 16-20 sessions • Session 3 -5 • Pre-therapy mean PQ = 6.24 (vs. 5.59 for completers) • Last session mean PQ = 5.55 • Included 3 of the 4 most initially distressed clients

  22. Clients who changed therapies • Early drop-outs included 4 clients who switched between arms of the study • 1 client changed from EFT  PCT • Scheduling issue • 3 clients changed PCT  EFT • Negative reaction to lack of structure in session 1

  23. Discussion – General Conclusion • EFT (also PCT) for Social Anxiety • Promising new approach • Substantial change over therapy • On long-standing problems • Comparable to benchmark treatments (medication, CBT)

  24. Discussion – EFT vs PCT? • Slight advantages to EFT over PCT? • On CORE, IIP, Strath, but not on SPIN, PQ • +.37: Same order as York I study (Greenberg & Watson, 1998), but smaller than York II (Goldman et al., 2006) • Some clients react negatively to PCT in early sessions; fewer drop-outs in EFT • Appears related to greater structure in EFT

  25. Discussion - Cautions • But: • Not statistically significant (low power), but current best guess • Nonrandomized design • Possibility of treatment diffusion (Chairwork in PCT condition?) • Some clients refuse EFT Chair work • Need to collect more data: target n = 30

  26. Next Steps • RCT: Primary Care client population • PCE therapy (PCT & EFT) vs. NHS Primary Care Mental Health Team Treatment as Usual (group & individual CBT) • Continue developing EFT therapy for SA • Piloting PCT & EFT Adherence Measures

  27. E-mail: Fac0020@gmail.com • Blog: pe-eft.blogspot.com

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