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Despite the vast majority of evidence indicating the efficacy of traditional and recent cognitive behaviour therapy (CBT) therapies in treating social anxiety disorder (SAD), some individuals with SAD do not improve by these interventions, particularly when co-morbidity is present.
It is not clear how emotion regulation therapy (ERT) can improve SAD co-morbid with symptoms of generalized anxiety disorder (GAD) and depression. This study investigated this gap.
Treatment efficacy was assessed using a single case series methodology. Four clients with SAD co-occurring with GAD and depression symptoms received a 16-session version of ERT in weekly individual sessions. During the treatment, self-report measures and clinician ratings were used to assess the symptom intensity, model-related variables, and quality of life, work and social adjustment of participants every other week throughout the treatment. Follow-up was also conducted at 1, 2 and 3 months after treatment. Data were analysed using visual analysis, effect size (Cohen’s d) and percentage of improvement.
SAD clients with depression and GAD symptoms demonstrated statistically and clinically significant improvements in symptom severity, quality of life, work, social adjustment and model-related measures (i.e. negative emotionality/safety motivation, emotion regulation strategies). The improvements were largely maintained during the follow-up period and increased for some variables.
These findings showed preliminary evidence for the role of emotion dysregulation and motivational factors in the aetiology and maintenance of SAD and the efficacy of ERT in the treatment of co-morbid SAD.
Given the personal and societal costs associated with acute impairment and enduring post-traumatic stress disorder (PTSD), the mental health response to disasters is an integral component of disaster response planning. The purpose of this paper is to explore the compatibility between cognitive-behavioral psychology and the disaster mental health model, and explicate how cognitivebehavioral perspectives and intervention methods can enhance the effectiveness of disaster mental health services. It is argued that cognitive-behavioral methods, if matched to the contexts of the disaster and the needs of individuals, will improve efforts to prevent the development of PTSD and other trauma-related problems in survivors of disaster or terrorist events. First, the similarities between models of care underlying both disaster mental health services and cognitive-behavioral therapies are described. Second, examples of prior cognitive-behavioral therapy-informed work with persons exposed to disaster and terrorism are provided, potential cognitive-behavioral therapy applications to disaster and terrorism are explored, and implications of cognitive-behavioral therapy for common challenges in disaster mental health is discussed. Finally, steps that can be taken to integrate cognitive-behavioral therapy into disaster mental health are outlined. The aim is to prompt disaster mental health agencies and workers to consider using cognitive-behavioral therapy to improve services and training, and to motivate cognitive-behavioral researchers and practitioners to develop and support disaster mental health response.
Interest in the study of anxiety disorders has increased dramatically since the publication of the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III; American Psychological Association (APA), 1980). In fact, the 1980s witnessed a 10-fold increase in the number of published articles devoted to the study of anxiety disorders (Norton et al., 1995), and anxiety disorders were the topic of 14% of the articles published in clinical psychology and psychiatry journals between 1990 and 1992 (Cox et al., 1995). The large majority of these studies focused on panic disorder (McNally, 1994) and social phobia (Heimberg et al., 1995). However, investigations of generalized anxiety disorder (GAD) have recently begun to appear with increasing frequency (Borkovec et al., 1991; Brownand Barlow, 1992; Wittchen et al., 1994).
Compared to other anxiety disorders, GAD remains poorly understood. Advances in understanding have been slowed by the evolving definition of the disorder. In DSM-III, GAD was a residual category that could not be diagnosed in the presence of any other anxiety or affective disorder (APA, 1980). Attempts to diagnose GAD according to DSM-III criteria were also characterized by low inter-rater reliability (Barlow, 1987). However, the diagnostic criteria for GAD changed substantially from DSM-III to DSM-IV (APA, 1994). GAD is no longer considered to be a residual category, but a disorder specifically characterized by excessive and uncontrollable worry and somatic symptoms suggestive of central nervous system hyperarousal (e.g., muscle tension).
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