The Success of Treatments for Social Anxiety Disorder Essay

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The Success of Treatments for Social Anxiety Disorder Essay

With the increased dependence on others because of the boom in societies’ populations, social skills are becoming more of a necessity in the normal functioning of individuals. Behaviors which obstruct the normal functioning of individuals in social situations are therefore a growing cause of concern. One such behavior is the psychological disorder, social anxiety disorder. Social anxiety disorder is a psychological disorder characterized by a persistent fear of negative evaluation from others in social situations to which the individual is exposed (Stein, 2006). Because of this increase in fear of experiencing humiliation, there is an observed pattern of irregular functioning as well as clinically diagnosed distress in the individual (Stein, 2006).

This therefore stops the suffering individual from relating to others in regular social situations. Furthermore, the distress resulting from the fear incapacitates the individual from other day-to-day patterns of behavior. Social anxiety disorder manifests during early stages of human development and has been found to be one of the most prevalent mental disorders (Stein, 2006). Because of this, an increase in concern has been raised for the treatment of the disorder, especially because the nature of the disorder prevents individuals from seeking treatment of the same.

This paper will deal with two therapies used in treating social anxiety disorder. The treatment procedures offered by cognitive-behavioral therapy and pharmacotherapy, the use of medicine in treatments. This will be done by reviewing several articles written by experts studying methods of treating the symptoms of social anxiety disorder. Also the effectiveness of the different treatment procedures in helping clients will be discussed. By the end of this paper a clearer picture will have been made of the research methods utilized in studying social anxiety disorder, the treatments suggested, and the effectiveness of such treatments.

The Importance of Working Alliance

Hayes, Hopes, VanDyke, and Heimberg (2007) conducted a study regarding the effectiveness of cognitive-behavior therapy in addressing the concerns of patients suffering from social anxiety disorder. One of the processes of cognitive-behavior therapy involves the firm establishment of an interpersonal relationship between the client and therapist. This relationship is known as the working alliance. Working alliance goes beyond forming a bond and involves the foundation of an agreement between the client and therapist regarding the tasks and goals of the therapy proceedings (Hayes et al., 2007). In their research study, Hayes et al. (2007) studied the role that working alliance played in having treatments result in effective treatments.

The research was conducted through first assessing that the patients were seeking treatment for social anxiety disorder and that no other therapist was being consulted (Hayes et al., 2007). Participants were then asked to rate the level of distress they felt before entering the therapy. After the session, participants and third-person observers rated the perceived level of working alliance as well as the degree of helpfulness of the session (Hayes et al., 2007). Only the first session was studied by the researchers as they believed this first session was important in knowing if the client would come back or not. This may have limited the results as the researchers couldn’t make sure if the long-term effectiveness of the treatment is because of working alliance or because of other reasons.

The research ended with the finding that high levels of working alliance didn’t lower the reported level of depression of the clients (Hayes et al., 2007). However, the treatment did get positive reports as to helpfulness. Those participants who reported moderate levels of working alliance showed decreases in depression (Hayes et al., 2007). In fact, those who reported before the session the highest levels of depression and showed the greatest decrease in depression after the session were those who reported average working alliance levels (Hayes et al., 2007).

The research raises the question whether or not an entirely open relationship with therapists would help change the non-helpful social behavior of participants. Also, the research does not clearly point out whether it is the process which clients say is helpful or if it’s working alliance. More than anything, this study points out the need to study more the processes of cognitive-behavior therapy so that it will be understood what particular process helps social anxiety disorder patients.

The Efficacy of Cognitive-Behavior Therapy

A research study conducted through the review of relevant past research was conducted by Zaider and Heimberg (2003). Past research was tapped through the use of literature searches, reference lists and research databases (Zaider & Heimberg, 2003). This provided the researchers with a long list of research papers to review – more than 100 papers were found but only 80 were accepted based on relevance. This method serves to summarize research conducted over the last fifteen years, making clear the contribution of each individual research conducted. But the study is limited because of the method used. Data still needs to be collected by studying the conclusions and proposals of this review of past literature.

