None listed
Conditions
Brief summary
Several research groups from around the world, including our own group at the Centre for Emotional Health (Macquarie University), have demonstrated the efficacy of theoretically derived cognitive behavioural treatment (CBT) protocols for Social Phobia (Clark et al, 2003; 2006; Rapee, Gaston, & Abbott, 2009). However, despite the effective treatments available there is evidence that treatment outcomes are still less than optimal due to poor engagement and motivation for treatment. For example, Issakidis & Andrews (2004) found that around 30% of clients presenting for CBT group treatment for social phobia did not commence treatment, and a further 10% discontinued their treatment. Similarly, in a large trial in our own clinic, 18% of clients who commenced treatment for social phobia discontinued after less than 3 sessions (Rapee et al, 2009). This suggests that strategies that promote engagement with and motivation for treatment may further enhance treatment outcomes. One approach that has received attention, particularly in the substance use disorders, is motivational interviewing (MI; Miller & Rollnick, 2002). This approach aims to enhance motivation for change and focuses on ambivalence about embarking upon treatment that might lead to clients not engaging fully in, or dropping out completely from, treatment (Arkowitz & Miller, 2008). While this approach has good evidence for its value in the substance-use field (Arkowitz & Miller, 2008), it is only beginning to be considered in the anxiety-disorders literature (e.g., Westra & Dozois, 2008). We have developed a program based on MI which addresses treatment expectations and engagement (called TEE). The aim of the current project is to determine whether the addition of TEE to a highly efficacious CBT treatment package for social phobia can provide a significantly greater treatment effect and improved maintenance of effects.
Interventions
Motivational interviewing (MI), cognitive-behavioural treatment (CBT).
Motivational interviewing will occur in weeks 1-3. Cognitive behavioural treatment will occur in weeks 4-15.
All treatment sessions will be conducted by clinical psychologists.
The MI sessions will be based on the principles of motivational interviewing outlined in Westra & Dozois (2008) with a focus on ambivalence about anxiety change and about the treatment procedures used to effect change. The program will be based on
Motivational interviewing (MI), cognitive-behavioural treatment (CBT). Motivational interviewing will occur in weeks 1-3. Cognitive behavioural treatment will occur in weeks 4-15. All treatment sessions will be conducted by clinical psychologists. The MI sessions will be based on the principles of motivational interviewing outlined in Westra & Dozois (2008) with a focus on ambivalence about anxiety change and about the treatment procedures used to effect change. The program will be based on the four main principles of MI (empathy, rolling with resistance, developing discrepancy and enhancing self-efficacy). Homework exercises are optional. MI will be delivered on an individual basis for one hour per week for three weeks. The CBT program includes the basic principles of standard CBT such as cognitive restructuring, exposure and skills training. In addition, it includes components of attentional training, cognitive change at the schema level, detailed focus on dropping safety behaviours and extensive performance feedback to increase the participant's perceptions of their performance and modify their normally negative self-evaluations to be more consistent with those of independent observers. A major component of the technique utilises video feedback following performance of a role play in group. These exercises are then reinforced during exposure by identifying novel methods of obtaining feedback in the real world. The skills learned in session are practised by participants in weekly homework exercises. CBT will be delivered in a group format for 2.5 hours once a week for 12 weeks.
Sponsors
Dr Lorna Peters
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
People who meet DSM-IV criteria for social phobia. If multiple anxiety disorders are present, social phobia must be the principal diagnosis based on severity and life interference.
Exclusion criteria
current, active suicidal ideation; organic mental disorders; comorbid psychotic disorder; unmanaged substance dependence. Participants will be required to be fluent in their use of English.
Outcome results
None listed