Residential cognitive and interpersonal treatment for social phobia: Outcomes, predictors and factors associated with in treatments changes of social phobia
Appears in the following Collection
- Psykologisk institutt 
AbstractThe prevalence of social phobia is high, and the impact on the life of individuals suffering from this disorder is devastating. Several studies have shown that individuals with social phobia have difficulties to apply for help. When they do seek treatment, they have often not responded. If untreated, it demonstrates an enduring, and frequently lifelong course. As a consequence, it is important to develop effective treatments. The aim of this dissertation is to gather knowledge on how well two promising different psychological treatments for social phobia; cognitive and interpersonal therapy, could be implemented in a residential setting, which factors affected the course of treatment, and for whom the treatment was most suitable. Individual cognitive therapy (CT) for social phobia has produced large improvement on specific social phobia symptoms, whereas individual interpersonal therapy (IPT) has lead to promising improvement, but not equivalent to CT. The dissertation consists of three papers on patients admitted to two specifically developed residential treatment programs localized at two different departments at the Modum Bad psychiatric hospital. The treatments were medication-free. The 80 participants were randomized to either residential CT or residential IPT and assessed at evaluation, pre treatment, mid treatment, post treatment, and one year follow-up.
The first paper reports on the effect of treatments at mid treatment, post treatment and one year follow up. The key findings were reliable improvements on main and secondary outcomes from pre treatment to posttreatment, and from post treatment to one year follow-up, indicating that the improvements were robust and permanent. Twenty five patients (31%) exhibited clinically significant improvement at post treatment, rising to 38 (48%) at one year follow-up. These were considered to have recovered. Additional patients had reliably improved (but not recovered), so that 45 patients (56%) had improved at post treament, and 56 (70%) at one year follow-up. No between treatment condition differences were observed, the hypothesized superiority of residential CT on specific sosial phobia symptoms did not occure.
The second paper examines the course of avoidant (AvPD) and dependent (DPD) personality disorders, pre treatment predictors of changes in avoidant (AvPD) and dependent (DPD) personality dimensions and how changes of in treatment factors affect changes in these personality dimensions. The results showed a marked decrease in number of patients who satiesfied the criteria of a PD at one year follow-up, and the majority of patients had no PD. Only pre treatment use of anxiolytics predicted changes in the PD indices, so that pre treatment use of anxiolytics predicted larger improvements. Patients in residential CT improved more on DPD dimension than residential IPT patients. Changes in the cognitive factor estimated cost was the most powerful in treatment factor associated with changes in DPD and AvPD dimensions.
The third paper explores predictors of post treatment and one year follow-up outcome, with a focus on the influence of cognitive and social dysfunction. Sotsky and colleagues (1991) found differential effects of CT and IPT for depression, suggesting that level of cognitive and social dysfunction predicted differential outcome. Sotsky and colleagues’ findings were not reproduced. Residential IPT patients with poor pre treatment general functioning were less improved following treatment, whereas pre treatment level of dysfunction was of no significance in residential CT. Patients with comorbid panic disorder with agoraphobia responded better compared to patients without such comorbidity, in residential CT. Age of onset and expectations were the most powerful predictors of post treatment outcome. Age of onset also predicted the one year outcome, exhibiting a robust longer term effect.
List of papers. Papers I-III are removed from the thesis due to copyright restrictions.
Paper I: Borge, F.-M., Hoffart, A., Sexton, H., Clark, D. M., Markowitz, J. C., & McManus, F. (2008). Residential Cognitive Therapy versus Residential Interpersonal Therapy for Social Phobia: A Randomized Clinical Trial. Journal of Anxiety Disorders, 22, 991-1010. doi:10.1016/j.janxdis.2007.10.002
Paper II: Borge, F.-M., Hoffart, A., Sexton, H., Martinsen, E., Gude, T., Hedley, L. M., & Abrahamsen, G. (2010). Pre-treatment predictors and in-treatment factors associated with change in avoidant and dependent personality dimensions among patients with social phobia. Clinical Psychology and Psychotherapy, 17, 87–99. doi:10.1002/cpp.640
Paper III: Borge, F.-M., Hoffart, A., & Sexton, H. (2010). Predictors of short term and longer term outcome in Residential Cognitive and Interpersonal Treatment for social phobia: Do cognitive and social dysfunction moderate treatment? Journal of Behavior Therapy and Experimental Psychiatry, 41, 212–219. doi:10.1016/j.jbtep.2010.01.005