Manualized cognitive therapy versus cognitive-behavioral treatment-as-usual for social anxiety disorder in routine practice: A cluster-randomized controlled trial

Hoyer, Jürgen; Čolić, Jasmin; Pittig, Andre; Crawcour, Stephen; Moeser, Manuela; Ginzburg, Denise M.; Lin, Jihong; Wiltink, Joerg; Leibing, Eric; Stangier, Ulrich

doi:10.1016/j.brat.2017.05.012

Cited by 38 publications

(28 citation statements)

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“…(46). Although it is said to be the most frequently neglected therapeutic strategy in routine clinical practice (47), it seems that it is used by most educated therapists who participated in the research, although we do not have data that would allow us to claim that they do so regularly when there is indication for it.…”

Section: Discussionmentioning

confidence: 89%

“…Ovi su podatci ohrabrujući s obzirom na brojne nalaze o rijetkom korištenju izlaganja čak i među bihevioralno-kognitivnim terapeutima (46). Premda se navodi da je to najčešće zanemarena terapijska strategija u rutinskoj kliničkoj praksi (47), čini se da je consequences of its application, which means that it is possible to assume that they will be able to recognize situations when exposure therapy is beneficial for the patient.…”

Section: Discussionunclassified

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Therapeuts’ Beliefs about Exposure Therapy

2019

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Brojna istraživanja potvrđuju učinkovitost tehnike izlaganja zbog čega se ta tehnika smatra prvim izborom u tretmanu većine anksioznih poremećaja. Unatoč tome u praksi se tehnika nedovoljno primjenjuje. Osim nesklonosti klijenata da se izlažu neugodi, tome pridonose i negativni stavovi terapeuta prema primjeni ove tehnike. Cilj je istraživanja ispitati stavove terapeuta prema terapiji izlaganjem, te razlike u vjerovanjima s obzirom na tip i razinu psihoterapijske edukacije, kao i na iskustvo u primjeni ove terapije. U istraživanju je sudjelovalo 226 terapeuta različitih psihoterapijskih usmjerenja i razina edukacije. Ispitanici su ispunili kratki online upitnik koji je sadržavao Ljestvicu vjerovanja terapeuta o izlaganju. Rezultati pokazuju da terapeuti bihevioralno-kognitivnog usmjerenja i oni koji u svom radu primjenjuju tehniku izlaganja imaju pozitivniji stav prema njezinoj primjeni u odnosu na terapeute drugih psihoterapijskih usmjerenja i one koji je u svom radu ne koriste. Među bihevioralno-kognitivnim terapeutima, akreditirani terapeuti, supervizori i supervizanti imaju pozitivniji stav od terapeuta na nižim stupnjevima edukacije. Može se zaključiti da znanje i pozitivna vjerovanja o terapiji izlaganjem potiču primjenu ove tehnike, a pozitivna iskustva u primjeni povratno podržavaju i jačaju pozitivna vjerovanja o njoj. Preporuča se da se u okviru edukacije iz bihevioralno-kognitivne terapije radi na prepoznavanju i mijenjanju potencijalnih disfunkcionalnih vjerovanja o terapiji izlaganjem./ Numerous studies have confirmed the efficacy of exposure therapy, which is why this approach is considered the primary option in the treatment of most anxiety disorders. Despite this fact, in practice this approach is not used enough. Apart from the reluctance of clients to expose themselves to discomfort, therapists' negative attitudes to exposure therapy also contribute to this. The aim of this study is to examine therapists' attitudes toward exposure therapy and differences in beliefs according to type and level of psychotherapeutic education as well as experience with using this type of therapy. 226 therapists of various psychotherapeutic orientations and education levels participated in the study. The participants filled in a short online questionnaire which contained the Therapist Beliefs about Exposure Scale. The results show that behavioural-cognitive therapists and those who apply exposure therapy in their work have a more positive attitude toward its use in comparison with therapists of other psychotherapeutic orientations and those who do not use exposure therapy in their work. Among behavioural-cognitive therapists, accredited therapists, supervisors, and supervisees have a more positive attitude than therapists with lower levels of education. It may be concluded that knowledge and positive beliefs about exposure therapy encourage the application of this technique, while positive experiences of its application support and strengthen positive beliefs about it. It is suggested that within the training in beh...

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Section: Discussionmentioning

confidence: 89%

Section: Discussionunclassified

Therapeuts’ Beliefs about Exposure Therapy

2019

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“…The results of the adherence ratings, however, might be related to the adolescents’ disposition of stopping treatment prematurely: presumably, it is a reaction of the therapists in both conditions to intervene not entirely in accordance with the manuals, but more flexibly, in order to avoid too much confrontation. Interestingly, another study implemented within the SOPHO-NET found no differences in outcome between manualized cognitive therapy and nonmanualized CBT as usual for SAD in adults treated in routine practice [37], thus eventually questioning the meaningfulness of adherence to a manual regarding treatment outcome. However, this perspective does not take the influence of the therapists’ competence into account.…”

Section: Discussionmentioning

confidence: 99%

Cognitive-Behavioral and Psychodynamic Therapy in Adolescents with Social Anxiety Disorder: A Multicenter Randomized Controlled Trial