The studies reviewed also reflected several treatment procedures used in cognitive-behavior therapy. To name some of these treatments: relaxation training, social skills training, exposure, cognitive-restructuring techniques, and combined exposure and cognitive restructuring (Zaider & Heimberg, 2003). However, the general conclusion that could be made was that the treatments were most efficient when applied together. The exact combination of treatments that would give the best results was not made clear though. But the research did conclude that the use of cognitive-behavior therapy greatly improves social performance fears (Zaider & Heimberg, 2003). Moreover, the therapy resulted in the improvement of social skills and feelings of depression associated with the disorder (Zaider & Heimberg, 2003).

The research reflects that cognitive-behavior therapy is quick to answer the needs of social anxiety disorder. But it doesn’t answer the question of which aspect of the therapy directly contributes to the improvement. With the many treatments that may be used in cognitive-behavior therapy it is vague which one results in the best stage of improvement. There is also no explanation regarding the concepts used in this theory which help patients overcome their disability.

Comparison between Cognitive Behavior Therapy and Pharmacological Interventions

A handout for clinical practice guidelines (Paris, 2006) further discussed the efficacy of cognitive-behavior therapy in treating social anxiety disorder. The goal was to determine methods of improving the helpfulness of the therapy. This was done through a comparison of the data obtained from past researchers treating social anxiety disorder with three different treatments: cognitive-behavior therapy alone, cognitive-behavior therapy combined with prescribed medications, and pharmacology alone (Paris, 2006). However, this comparison method doesn’t control for certain conditions which might not be present in all studies. This would leave room for error in the data obtained and not make the conclusions objective and reliable.

The research also enumerates the treatments applied in cognitive-behavior therapy. The list is similar to the list provided by Zaider and Heimberg (2003), as discussed earlier, except for the deletion of relaxation training and the addition of education and emotion-regulation approaches (Paris, 2006).

When the researchers compared the effectiveness of the three above-mentioned conditions, no significant were noted. Therefore there were no added benefits to the use of the therapies in combination as compared to applying them separately. However, the findings did show that after stopping treatment, improvements made through cognitive-behavior therapy lasted longer than those in pharmacotherapy (Paris, 2006). Such findings raise the question as to why cognitive-behavior therapies are not the default treatment for social anxiety disorder.

Combined Cognitive-Behavior Therapy and Pharmacotherapy

As has been said in the previous study, there have been little to no proof showing the benefits of combining cognitive-behavior therapy with pharmocological treatments. However, medications have been found to lead to faster relief than cognitive-behavior therapy which takes a long and slow process (Rodebaugh & Heimberg, 2005). On the other hand, medications have been associated with higher possibilities of relapse while cognitive-behavior therapy has shown low cases of relapse (Rodebaugh & Heimberg, 2005).

This accounts for the potential of exploring options for a combined treatments therapy. The possibility was studied through a review of current and recent research concerning combination treatments. But this review method fails to give a thorough control for factors which may affect the studied result along with the studied factors. There is no certainty of direct compatibility between studies.

The review of the current state of knowledge served to show that some experiments had resulted in the growth of improvement effects through the combination of the two therapies (Rodebaugh & Heimberg, 2005). However, this progress was observed only in the short-term effect of the therapy and no data is yet present as to the long-term benefits provided by combined treatments. It has further been found that clients who go through therapy may think that real-life practice situations as safe only when under medication. But when medication is stopped, the fear may return. This shows in truth, little improvement is made in the therapy sessions.

This research brings about more questions for future research than it does provide answers. Of particular focus for future research would be the long-term rise in improvements through the early prescription of medication to a client and the delayed start of psychotherapy. Given that the effectiveness of therapy undergone while under medication may only be observed after the stop of such medication, therapy must extend after medication has been stopped. This picture gives a probable combination treatment set up.

Pharmacological Treatments of Social Anxiety Disorder

Stein (2006) presented his study considering the effect of clinical practices combined with advancements in medical research. This was done through the review of current clinical guidelines. The effects of known medications when applied to individuals suffering from social anxiety disorder were also considered. This method serves to provide a clear picture of the role of pharmacology in the clinical setting. It also identifies the most effective medicine to prescribe to a client asking for help for social anxiety disorder. Unlike other studies which only find basis on the helpfulness of particular pharmaceutical products in combating disorders, this method, evidence-based treatment, looks at clinical data in order to identify the best medication may be given to a client (Stein, 2006).

