Cognitive behavioural treatment of social phobia [Elektronische Ressource] : bridging the gap between research and practice / vorgelegt von Tania Marie Lincoln

Sujets

• Psychologie
• Gesundheit

Informations

• Publié par: philipps-universitat_marburg
• Publié le: 01 janvier 2003
• Nombre de lectures: 13
• Langue: English

Extrait

Cognitive Behavioural Treatment
of Social Phobia
Bridging the Gap between Research and Practice



DISSERTATION
zur Erlangung des Doktorgrades
der Naturwissenschaften
(Dr. rer. nat.)

dem Fachbereich Psychologie
der Philipps-Universität Marburg
vorgelegt von


Tania Marie Lincoln
aus Marburg





Marburg/Lahn, Februar 2003











Erstgutachter: Prof. Dr. Winfried Rief

Zweitgutachter: Prof. Dr. Gert Sommer

Tag der mündlichen Prüfung: 03. Juli 2003


Bibliography
Bibliography

Preliminary Comments______________________________________________________IV
Acknowledgements__________________________________________________________V


1. Theoretical Background ___________________________________________________ 1
1.1. Social Phobia: Concept and Classification ________________________________ 1
1.2. Differential Diagnosis _________________________________________________ 3
1.2.1. Panic Disorder_____________________________________________________ 3
1.2.2. Generalized Anxiety Disorder ________________________________________ 4
1.2.3. Depression _______________________________________________________ 4
1.2.4. Avoidant Personality Disorder 5
1.3. Epidemiology ________________________________________________________ 5
1.3.1. Prevalence 5
1.3.2. Developmental Aspects _____________________________________________ 6
1.3.3. Risk Factors and Socio-demographic Correlates __________________________ 6
1.3.4. Comorbidity ______________________________________________________ 7
1.4. The Biological Basis of Social Phobia ____________________________________ 7
1.4.1. Genetic Factors ____________________________________________________ 7
1.4.2. Neurobiological Factors _____________________________________________ 8
1.4.3. Evolutionary Factors________________________________________________ 9
1.5. Cognitive and Behavioural Models of Explanation ________________________ 10
1.5.1. Early Theories 10
1.5.2. Integrative Models 13
1.6. Treatment of Social Phobia____________________________________________ 15
1.6.1. Cognitive Behavioural Interventions __________________________________ 15
1.6.2. Pharmacological Treatment _________________________________________ 18
1.6.3. Present State of Treatment Research 19 Bibliography
2. Purpose and Summary of the Studies ________________________________________ 24
2.1. Purpose and Summary of STUDY I_____________________________________ 24
2.2. Pu STUDY II ____________________________________ 26
2.3. Pu STUDY III ___________________________________ 28
3. STUDY I_______________________________________________________________ 30
3.1. Introduction ________________________________________________________ 30
3.2. Method ____________________________________________________________ 32
3.2.1. Retrieval of Studies________________________________________________ 32
3.2.2. Study Sample ____________________________________________________ 32
3.2.3. Data Analysis Plan 33
3.3. Results _____________________________________________________________ 35
3.3.1. Comparison of Studies According to Sample and Laboratory Characteristics __ 35
3.3.2. Effects of Accumulative Research Characteristics________________________ 35
3.3.3. Effect of Sample Selection on the Standard Deviations ____________________ 36
3.4. Discussion __________________________________________________________ 36
4. STUDY II ______________________________________________________________ 42
4.1. Introduction ________________________________________________________ 42
4.2. Method ____________________________________________________________ 45
4.2.1. Setting 45
4.2.2. Participants ______________________________________________________ 45
4.2.3. Treatment _______________________________________________________ 46
4.2.4. Therapists 48
4.2.5. Measures ________________________________________________________ 49
4.3. Results _____________________________________________________________ 51
4.3.1. Comparison of Treatment Completers and Dropouts ______________________ 51
4.3.2. Preliminary Analyses ______________________________________________ 52
4.3.3. Treatment Outcome and Consumer Satisfaction _________________________ 53
4.3.4. Intra Group Effect Sizes, Reliable Change, and Clinical Significance_________ 53
4.3.5. Effects of Sample Selection _________________________________________ 55
4.4. Discussion __________________________________________________________ 55 Bibliography
5. STUDY III _____________________________________________________________ 65
5.1. Introduction ________________________________________________________ 65
5.2. Method ____________________________________________________________ 68
5.2.1. Setting __________________________________________________________ 68
5.2.2. Treatment _______________________________________________________ 68
5.2.3. Participants ______________________________________________________ 69
5.2.4. Measures 70
5.2.5. Analysis ________________________________________________________ 72
5.3. Results _____________________________________________________________ 73
5.3.1. Preliminary Analyses ______________________________________________ 73
5.3.2. Predictors of Treatment Refusal and Dropout ___________________________ 74
5.3.3. Predictors of Treatment Outcome_____________________________________ 74
5.3.4. Predictors of Dterioration after Treatment ______________________________ 75
5.4. Discussion __________________________________________________________ 75
6. Summary ______________________________________________________________ 88
6.1. Summary___________________________________________________________ 88
6.2. Zusammenfassung ___________________________________________________ 90
7. References _____________________________________________________________ 93
Preliminary Comments IV
Preliminary Comments

