Elsevier

Behavior Therapy

Volume 47, Issue 5, September 2016, Pages 669-674
Behavior Therapy

Social Phobia: The Role of In-Situation Safety Behaviors in Maintaining Anxiety and Negative Beliefs – Republished Article,☆☆

https://doi.org/10.1016/j.beth.2016.08.010Get rights and content

One of the puzzles surrounding social phobia is that patients with this problem are often exposed to phobic situations without showing a marked reduction in their fears. It is possible that individuals with social phobia engage in behaviors in the feared situation that are intended to avert feared catastrophes but that also prevent disconfirmation of their fears. This hypothesis was tested in a single case series of eight socially phobic patients. All patients received one session of exposure alone and one session of exposure plus decrease in "safety" behaviors in a counterbalanced within-subject design. Exposure plus decreased safety behaviors was significantly better than exposure alone in reducing within-situation anxiety and belief in the feared catastrophe. Other factors that may moderate exposure effects are also discussed.

Section snippets

Subjects

Eight patients (five female) meeting DSM-III-R (APA, 1987) criteria for social phobia as operationalized by the Structured Clinical Interview for DSM-111-R (Spitzer, Williams, & Gibbons, 1987) were selected for the study. (Although diagnostic reliability data are unavailable, SCID interviews were all conducted by A. W., who had received training in the use of the instrument and had four years subsequent experience.) Patients' ages ranged from 24 to 53 years. None met criteria for avoidant

Results

The patients' main fears and associated safety behaviors are shown in Table 1. Four patients were concerned with symptoms of shaking and interpreted these as a sign of "loss of control," two patients were concerned with "talking funny," one was concerned with "vomiting" and the other with "collapsing." A wide range of in-situation safety behaviors were elicited, and patients' belief in the feared outcomes ranged from 50 to 1000% just before exposures to the feared situation on the first

Discussion

The results of this initial study were as predicted. One session of exposure with decreased safety behaviors and appropriate information-processing rationale was significantly more effective than exposure of equivalent duration with no change in safety behaviors and an extinction rationale. For most patients, both types of exposure produced decrements in anxiety and belief. However, the mean decrement was greater in the decrease condition. In addition, although all patients showed improvements

Conflict of Interest Statement

The authors declare that there are no conflicts of interest.

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This research was supported by grants from the Medical Research Council of the United Kingdom and the Welcome Trust. Correspondence concerning this article should be addressed to Adrian Wells, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, U.K.

☆☆

This article is a reprint of a previously published article. For citation purposes, please use the original publication details; Behavior Therapy, 29 (1998), pp 357–370.

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