The study reported that the selective serotonin reuptake inhibitors and serotonin-noradrenaline reuptake inhibitors were the primary pharmacological treatments recommended for manifesting social anxiety disorder (Stein, 2006). It was explained that selective serotonin reuptake inhibitors serve as effective short- and long-term treatments for social anxiety disorder. This treatment has been found to be superior to other medications available for social anxiety disorder. However, the occurrence of relapse was common in cases where treatments were not continued. It is therefore best to give long-term treatment for maximum improvement of the patient. Long- term treatment would also decrease the frequency of relapse.

Instead of concluding that selective serotonin reuptake inhibitors alone should be used for treatment, this research only encourages more research. Although the best possible medication has been identified, the contribution of other known medications has not been forgotten. Stein leaves open the possibility of creating new medicines for the treatment of social anxiety disorder with selective serotonin reuptake inhibitors as the main ingredient.

Summary of Research Material Reviewed

To summarize the research findings discussed above, the only successful psychotherapy so far applied to social anxiety disorder is cognitive-behavior therapy. This may be because of the close working alliance between the client and therapist as well as the real life experimentation which acts as practice for the client. This treatment has been found to have more long-lasting improvements than pharmacological treatments. However, on the basis of quality of improvements observed, no significant difference has been found between cognitive-behavioral and pharmacological treatments. It is theorized though that the best improvement environment might be achieved through the combination of the two treatments.

However, there is little evidence collected to support such a theory. It should also be noted that the most effective medication, on the basis of evidence from clinical records, has been identified as selective serotonin reuptake inhibitors. But the combination of this medication with others has not been considered or studied yet. Even though the research findings have not pinpointed the specific predictors of improvement in clients’ conditions, it has been shown that indeed social anxiety disorder may be treated. In fact the challenge for researchers is to make treatment conditions better in order to maximize the improvements already offered by current therapies.

Reflection on Research Findings

The research has served to the existing state of research clear. From the conclusions of the researchers it can be seen that successful treatments of social anxiety disorder have been achieved. However, the reliability of medication as a treatment for this disorder remains uncertain. Medication gives quick relief of the symptoms of social anxiety disorder. However, when taking medicine is stopped, relapse is not only likely, it is sure to follow.

On the other hand, cognitive-behavior therapy offers a more stable process of improvement with fewer chances of relapse. Although this therapy takes longer in showing improvement, the wide variety of treatments it offers allows for the specialization of client-therapy interactions based on the specific concerns and situation of individual clients. This allows for a stronger foundation of change. This would improve interaction even outside the clinical setting. This is quite different from the role of medication which is only to prevent the manifestation of symptoms without addressing the cause of the actual behavior being treated.

Although a combination treatment is hoped for, it should be remembered that medication might only bring about a false sense of reliance. Medication should therefore not be regarded as the primary intervention mechanism. It’s psychotherapy which empowers the individual to face different social situations. Cognitive-behavioral therapy gives the patient the ability to develop coping mechanisms which he or she will learn to apply in many different social interactions that may come his or her way.

References

Hayes, S.A., Hope, D.A., VanDyke, M.M., and Heimberg, R.G. (2007). Working Alliance for Clients with Social Anxiety Disorder: Relationship with Session Helpfulness and Within-Session Habituation, Cognitive Behaviour Therapy, 36(1), 34-42.

Paris, J. (2006). Social Anxiety Disorder. Canadian Journal of Psychiatry, 51(2), 35S-41S.

Rodebaugh, T.L. and Heimberg, G.T. (2005). Combined Treatment for Social Anxiety Disorder. Journal of Cognitive Psychotherapy: An International Quarterly, 19(4), 331-345.

Stein, D.J. (2006). Evidence-based treatment for social anxiety disorder. International Journal of Psychiatry in Clinical Practice, 10(1), 16-21.

Zaider, T.I. and Heimberg, R.G. (2003). Non-pharmacologic treatments for social anxiety disorder. Acta Psychiatrica Scandinavica, 108(417), 72-84.

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