Ariel Stravynski

Clinical phobias and avoidant personality disorder among alcoholics admitted to an alcoholism rehabilitation setting.

One hundred seventy-three abstinent patients were screened for phobias and avoidant personality disorder. Ninety-six patients were interviewed and diagnosed by two independent assessors who were in agreement on 74% of the diagnoses. In DSM-III terms, over half of the sample (51.4%) met criteria for agoraphobia (8.5%), social phobia (7.8%) and avoidant personality disorder (35.1%). More than 70% of the patients in each diagnostic category were men. For the vast majority of the patients in the sample the disorder preceded the abuse of alcohol which was used by at least 40% of them to relieve their distress in the past. For many it had still a moderating effect on distress at the present but appeared to be mainly used out of “psychological dependence.”

The Treatment of Avoidant Personality Disorder by Social Skills Training in the Clinic or in Real-Life Settings

Twenty-eight outpatients who met DSM-III diagnostic criteria for avoidant personality disorder completed 14 one and a half hour sessions of social skills training in the clinic only or a combination of four sessions in the clinic, four sessions in real-life and six follow-up sessions in the clinic. Subjects were assessed before treatment began, after four sessions, at the end of treatment and at three month follow-up points. Training in real-life did not enhance social skills training; no significant difference between the groups at any assessment points was found. In both groups improvement in time was significant and clinically worthwhile. The treatment effects were maintained up to the three month follow-up, where available. Social skills training appears to be a useful and promising intervention for avoidant personality disorder but its long term impact remains to be investigated.

Perception of early parenting by patients diagnosed avoidant personality disorder: a test of the overprotection hypothesis.

ABSTRACT— The perceptions of their parents by patients diagnosed avoidant personality disorder (DSM‐III) and matched normal subjects were compared. The overprotection hypothesis proposed by Parker was not found to predict the perceptions of patients diagnosed avoidant personality disorder. Social introversion in patients was found to be related to perceptions of their parents as shaming, guilt‐engendering and intolerant.

The treatment of social phobia: a critical assessment

This article critically reviews the effects of psychological treatment (exposure, cognitive restructuring, social skills training) and pharmacological treatment (MAOIs, reversible MAOIs, anxiolytics and SSRIs) of social phobia. Only controlled studies have been included, and their outcomes were assessed for improvement in anxiety and avoidance, social functioning and clinical status. Both psychological and pharmacological treatments resulted in a significant and meaningful reduction in anxiety and, in most cases, a weakening of the tendency to avoid. Although useful, the effects were not of such a magnitude as to result in remission. Reduction in anxiety was long‐lasting in patients treated by psychological methods. The lessening of anxiety did not necessarily lead to meaningfully improved social functioning. The combination of psychological and pharmacological treatments was disappointing, and did not exceed the effects of psychological treatments alone. However, the most promising medications were not tested. Subtype of social phobia and additional diagnoses did not determine the response to treatment.

The treatment of social dysfunction in nonpsychotic outpatients. A review.

A sizable proportion (7 to 16 per cent) of psychiatric outpatients suffer from social dysfunction, either as the main complaint or in conjunction with other psychiatric problems. Social skills training is a newly evolved treatment regimen that involves teaching patients new forms of social behavior by their rehearsal within sessions and their practice in real life between sessions. In an overview of controlled studies, social skills training was found to have been useful for up to 16 months follow-up in mainly nonpsychotic socially dysfunctional outpatients. Its effects supersede “no-treatment” periods and it appears a more potent treatment of social dysfunction than contrasting methods such as short term psychotherapy, systematic desensitization, sensitivity training, etc. The adjunct use of an anxiolytic or cognitive modification has not enhanced outcome. Social skills training is recommended as the treatment of choice for patients with social dysfunction, especially when no other major psychiatric disorders are present.

A retrospective study of separation in the development of adult avoidant personality disorder

This retrospective study investigated experiences of separation and perceptions of early relations with parents and peers by patients diagnosed as having avoidant personality disorder. The main hypothesis of our study was that patients diagnosed as having avoidant personality disorder would report more actual separations and more pathogenic parenting than normal control subjects. This hypothesis was not supported. The main features differentiating patients from normals were: perceptions of a unencouraging home climate, and less demonstrations of love and pride in the child on the part of the parents.

Social phobia treated as a problem in social functioning : a controlled comparison of two behavioural group approaches

Objective: Treatments for social phobia result typically in significant anxiety and avoidance reduction; the repercussions in terms of social functioning, however, are not clear. This controlled study compared two approaches designed to improve the social functioning of social phobics.

Behavioral treatment of psychogenic vomiting in the context of social phobia.

A case of psychogenic vomiting in the context of social phobia was treated by a combination of exposure in vivo, social skills training, and cognitive modification. The intervention was not directly aimed at the vomiting, but at aspects of the patients behavior hypothesized to be instrumental in maintaining it; deficits in prosocial behaviors and associated anxiety. Change was assessed on the basis of patients records of daily frequency of: vomiting; performance of treated behaviors; and associated anxiety within a single-case multiple baseline design. Change occurred only with the introduction of treatment and not before it, ruling out effects of time or mere contact. Clinically, the vomiting was virtually eliminated after 7 weeks, and the anxiety was substantially reduced in most previously feared (and avoided) social situations; except for a 2-week depressive spell, this outcome has been maintained for an available 2-year follow-up. A general improvement in the patients personal, social, and vocational life has also occurred.

The treatment of depression with group behavioural-cognitive therapy and imipramine.

Twenty-four outpatients meeting DSM-III-R criteria for major depression were assigned to group behavioural-cognitive therapy either with or without antidepressant medication (imipramine). Eighteen patients completed 15 weekly sessions of treatment. Equivalent improvement was observed in both regimens after treatment. The results essentially maintained at six months follow-up. This suggests that a group format of behavioural-cognitive therapy is a viable therapeutic intervention for outpatients diagnosed as suffering from major depression. However, the addition of imipramine to group behavioural-cognitive therapy did not enhance the outcome.

A Test of the Therapeutic Mechanism in Social Skills Training with Avoidant Personality Disorder

Twenty-eight patients meeting the criteria for DSM-III avoidant personality disorder were randomly assigned to two treatment groups consisting each of five sessions of social skills training plus homework and five sessions of group discussion plus homework administered in different order in accordance with a latin-square (crossover) design. Twenty-one subjects completed the study. No significant differences between the treatment groups or treatment modalities (i.e., social skills training and group discussion combined with homework each) were found. Significant improvements in time on most measures were found when data from both groups were amalgamated.