I would like to use to opportunity to comment on a couple of formal aspects of this work.
The first chapter contains an introduction to the theoretical background of the concept,
epidemiological aspects, aetiology and treatment of social phobia. Because the emphasise of
this work is placed on the evaluation of treatment for social phobia, the theoretical part also
focuses largely on the description of aetiological models and the treatment concepts derived
from them as well as on the current state of treatment research.
The second chapter gives a short introduction to the intention, methods and results of the three
conducted studies. The chapters 3, 4, and 5 are the original versions of the publication-based
manuscripts. The second study „Effectiveness of an Empirically Supported Treatment for
Social Phobia in the Field” is now in press in the Journal “Behaviour Research and Therapy”.
In the appendix the interested reader will find a table of the studies analysed in STUDY I, a
more detailed description of the complete patient sample underlying STUDY III, a detailed
description of the therapeutic procedure as well as a copy of all assessment measures and
formulas used.
Because the publication based manuscripts were submitted in English language it seemed
appropriate, for reasons of standardization, to write the complete doctoral dissertation in
English. The sole exceptions to this are the German summary as well as the German original
questionnaires and formulas depicted in the appendix.
Acknowledgements V
Acknowledgements
In the course of my research for this doctoral dissertation, I was supported by a number of
people to whom I would like to express my gratitude.
First of all I would like to thank Prof. Dr. Winfried Rief and Prof. Dr. Kurt Hahlweg for their
constructive guidance and practical assistance and particularly for the suggestion to conduct
this work in an accumulated, publication based manner. The structure of combining individual
units written for a wider leadership into a continuous whole has had a very motivating effect.
I am especially obliged to the management board of the Christoph-Dornier-Foundation for
Clinical Psychology and the director of the institute in Marburg, Dr. Monika Frank. The
Christoph-Dornier-Foundation has supported this work in many ways. I would like to
emphasize the financial resources they made available as well as the free access to all data
laboriously compiled by colleagues and assistants. Finally, I have greatly benefited from the
opportunity to carry out treatment for social phobic patients and thus develop a personal
understanding of the disorder that is the underlying basis of this work. I am particularly
indebted to all trainees in the Christoph-Dornier-Foundation, who so patiently supported me
in gathering literature and entering data into the computer. I am also grateful for all the
personal support and informed advice I received from my colleagues Vera Martin and
Thomas Lang. Finally, I would like to mention by name the colleagues who founded the
group “Promoventen unterstützen Promoventen [doctorands support doctorands],” - Dr. Anne
Wietasch, Dr. Markus Fu