109L
eon is a 45-year-old postal employee who was evaluated at
a clinic. He claims to have felt constantly depressed since
the fi rst grade, without a period of ‘normal’ mood for more
than a few days at a time. His depression has been accom-
panied by lethargy, little or no interest or pleasure in any-
thing, trouble concentrating, and feelings of inadequacy,
pessimism, and resentfulness. His only periods of normal
mood occur when he is home alone, listening to music or
watching TV.
“On further questioning, Leon reveals that he cannot ever
remember feeling comfortable socially. Even before kindergarten, if
he was asked to speak in front of a group of his parents’ friends, his
mind would ‘go blank.’ He felt overwhelming anxiety at children’s
social functions, such as birthday parties, which he either avoided
or, if he went, attended in total silence. He could answer questions
in class only if he wrote down the answers in advance; even then, he
frequently mumbled and couldn’t get the answer out. He met new
children with his eyes lowered, fearing their scrutiny, expecting to
feel humiliated and embarrassed. He was convinced that everyone
around him thought he was ‘dumb’ or ‘a jerk.’
“As he grew up, Leon had a couple of neighborhood playmates,
but he never had a ‘best friend.’ His school grades were good, but suf-
fered when oral classroom participation was expected. As a teenager,
he was terrifi ed of girls, and to this day he has never gone on a date
or even asked a girl for a date. This bothers him, although he is so
often depressed that he feels he has little energy or interest in dating.
“Leon attended college and did well for a while, then dropped
out as his grades slipped. He remained very self-conscious and
‘terrifi ed’ of meeting strangers. He had trouble fi nding a job because
he was unable to answer questions in interviews. He worked at a
few jobs for which only a written test was required. He passed a
civil service exam at age 24 and was offered a job in the post offi ce
on the evening shift. He enjoyed this job as it involved little con-
tact with others. He was offered several promotions but refused
them because he feared the social pressures. Although by now he
supervises a number of employees, he still fi nds it diffi cult to give
instructions, even to people he has known for years. He has no
friends and avoids all invitations to socialize with co-workers....
Leon has never experienced sudden anxiety or a panic attack in
social situations or at other times. Rather, his anxiety gradually
builds to a constant high level in anticipation of social situations.”
(Spitzer et al., 2002, pp. 124–125)Foundations Of Treatment
CHAPTER
4
Chapter Outline
Treatments That Target Neurological
Factors
Medications that Change Brain Functioning
Changing Brain Function Through Brain
Stimulation
Biofeedback
Changing Brain Structure Through
NeurosurgeryOlder Populations Targeting Social Factors in Younger and
and Older Populations
Treatments That Target Psychological
Factors
Psychodynamic Therapy
Client-Centered Therapy
Cognitive-Behavior Therapy
Incorporating Technology Into Treatment
Targeting Psychological Factors in Younger
and Older Populations
Treatments That Target Social Factors
Interpersonal Therapy
Family and Systems Therapy
Group TherapyCommunity-Based Treatment x Contents
Targeting Social Factors in Younger and
Older PopulationsTreating a Multicultural Population
Finances and Managed Care
Creating a Treatment Plan
Choosing a Specifi c Treatment
Choosing One or More Treatments
‘‘
Diane Fenster