Kognitiewe terapie en blootstelling in die behandeling van sosiale fobie

Nortje, Charl (2000-12)

Thesis (PhD)--Stellenbosch University, 2000.

Thesis

ENGLISH ABSTRACT: The objective of this study was to investigate and compare the effectiveness of a combined exposure and cognitive restructuring programme versus exposure only in the treatment of social phobia. The 44 participants in the study met the DSM-IV diagnostic criteria for social phobia at pre-treatment assessment, and presented mainly with general interactional social fears. They were allocated to a group which received a combined exposure and cognitive restructuring treatment (n = 15), a group treated with exposure only (n = 15), and a waiting-list control group (n = 14). For treatment purposes, both treatment groups were subdivided into two smaller groups of 7 and 8 participants each. The effects and differential effects of the treatments were compared in terms of four broad categories of variables: target phobia variables (anxiety/avoidance/escape in relation to a specific target phobia), social phobia variables (associated with the degree, nature, aspects and/or consequences of social phobia), cognitive variables (thought functionality, fear-of-negative-evaluation, and attentional bias), and severity of depression. Participants were individually assessed before treatment, immediately after treatment, and at follow-up after three months. Treatment were conducted by two co-therapists in 12 weekly group sessions of two hours each. Compared to a waiting-list control condition, both treated groups showed a significant improvement of the target phobia variables at post-treatment and, with the exception of target phobia anxiety for the exposure only condition, the significant effects were maintained at follow-up after three months. As for the social phobia variables, cognitive restructuring and exposure combined showed a significantly larger improvement compared to the waiting-list control condition on four of the variables (social phobia avoidance, social phobia observation anxiety, social phobia general symptomatology, and social phobia disturbance/disablement), and these significant effects were maintained at follow-up. The exposure only group showed significantly larger effects on only two variables (social phobia avoidance and social phobia disturbance/disablement) and only the effects on social phobia avoidance were maintained for the followup period of three months. With regard to the cognitive variables, the combined treatment led to significanly larger improvements in thought functionality compared to the waiting-list control condition and these effects were maintained at follow-up. No other significant differences between the effects of any of the treatments and the waiting-list control condition were demonstrated at post-treatment or at follow-up on any of the cognitive variables. Only the combined treatment resulted in significantly larger reductions in the severity of depression, The effects were maintained for the follow-up period of three months. Compared to the waiting-list control condition, the combined treatment resulted in improvement over a broader spectrum of social phobia symptomatology than exposure only at post-treatment and follow-up. The two treatments were also directly compared in terms of their effects on each of the dependent variables and the differences were largely insignificant at both post-treatment and follow-up. Only in terms of thought functionality tentative indications of a possible larger effect for the combined treatment were found. However, if this was the case, the differences were cancelled out at follow-up. It seems that both the combined treatment and exposure only were effective treatments for social phobia and that the combined treatment might have demonstrated slightly better results. These findings support the emerging view that the most important cognitive-behavioral treatments of social phobia do not differ greatly in terms of efficacy. It also offer support for the view of prominent researchers on social phobia outcome, namely that treatment effects are less dependent on procedural variations than on other critical elements, such as the length and frequency of treatment sessions, and exposure to the critical elements of patients' social fears.