Salzer

Stefini

Kronmüller

et al. 2018

Psychother Psychosom

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Background: Although social anxiety disorder (SAD) has an early onset and is frequently found in adolescence, evidence for psychotherapeutic treatments of SAD in adolescents is rather scarce. Within the Social Phobia Psychotherapy Research Network (SOPHO-NET), we examined the efficacy of cognitive-behavioral (CBT) and psychodynamic therapy (PDT) compared to a waiting list (WL) in these patients. Methods: In a multicenter randomized controlled superiority trial, 107 patients, aged 14–20 years, were randomized to CBT (n = 34), PDT (n = 34), or WL (n = 39). Assessments were made at baseline, at the end of treatment, and 6 and 12 months after termination. The Liebowitz Social Anxiety Scale for Children and Adolescents (LSAS-CA) applied by raters masked to the treatment condition was used as the primary outcome. As secondary outcomes, rates of response and remission and the Social Phobia Anxiety Inventory (SPAI) were used. Results: Both treatments were superior to WL in the LSAS-CA (CBT: p = 0.0112, d = 0.61, 95% CI 0.14–1.08; PDT: p = 0.0261, d = 0.53, 95% CI 0.06–1.00). At the end of treatment, response rates were 66, 54, and 20% for CBT, PDT, and WL. The corresponding remission rates were 47, 34, and 6%, respectively. CBT and PDT were significantly superior to WL regarding remission (CBT: p = 0.0009, h = 1.0; PDT: p = 0.0135, h = 0.74), response (CBT: p = 0.0004, h = 0.97; PDT: p = 0.0056, h = 0.72), and the SPAI (CBT: p = 0.0021, d = 0.75, 95% CI 0.27–1.22; PDT: p = 0.0060, d = 0.66, 95% CI 0.19–1.13). Treatment effects were stable at 6- and 12-month follow-ups. Conclusions: These results are comparable to the large SOPHO-NET trial in adults (n = 495). Early treatments for social anxiety are needed in order to prevent chronic manifestation of SAD.

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“…Drei wendeten ein Manual an. Eine weitere, kürzlich publizierte Studie untersuchte die KVT für soziale Ängste in der Routineversorgung und zeigte eine starke Reduktion der Symptomatik bei 77 eingeschlossenen Patient*innen [Hoyer et al, 2017]. Es ist jedoch anzumerken, dass die Verfahren und Ausschlusskriterien in dieser Studie denen einer randomisiert-kontrollierten Studie sehr ähnlich waren, sodass die Ergebnisse die Realität in der Routineversorgung möglicherweise nicht abbilden.…”

Section: Einführungunclassified

Die Behandlung der sozialen Angststörung und ängstlich-vermeidenden Persönlichkeitsstörung in der Versorgung: eine naturalistische Studie zu einer kombinierten Einzel- und Gruppentherapie

et al. 2019

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Schlüsselwörter Effectiveness • Gruppentherapie • Soziale Phobie • Ängstlich-vermeidende Persönlichkeitsstörung Zusammenfassung Hintergrund: Eine Vielzahl von randomisiert-kontrollierten Studien belegen die Wirksamkeit der kognitiven Verhaltenstherapie (KVT) für soziale Ängste. Die Wirksamkeit der KVT unter Routinebedingungen wurde allerdings seltener untersucht. In den wenigen naturalistischen Studien werden Ergebnisse ausschließlich für die soziale Angststörung (SAS) berichtet. Befunde für die ängstlich-vermeidende Persönlichkeitsstörung (ÄVPS) stehen noch gänzlich aus. Die vorliegende Studie untersucht die Wirksamkeit einer kombinierten Gruppen-und Einzeltherapie für SAS und ÄVPS in der Routineversorgung. Methode: Einhundert und fünf Patient*innen mit SAS, von welchen 36% komorbid mit ÄVPS diagnostiziert waren, nahmen an einer Kombination aus Gruppen-und Einzeltherapie teil. Die Patient*innen füllten zu Beginn der Einzeltherapie, vor der Gruppentherapie, nach der Gruppentherapie und am Ende der Einzeltherapie Fragebögen aus. Ergebnisse: Die Behandlung führte zu einer starken Verbesserung sozialängstlicher Symptome (d = 1,1), zu einer Verringerung depressiver Symptome (d = 1,0) und allgemeiner psychischer Beschwerden (d = 1,1) sowie zu einem starken Anstieg der Selbstwirksamkeit (d = 1,1). Während der Gruppentherapie nahmen die sozialen Ängste am stärksten ab. ÄVPS war kein signifikanter Prädiktor für den Therapieerfolg. Diskussion: Die Effektstärken der kombinierten Behandlung sind mit denen anderer Studien in der Routineversorgung vergleichbar. Patient*innen mit ÄVPS erlebten ähnliche Therapieerfolge wie Patient*innen ohne ÄVPS.

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Manualized cognitive therapy versus cognitive-behavioral treatment-as-usual for social anxiety disorder in routine practice: A cluster-randomized controlled trial

Cited by 38 publications

References 46 publications

Therapeuts’ Beliefs about Exposure Therapy

Therapeuts’ Beliefs about Exposure Therapy

Cognitive-Behavioral and Psychodynamic Therapy in Adolescents with Social Anxiety Disorder: A Multicenter Randomized Controlled Trial

Die Behandlung der sozialen Angststörung und ängstlich-vermeidenden Persönlichkeitsstörung in der Versorgung: eine naturalistische Studie zu einer kombinierten Einzel- und Gruppentherapie

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