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What happens in treatment for social phobia?

There are several stages in treatment

 

0. Assessment to rule out BDD or fear of body adour (olfactory syndrome) and assess for comorbidies including D&A and depression.

 

1. Devise an idiosyncratic version of the model

 

2. Show that Self focused attention and safety behaviours are unhelpful by doing something that is difficult but managable.  This is done twice.  In the first role-play they are asked to do everything they usually do including safety behaviours and focusing on how they are feeling and coming accross.  They asked to compare how they felt and how they came accross.  When asked to compare the two conditions they often feel better and think that they come accross better.  Although they think they are coming accross better

than they think, they still think it is pretty bad so they need to see their true self via video.

 

3 Video feedback is used to deal with the negative images they have of themselves so that they can actually see their true observable self.   They are asked to watch the video of themself.   If they think they blushed they are asked to indicate what shade of red they think it was.  Whatever is observed, their image is much more negative.   Realise that self images are extremely distorted.

 

4. So all the evidence so far to decide how you come across, your feelings and your images, is poor evidence and it doesnt actually tell you how you appear to others.  So you need find good eivdence that is realist by shifting their focus of attention by coming out of their head and into the social interaction AND test their beliefs by doing experiments by facing the social situation and drops behaviour and self focused attention because by now they know that this is bad evidence for how they come accross.  Instead, watch the social environment like a hawke.  Look for doubt in any conclusions and make another experiment to test the doubt. 

 

5.  Once they build confidence then behave in an unacceptable way (e.g., leave long gaps while talking).  David did this while giving a talk and asked the audience if they noticed. 

The client is asked to make predictions.  Other clients who fear blushing with splash water under arms alongside therapist and make predictions.  The therapist goes into a shop and has the client observe what happens and then concludes that fears don't happen to YOU.  They do the experiment themselves to find out that their armpits are so different.

 

6.  If this doesn't work to update the image then carry out imagery rescripting - they bring up the image and experience it with all of their senses.  Then come of it and discuss the image.  Then go back to memory at the adult and help the child (David said that this comes from gestalt therapy).  Vulnerability via temperatment and early experiences.

 

Evidence: CBT is twice as much improved as prozac.  Compared to ERP which is effective CBT was twice as effective: 85% no longer had a diagnosis as opposed to ERP where 35% had no diagnosis.  David also did a study to show that PD doesn't diminish the effectiveness of CBT for social phobia.  David said that individual therapy works a bit better than group therapy.  

 

 

 

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