AFRIKAANSE OPSOMMING: Die doel van hierdie studie was om die effektiwiteit van 'n gekombineerde blootstelling en kognitiewe herstruktureringsprogram teenoor blootstelling alleen in die behandeling van sosiale fobie te ondersoek en te vergelyk. Die 44 deelnemers aan die studie het voor behandeling aan die DSM-IV diagnostiese kriteria vir sosiale fobie voldoen en met oorwegend algemene interaksionele vrese gepresenteer. Hulle is verdeel in 'n groep wat met kognitiewe herstrukturering en blootstelling gekombineerd behandel is (n = 15), 'n groep wat slegs blootstelling ontvang het (n = 15), en 'n waglys-kontrolegroep (n = 14). Vir behandelingsdoeleindes is die behandelingsgroepe in twee subgroepe van onderskeidelik 7 en 8 deelnemers elk verdeel. Die effekte en differensiële effekte van die behandelings is in terme van die volgende vier breë kategorieë veranderlikes ondersoek: teikenfobie-veranderlikes (angslvermyding/ontsnapping ten opsigte van 'n spesifieke fobie), sosialefobie-veranderlikes (wat verband hou met die graad, aard, aspekte en/of gevolge van sosiale fobie), kognitiewe veranderlikes (gedagte-funksionaliteit, vrees-vir-negatiewe-evaluasie en aandagsverdraaiing), en graad van depressie. Deelnemers is individueel beoordeel voor behandeling, onmiddellik na afloop daarvan en na 'n 3- maande-opvolgperiode. Behandeling deur twee ko-terapeute het in 12 weeklikse groepsessies van twee uur elk geskied. In vergelyking met die waglys-kontrolekondisie, het beide behandelings tot 'n beduidende verbetering van die teikenfobie-veranderlikes by nameting gelei en, met uitsondering van teikenfobie-angs by die blootstellingsbehandeling, is die beduidende effekte vir 'n opvolgperiode van drie maande volgehou. Wat die sosialefobie-veranderlikes betref, het kognitiewe herstrukturering plus blootstelling 'n beduidend groter verbetering in vergelyking met die waglys-kontrolekondisie op vier veranderlikes (sosialefobievermyding, sosialefobie-observasie-angs, sosialefobie-algemenesimptomato/ogie, en sosialefobieongemak/ belemmering) tot gevolg gehad en is die beduidende effekte vir 'n opvolgperiode van drie maande volgehou. Daarenteen het die blootstellingsgroep slegs ten opsigte van twee veranderlikes (sosialefobie-vermyding en sosialefobie-ongemak/belemmering) tot beduidend groter effekte aanleiding gegee, waarvan die effekte net op een van die twee veranderlikes (sosialefobie-vermyding) vir 'n opvolgperiode van drie maande in stand gehou is. Ten opsigte van die kognitiewe veranderlikes, het kognitiewe herstrukturering plus blootstelling, in vergelyking met die waglys-kontrolekondisie, tot 'n beduidende verbetering van gedagte-funksionaliteit gelei wat vir 'n opvolgperiode van drie maande in stand gehou is. Geen ander beduidende verskille tussen die effekte van behandelings en die waglys-kontrolekondisie is vir enige van die ander kognitiewe veranderlikes by nameting of opvolg gedemonstreer nie. Slegs die gekombineerde behandeling het tot beduidend groter verlagings van die graad van depressie gelei wat vir 'n opvolgperiode van drie maande gehandhaaf is. In vergelyking met die waglys-kontrolekondisie, het die gekombineerde behandeling dus tot 'n beduidende verbetering oor 'n breër basis van sosialefobie-simptomatologie as blootstelling alleen by nameting en opvolg aanleiding gegee. Die twee behandelings is ook direk met mekaar in terme van effekte op elkeen van die afhanklike veranderlikes vergelyk en die verskille was by nameting en opvolg grootliks onbeduidend. Dit is slegs ten opsigte van gedagte-funksionaliteit dat daar tentatiewe aanduidings was dat die gekombineerde behandeling moontlik 'n beduidend groter verbeterende effek as blootstelling alleen kon gehad het, maar indien dit so was, was hierdie verskille by die opvolgmeting reeds uitgewis. Dit wil dus voorkom asof beide die gekombineerde behandeling en blootstelling alleen effektiewe behandelings vir sosiale fobie was en dat eersgenoemde dalk effens beter resultate kon gelewer het. Hierdie resultate ondersteun die standpunt wat tans besig is om op grond van navorsing te ontwikkel, naamlik dat daar nie betekenisvolle groot verskille in die effektiwiteit van die belangrikste kognitiefgedragsterapeutiese behandelings van sosiale fobie is nie. Dit bied ook steun vir die standpunt van prominente navorsers op die gebied van sosiale fobie uitkomsnavorsing dat behandelingseffek minder afhang van verskille in prosedure-variasies as van ander kritieke elemente, soos byvoorbeeld die lengte en frekwensie van die behandelingsessies en blootstelling aan die kritieke elemente van die sosiale vrese.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/51810
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