Workshop 6

 

Cognitive Therapy for Social Anxiety Disorder

David M Clark. Institute of Psychiatry, UK

 

 

 David Clark

Social anxiety disorder is common and disabling. Epidemiological studies show it has a particularly low natural recovery rate, emphasizing the need for effective treatment. Clark and Wells (1995) proposed a cognitive model of the maintenance of the disorder and, with colleagues, developed a specialized cognitive therapy programme which aims to treat the disorder by reversing the maintenance processes specified in the model (self-focused attention, use of interoceptive information to make erroneous inferences about one’s social performance, covert and overt safety behaviors, distorted self-imagery, and other mental processes). Randomized controlled trials have shown that the cognitive therapy programme is associated with a high recovery rate and is more effective than exposure therapy, various group CBT programmes, and treatment with SSRIs. The workshop provides a detailed account of the cognitive model, particularly focusing on its treatment implications. Each of the steps in treatment (deriving the cognitive model with the patient; the attention and safety behaviours experiment; video and audio feedback; training in externally focused attention; setting up and conducting behavioural experiments; imagery techniques; rescripting of problematic early experiences; conducting surveys; working with assumptions) is described and illustrated with case material and videos of treatment sessions.
 
Key Objectives: By the end of the workshop, participants should be able to:
1) Identify key processes in maintaining social phobia
2) Develop an individual version of the cognitive model with their patients and
3) Be able to identify and plan appropriate therapeutic techniques.

Training Modalities: Didactic, experiential exercises, viewing videos of live treatment sessions.
 
David M. Clark is Professor of Psychology at the Institute of Psychiatry and Director of the Centre for Anxiety Disorders and Trauma at the Maudsley Hospital (UK).  He is also a Distinguished Founding Fellow of the Academy of Cognitive Therapy (USA) and recipient of the Behaviour Research and Therapy award for the most outstanding article (‘A cognitive approach to panic’)  published during the first 30 years of that journal.  In collaboration with colleagues, his research has led to the development of new and effective cognitive therapy programmes for 4 different anxiety disorders (panic disorder, hypochondriasis, social phobia, and post-traumatic stress disorder).
 
References: 1) Clark, D.M. and Wells, A. (1995). A cognitive model of social phobia. In RG Heimberg, M. Liebowitz, D.Hope and F.Scheier (Eds) Social Phobia: Diagnosis, Assessment and Treatment. Pp 69-93. Guilford: New York.
2) Clark, D.M., Ehlers, A., McManus, F., Hackmann, A., Fennell, M.J.V., Campbell, H., Flower, T., Davenport, C. and Louis, B. (2003).  Cognitive therapy vs fluoxetine plus self-exposure in the treatment of generalized social phobia (social anxiety disorder): a randomized controlled trial. Journal of Consulting and Clinical Psychology, 71, 1058-1067.
3) Clark, D.M., Ehlers, A., Hackmann, A., McManus, F., Fennell, M.J.V., Waddington, L., Grey, N, and Wild, J. (2006). Cognitive therapy and exposure plus applied relaxation in social phobia: a randomized controlled trial. Journal of Consulting and Clinical Psychology, 74, 568-578.