Effect of group cognitive behavioral therapy based on Hofmann model on anxiety symptoms and brain behavioral systems in adults suffering from social anxiety disorder

Document Type : Research Paper

Authors

1 M.Sc. in clinical psychology, Ferdowsi University of Mashhad, Mashhad, Iran

2 Assistant professor of clinical psychology, Ferdowsi University of Mashhad, Mashhad, Iran

Abstract

Introduction: Social Anxiety Disorder (SAD) as a negative emotion can be associated with specific patterns of brain behavioral system functions. The purpose of this research is to evaluate the effectiveness of Hofmann-based CBT (Cognitive Behavioral Therapy) in reducing anxiety symptoms and improving brain behavioral system functions in patients suffering from social anxiety disorder.
Materials and Methods: This research is a semi-experimental study with a pretest/posttest plan. 20 SAD patients were randomly selected and divided equally into two groups (experimental and control). The experimental group underwent 12 sessions of Hofmann-based CBT, whereas the control group was placed in the waiting list. Anxiety disorder Interview Schedule for DSM-IV (ADIS-IV), Social phobia questionnaire, and Gary-Wilson’s personality questionnaire were used for evaluating results at pretests and posttests. Data were analyzed with descriptive indices and multivariate analysis of covariance (MANCOVA) by SPSS software.
Results: The experimental group showed significant improvement in total scores of social phobia, including fear (P<0.001), avoidance (P<0.001), and physiological discomfort (P<0.001)
Also, brain behavioral systems (including behavioral activation, behavioral inhibition, and fight/flight) showed significant improvement (P<0.001) in behavioral inhibition in the experimental group.
Conclusion: Cognitive behavioral therapy based on Hofmann model is effective in patients suffering from social anxiety disorder, especially in improving anxiety symptoms and behavioral inhibition functions.

Keywords


1. Craske GM, Bogels SM, Friedman MG, Hollander E, Fernandez RL, Pynoos RS, et al. Diagnostic and statistical manual of mental disorders. DSM-5TM. USA: American Psychiatric Association; 2013: 202-3.
2. Ganji MGh. [Anxiety disorder, Abnormal psychology based on DSM-5]. Tehran: Savalan; 2012: 290-5. (Persian)
3. Ghaedi GH, Tavoli A, Bakhtiari M, Melyani M, Sahragard M. [Quality of life in college students with and without social phobia]. Social indicators research 2010; 97(2): 247-56. (Persian)
4. Bisserbe JC, Weiller E, Boyer P, Lépine JP, Lecrubier Y. Social phobia in primary care: Level of recognition and drug use. Int Clin Psychopharmacol 1996;11: 25-8.
5. Fehm L, Beesdo K, Jacobi F, Fiedler A. Social anxiety disorder above and below the diagnostic threshold: Prevalence, comorbidity and impairment in the general population. Soc Psychiatr Psychiatr Epidemiol 2008; 43(4): 257-65.
6. Freitas-Ferrari MC, Hallak JE, Trzesniak C, Machado-de-Sousa JP, Chagas MHN, Nardi AE, et al. Neuroimaging in social anxiety disorder: A systematic review of the literature. Prog Neuropsychopharmacol Biol Psychiatry 2010; 34(4): 565-80.
8. Rapee RM, Heimberg RG. A cognitive-behavioral model of anxiety in social phobia. Behav Res Ther 1997; 35(8): 741-56.
9. Dadshzadeh H, Yazdandoost R, Charraee B, Asgharnejad Farid A. [Effectiveness of exposure therapy on interpretation bias and fear of negative evalution in social anxiety]. Iranian journal of psychiatry and clinical psychology 2012; 18: 40-51. (Persian)
10. Boden MT, John OP, Goldin PR, Werner K, Heimberg RG, Gross JJ. The role of maladaptive beliefs in cognitive-behavioral therapy: Evidence from social anxiety disorder. Behav Res Ther 2012; 50(5): 287-91.
10. Moradi A, Modarres Gharavi M. [Comparison of brain activity and behavioral and mental health systems related to drug addicts and normal people]. Journal of public health 2012; 13: 304-13. (Persian)
11. Hofmann SG, Asmundson GJ, Beck AT. The science of cognitive therapy. Behav Ther 2013; 44(2): 199-212.
12. Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005; 62(6): 593-602.
13. Doehrmann O, Ghosh SS, Polli FE, Reynolds GO, Horn F, Keshavan A, et al. Predicting treatment response in social anxiety disorder from functional magnetic resonance imaging. JAMA Psychiatry 2013; 70(1): 87-97.
14. Hofmann SG. Cognitive factors that maintain social anxiety disorder: A comprehensive model and its treatment implications. Cogn Behav Ther 2007; 36(4): 193-209.
15. Atrifar M, Shaeiri M, Rasoolzade Tabatabaei K, Jan Bozorghi M, Azad Falah P. Effectiveness of group CBT using Hofmann pattern on decrease of symptoms from social anxiety disorder. Culture of counseling and psychotherapy 2012; 9: 23-50. (Persian)
16. Hofmann SG, Otto MW. Cognitive behavioral therapy of social anxiety disorder. USA: Routledge; 2008: 63-117.
17. Ottenbreit ND, Dobson KS, Quigley L. A psychometric evaluation of the cognitive-behavioral avoidance scale in women with major depressive disorder. J Psychopathol Behav Assess 2014; 36: 1-9.
18. Florsheim P. Chinese adolescent immigrants: Factors related to psychosocial adjustment. J Youth Adolesc 1997; 26(2): 143-63.
19. Brown TA, DiNardo P, Barlow DH. Anxiety disorders interview schedule for DSM-IV: Client interview schedule. Oxford: Oxford University; 1994.
20. Fathi Ashtiani A. [Psychologocal tests personality and mental health]. Tehran: Behsati; 2013: 141-2. (Persian)
21. Hayward C, Killen JD, Kraemer HC, Taylor C. Linking self-reported childhood behavioral inhibition to adolescent social phobia. J Am Acad Child Adolesc Psychiatry 1998; 37(12): 1308-16.
22. Hofmann SG, Scepkowski LA. Social self-reappraisal therapy for social phobia: Preliminary findings. J Cogn Psychother 2006; 20(1): 45.
23. Buckner JD, Heimberg RG, Ecker AH, Vinci C. A biopsychosocial model of social anxiety and substance use. Depression Anxiety 2013; 30(3): 276-84.
24. Fisher PL, Wells A. Metacognitive therapy for obsessive–compulsive disorder: A case series. J Behav Ther Exp Psychiatry 2008; 39(2): 117-32.
25. Rees CS, van Koesveld KE. An open trial of group metacognitive therapy for obsessive-compulsive disorder. J Behav Ther Exp Psychiatry 2008; 39(4): 451-8.
26. Nikoei F. Perfectionism and fear of evaluation by others in addressing social anxiety. J Educ Psychol 2012; 12: 94-111.