The Diagnostic and Statistical Manual (DSM-IV-TR) describes Social Phobia as having an intense and persistent fear of social or performance situations that causes immediate anxiety, and the fear, avoidance, or anticipation associated with such an event causes significant impairment to an individual’s life (American Psychiatric Association, 2000). Social Phobia may be further defined as being specific, in which fears only arise in certain circumstances such as public speaking, or generalized when fears occur in most social situations (American Psychiatric Association, 2000).
Social Phobia, Generalized is more common, and individuals typically fear circumstances involving both public performances and social interactions (American Psychiatric Association, 2000). Accordingly to 2002 Canadian Community Health Survey: Mental Health and Well-Being from Statistics Canada, 8% of Canadians over the age of 15 years suffer from Social Phobia during their lifetime (Shields, 2004). Although most people with Social Phobia recognize that their fear is irrational only 37 % with a lifetime history actually seek treatment (Shields, 2004).
Social Phobia is associated with reduced educational achievements, fewer employment opportunities, social isolation, and dissatisfaction with life and health (Shields, 2004). Literature Review Cognitive-behavioral therapy (CBT) has been shown to be an effective treatment for anxiety disorder (Cartwright-Hatton, Roberts, Chitsabesan, Fothergill,& Harrington, 2004; Ollendick, & King, 1998), public speaking anxiety (Anderson, Zimand, Hodges, & Rothbaum, 2005), social phobia (Curtis, Kimball, & Stroup, 2004), general anxiety disorder (Gosch, Flannery-Schroeder, Mauro, & Comptom, 2006).
Aand separation anxiety disorder in children ( Dia, 2001; Gosch et al. ). CBT programs include cognitive therapy, Eye Movement Desensitization and Reprocessing (EMDR), exposure therapy, stress inoculation training (SIT), and prolonged exposure therapy (PE), sometimes implemented individually and other times in combination (e. g. , PE + SIT) ( Cahill, Foa, Hembree, Marshall , & Nacash, 2006) . Exposure therapy comes from the learning-theory construct of extinction and it involves “exposing patients to the feared stimuli in a safe context” (Massad & Hulsey, 2006, p.418), with the goal of diminishing their fear response.
Although CBT has traditionally been used in combination with medication to treat phobias, there are studies that explore the use of CBT with exposure therapy. For example, Curtis, Kimball & Stroup (2004) explore the research to develop a better understanding of social phobia and a combined treatment of counseling and pharmacological treatments. They also explore CBT with and without exposure therapy and they determine that CBT together with exposure therapy has the best efficacy and that this is superior to using them alone.
Anderson, et al (2005) conducted a study in which they used an open clinical trial to test a cognitive behavioral treatment for public speaking anxiety and used virtual reality as a tool for exposure therapy. The study provides preliminary evidence that cognitive behavioral treat with exposure therapy may reduce public speaking anxiety although further research with a controlled design is recommended. Rowa, & Antony (2005) reviewed the empirical status of treatments for social phobia with a focus on cognitive-behavioral interventions using wait list controls and supportive therapy as comparisons.
Although there were some conflicting results, it was stated that a combination of CBT and exposure therapy are the most effective treatment for social phobia. Finally, Silverman, & Kurtines (1997) address the field of child psychosocial intervention from a broad perspective and in doing so, show that exposure is a key ingredient, together with CBT as the most effective way of reducing phobic and anxiety symptomology.