Does the Form or the Amount of Exposure Make a Difference in the Cognitive-Behavioral Therapy Treatment of Social Phobia?

Borgeat, François; Stanković, Miroslava; Khazaal, Yasser; Rouget, Beatrice Weber; Baumann, Marie-Claude; Riquier, Françoise; O’Connor, Kieron; Jermann, Françoise; Zullino, Daniele; Bondolfi, Guido

doi:10.1097/nmd.0b013e3181aacc08

Cited by 17 publications

(15 citation statements)

References 22 publications

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“…Ideally, future studies would include both social and non-social incentives, and reward and punishment trials. Another avenue for future research would be investigating whether the proposed motivational imbalance “shifts or normalizes” after a treatment which successfully increases reward sensitivity (e.g., Borgeat et al, 2009 ).…”

Section: Discussionmentioning

confidence: 99%

Neural sensitivity to social reward and punishment anticipation in social anxiety disorder

Cremers

Veer

Spinhoven

et al. 2015

Front. Behav. Neurosci.

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An imbalance in the neural motivational system may underlie Social Anxiety Disorder (SAD). This study examines social reward and punishment anticipation in SAD, predicting a valence-specific effect: increased striatal activity for punishment avoidance compared to obtaining a reward. Individuals with SAD (n = 20) and age, gender, and education case-matched controls (n = 20) participated in a functional magnetic resonance imaging (fMRI) study. During fMRI scanning, participants performed a Social Incentive Delay (SID) task to measure the anticipation of social reward and punishment. The left putamen (part of the striatum) showed a valence-specific interaction with group after correcting for medication use and comorbidity. The control group showed a relatively stronger activation for reward vs. punishment trials, compared to the social anxiety group. However, post-hoc pairwise comparisons were not significant, indicating that the effect is driven by a relative difference. A connectivity analysis (Psychophysiological interaction) further revealed a general salience effect: SAD patients showed decreased putamen-ACC connectivity compared to controls for both reward and punishment trials. Together these results suggest that the usual motivational preference for social reward is absent in SAD. In addition, cortical control processes during social incentive anticipation may be disrupted in SAD. These results provide initial evidence for altered striatal involvement in both valence-specific and valence-nonspecific processing of social incentives, and stress the relevance of taking motivational processes into account when studying social anxiety.

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Section: Discussionmentioning

confidence: 99%

Neural sensitivity to social reward and punishment anticipation in social anxiety disorder

Cremers

Veer

Spinhoven

et al. 2015

Front. Behav. Neurosci.

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“…There is evidence to support the effectiveness of exposure therapy alone [389,392], however the efficacy of exposure alone compared with CBT is equivocal in the current treatment literature [392-395]. …”

Section: Social Anxiety Disordermentioning

confidence: 99%

Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders

et al. 2014

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BackgroundAnxiety and related disorders are among the most common mental disorders, with lifetime prevalence reportedly as high as 31%. Unfortunately, anxiety disorders are under-diagnosed and under-treated.MethodsThese guidelines were developed by Canadian experts in anxiety and related disorders through a consensus process. Data on the epidemiology, diagnosis, and treatment (psychological and pharmacological) were obtained through MEDLINE, PsycINFO, and manual searches (1980–2012). Treatment strategies were rated on strength of evidence, and a clinical recommendation for each intervention was made, based on global impression of efficacy, effectiveness, and side effects, using a modified version of the periodic health examination guidelines.ResultsThese guidelines are presented in 10 sections, including an introduction, principles of diagnosis and management, six sections (Sections 3 through 8) on the specific anxiety-related disorders (panic disorder, agoraphobia, specific phobia, social anxiety disorder, generalized anxiety disorder, obsessive-compulsive disorder, and posttraumatic stress disorder), and two additional sections on special populations (children/adolescents, pregnant/lactating women, and the elderly) and clinical issues in patients with comorbid conditions.ConclusionsAnxiety and related disorders are very common in clinical practice, and frequently comorbid with other psychiatric and medical conditions. Optimal management requires a good understanding of the efficacy and side effect profiles of pharmacological and psychological treatments.

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“…In social phobia, what helps beyond exposure remains matter of debate and research. Among the usual components of CBT, more exposure appears related to more rapid positive cognitive changes while cognitive work was shown to contribute to more persistent decrease of social avoidance (Borgeat et al, 2009). Some unpublished pilot case studies of our group had indicated that social phobic patients making limited progress in CBT could respond to augmentation by preconscious priming.…”

Section: Introductionmentioning

confidence: 99%

Psychotherapy Augmentation through Preconscious Priming

et al. 2013

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Objective: To test the hypothesis that repeated preconscious (masked) priming of personalized positive cognitions could augment cognitive change and facilitate achievement of patients’ goals following a therapy.Methods: Twenty social phobic patients (13 women) completed a 36-weeks study beginning by 12 weeks of group behavioral therapy. After the therapy, they received 6 weeks of preconscious priming and 6 weeks of a control procedure in a randomized cross-over design. The Priming condition involved listening twice daily with a passive attitude to a recording of individualized formulations of appropriate cognitions and attitudes masked by music. The Control condition involved listening to an indistinguishable recording where the formulations had been replaced by random numbers. Changes in social cognitions were measured by the Social Interaction Self Statements Test (SISST).Results: Patients improved following therapy. The Priming procedure was associated with increased positive cognitions and decreased negative cognitions on the SISST while the Control procedure was not. The Priming procedure induced more cognitive change when applied immediately after the group therapy.Conclusion: An effect of priming was observed on social phobia related cognitions in the expected direction. This self administered addition to a therapy could be seen as an augmentation strategy.

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Does the Form or the Amount of Exposure Make a Difference in the Cognitive-Behavioral Therapy Treatment of Social Phobia?

Cited by 17 publications

References 22 publications

Neural sensitivity to social reward and punishment anticipation in social anxiety disorder

Neural sensitivity to social reward and punishment anticipation in social anxiety disorder

Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders

Psychotherapy Augmentation through Preconscious Priming

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