Kognitiewe terapie en hipnose in die behandeling van sosiale fobie

Posthumus, Tanya (2001-04)

Thesis (DPhil) -- University of Stellenbosch, 2001.

Thesis

ENGLISH ABSTRACT: Cognitive-behaviour therapy is criticised for focusing almost exclusively on strategic cognitive processing and for not attending sufficiently to non-verbal, automatic thoughts. Combining hypnosis with existing cognitive-behaviour therapy procedures is seen as a way of addressing this problem. The objective of the present study was therefore to investigate whether the effectiveness of a structured group cognitive behavioural therapy programme could be significantly improved if it is combined with hypnosis and whether such improvements will be maintained. This study, with a test-retest-follow-up design, involved 45 patients with a DSM-IV diagnosis of social phobia. Fifteen patients were treated with Heimberg's (1991) group cognitive-behaviour therapy for social phobia (the combined programme, consisting of cognitive restructuring and exposure treatment), while 16 patients were allocated to a waiting-list control condition. The effectiveness of the two treatments was assessed in terms of 13 dependent variables which were divided into the following broad categories: target phobia variables (anxiety/avoidance/escape with regard to a specific target phobia), social phobia variables (degree, nature, aspects and/or consequences of social phobia), cognitive variables (dysfunctional automatic thoughts, fear of negative evaluation and attentional bias), and severity of depression. Treatment was presented by two co-therapists in 12 \Neekly group sessions of 2 hours each. Patients were assessed in terms of the dependent variables before and after treatment and again at follow-up after 3 months. Compared to the waiting-list controls, patients in the combined treatment group (receiving cognitive restructuring and exposure) showed significant improvement at the end of treatment on all the target phobia variables, most of the social phobia variables (except for interaction anxiety and avoidance/distress), dysfunctional automatic thoughts and severity of depression. These improvements were maintained at follow-up. The combined treatment with hypnosis yielded similar results, when compared to the waiting-list control condition. In addition, this group also showed significant improvement in avoidance of and distress in social situations. A comparison of the two treatment conditions showed that they largely rendered similar results. However, the combined treatment with hypnosis yielded significantly greater improvement in terms of dysfunctional automatic thoughts compared to the treatment without hypnosis. Tentative indications were also found that adding hypnosis to the combined treatment fascilitated its ability to reduce avoidance behaviour in social phobia. The combined treatment with hypnosis did not, however, render greater change in attentional bias as reflected by the emotional Stroop task.

AFRIKAANSE OPSOMMING: 'n Belangrike beswaar teen die kognitiewe gedragsterapie is dat dit grootliks op strategiese kognitiewe prosessering fokus en dat daar nie genoegsaam aan nie-bewustelike, nie-verbale, outomatiese gedagtes aandag gegee word nie. Die kombinasie van hipnose met bestaande kognitiewegedragsterapeutiese prosedures word toenemend beskou as 'n manier om die probleem op te los. Die doel van hierdie studie was derhalwe om na te gaan of die effektiwiteit van 'n gestruktureerde groepkognitiewegedragsterapieprogram vir die behandeling van sosiale fobie beduidend verbeter kan word deur hipnose by die program te inkorporeer, en indien sodanige verbetering plaasgevind het, of dit oor 'n langer termyn gehandhaaf sou word. Die studie het 'n toets-hertoets-opvolgontwerp behels en 45 pasiënte met 'n DSM-lV-diagnose van sosiale fobie het daaraan deelgeneem. Vyftien pasiënte is met Heimberg (1991) se groepkognitiewegedragsterapie vir sosiale fobie (bestaande uit kognitiewe herstrukturering en blootstelling en ook die gekombineerde behandeling genoem) behandel, terwyl16 pasiënte dieselfde behandeling aangevul met hipnose ontvang het. Veertien pasiënte het 'n waglys-kontrolegroep gevorm. Vir behandelingsdoeleindes is die twee behandelingsgroepe in twee subgroepe van 7 of 8 deelnemers elk verdeel. Die uitwerking van die behandelings is in terme van 13 afhanklike veranderlikes wat in die volgende vier breë kategorieë verdeel is, ondersoek: teikenfobie-veranderlikes (angs/vermyding/ontsnapping ten opsigte van 'n spesifieke fobie), sosialefobie-veranderlikes (wat met die graad, aard, aspekte en/of gevolge van sosiale fobie verband hou), kognitiewe veranderlikes (gedagte-funksionaliteit, vrees-virnegatiewe- evaluasie deur ander en aandagsverdraaiing), en graad van depressie. Behandeling deur twee ko-terapeute het in 12 weeklikse groepsessies van 2 uur elk geskied. Pasiënte is voor behandeling, na afloop daarvan en na 'n opvolgperiode van 3 maande in terme van die afhanklike veranderlikes beoordeel. Die gekombineerde behandeling (bestaan uit kognitie-.ve herstrukturering en blootstelling) het, in vergelyking met die waglys-kontrolekondisie, aan die einde van behandeling tot 'n verbetering gelei van al die teikenfobie-veranderlikes, die meeste van die sosialefobie-veranderlikes (met uitsondering van sosialefobie-interaksie-angs en sosialefobie-vermyding/-ongemak), disfunksionele outomatiese gedagtes en graad van depressie. Hierdie verbeterings is gehandhaaf oor die opvolgperiode van 3 maande. In vergelyking met die waglys-kontrolekondisie het die gekombineerde behandeling met hipnose dieselfde resultate gele-.ver as die gekombineerde behandeling daarsonder. Addisioneel hiertoe het hierdie groep ook beduidend verbeter in terme van vermyding van en ongemak in sosiale-situasies. 'n Vergelyking van die effekte van die twee behandelingsprosedures het aangetoon dat hulle grootliks dieselfde resultate gel9lNer het. Die gekombineerde behandeling met hipnose het egter 'n groter verbeterende effek op disfunksionele outomatiese gedagtes gehad as die gekombineerde behandeling daarsonder. Aanduidings is ook gevind dat die byvoeging van hipnose by die gekombineerde behandeling 'n groter verbetering in vermydingsgedrag gefasiliteer het. Die gekombineerde behandeling met hipnose het egter nie 'n groter effek op aandagsverdraaiing as die behandeling daarsonder gehad nie.

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