Abnormal Psychology

Anxiety Disorders 287

with other research results (Van der Linden et al., 2000). And perhaps most striking,

1 year later, the people who had the greatest reduction in activation from the fi rst scan

to the second scan were the most improved clinically. This means that the brain scans

indicated how well the treatment worked for people with social phobia.

As shown by the study by Furmark and colleagues (2002), described above, cogni-

tive methods can alleviate symptoms of social phobia. Such treatment helps individuals

to identify irrational thoughts about social situations, develop more realistic thoughts

and expectations, and test predictions about the consequences of engaging in specifi c

behaviors (Antony & Barlow, 2002; Clark et al., 2006). For instance, let’s say that a

marketing manager is concerned that his voice might crack while making a presenta-

tion. Cognitive restructuring would address this concern: What would happen if his

voice did crack? How could he resume his presentation? As the marketing manager

identifi es his automatic negative thoughts, he can develop more rational thoughts about

giving presentations and develop possible solutions should his fears become reality.

In addition, the behavioral method of exposure can be very effective in treat-

ing people with social phobia: When people put themselves in social situations in

order to habituate to their anxiety symptoms, their anxiety diminishes (Taylor,

1996). However, for those who do not want to participate in group therapy, or for

those whose social anxiety is extremely high, exposure in individual sessions may

allow them to habituate to less overwhelming stimuli that lead them to feel anxious.

Following this, they are habituated to increasingly challenging stimuli. Table 4.3

(p. 127) provides an example of the kind of hierarchy of fear and avoidance of so-

cial situations that is used for exposure.

Targeting Social Factors: Group Interactions

Changing someone’s thoughts and feelings about social interactions is an important

part of treating social phobia (McEvoy et al., in press). However if the patient does

not actually interact more with others after the treatment, then it cannot be consid-

ered a success. A patient might feel less anxious about social interactions but still

avoid them out of habit. Because the very nature of the anxiety symptoms relate

to social interactions, group therapy is the preferred mode of exposure treatment.

Such therapy immerses people in the very type of experience that is associated with

anxiety. Cognitive-behavioral group therapy uses exposure and cognitive restruc-

turing in a group setting. This setting allows patients to try out their new skills

immediately (Heimberg et al., 1990; Heimberg et al., 1998). Moreover, the expo-

sure involved in group therapy helps to extinguish the conditioned bodily arousal

(learned alarm) that arises in social situations. Cognitive-behavioral group therapy

is as effective as medication (Davidson et al., 2004) and has the added benefi t that

the positive effects continue after treatment ends (Mörtberg et al., 2006).

In addition to therapy groups, there are self-help organizations for people who

are afraid of speaking in public, such as Toastmasters, which give individuals an

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7.9 • Effects of CBT and an SSRI on

Brain Activity Results from a study by

Furmark and colleagues (2002) show that

activity in the amygdala, the hippocampus,

and related areas was reduced by both CBT (a)

and the SSRI citalopram (b). Brighter colors

indicate greater reduction in activity. The

scans are shown as viewed from the bottom.

Source: Furmark et al., 2002, Fig. 2-a. For more

information see the Permissions section.

Figure 7.9

(a) (b)

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