Monroe A. Bruch

Cognitive‐behavioral group therapy versus phenelzine in social phobia: Long term outcome

To evaluate the effects of maintenance treatment and durability of gains after treatment discontinuation, responders to either phenelzine (PZ) or cognitive‐behavioral group therapy (CBGT) from an acute trial comparing these two treatments as well as pill placebo and a psychotherapy control (educational supportive group therapy) were enrolled into maintenance and treatment‐free follow‐up phases. Experimental design: Responders to an acute trial contrasting PZ and CBGT entered a six‐month maintenance phase. Patients who continued to respond through the maintenance phase entered a six‐month treatment free phase. Patients receiving pill placebo or educational supportive group therapy in the acute trial did not enter the long term study. Principal observations: PZ patients entered maintenance more improved than CBGT patients, and nonrelapsing PZ patients maintained their superior gains throughout the study. Relapse during maintenance did not differ between treatments. However, PZ patients showed a trend toward greater relapse during treatment‐free follow‐up. There was a greater relapse among patients with generalized social phobia with phenelzine. Conclusions: PZ and cognitive‐behavioral group therapy may differ in their long term effects. The superiority seen with PZ on some measures in the acute study persisted in patients who maintained their gains over the course of maintenance and treatment‐free follow‐up. However, CBGT may lead to a greater likelihood of maintaining response after treatment has terminated. Replication with larger samples is needed, as is a study of the acute and long‐term efficacy of combined PZ and CBGT. Depression and Anxiety 10:89–98, 1999.

Dismantling Cognitive-Behavioral Group Therapy for social phobia

The efficacy of Heimbergs (1991) Cognitive-Behavioral Group Therapy (CBGT) [Unpublished manuscript] for social phobia has been demonstrated in several studies in recent years. However, little is known about the mechanisms underlying the treatments success. In order to determine whether the cognitive restructuring component of CBGT is essential, this study compared CBGT to an exposure-based treatment without formal cognitive restructuring. A wait-list control was also included. In general, Ss in the active treatment conditions improved and control Ss did not improve on a variety of self-report, clinician, and behavioral measures. Limited evidence indicated that Ss in the non-cognitive treatment may have made somewhat greater gains on some measures. Although CBGT Ss reported more improvement than exposure-alone Ss in subjective anxiety during an individualized behavioral test at posttreatment, this difference disappeared at 6-month follow-up. Surprisingly, CBGT was less effective than in previous controlled trials, and possible reasons for this are discussed. Implications of the results for cognitive theory and cognitive-behavioral therapy for social phobia are addressed.

Five-Factor Model of Personality and Career Exploration

This study investigates whether the dimensions of the five-factor model (FFM) of personality are related to specific career exploration variables. Based on the FFM, predictions were made about the relevance of particular traits to career exploration variables. Results from a canonical correlation analysis showed that variable loadings on three roots were generally consistent with predictions. One source of covariation involved association between conscientiousness/extraversion/low neuroticism and career search self-efficacy/career information seeking. A second source involved association between openness and a lack of career information seeking. The third source involved association between neuroticism/openness and self-exploration. Results are discussed relative to the FFM and implications for career counseling and assessment.

Familial and developmental antecedents of social phobia: Issues and findings

Abstract This article reviews research on familial and developmental factors that may be associated with social phobia. It begins with a discussion of two issues that have impeded research on the etiology of social phobia. Then, evidence for the heritability of shyness and the genetic transmission of dispositions that may increase proneness to social fears is reviewed. The findings regarding the impact of child-rearing characteristics of isolation, admonitions about proper appearance and manners, and lack of family sociability on shyness are reviewed relative to social phobia. Also, four developmental factors that have been empirically linked to child and adolescent shyness are discussed. Finally, a summary of results from a recent study in which social phobics and agoraphobics were compared on selected family and developmental antecedents considered in this review is presented.

Shyness, alcohol expectancies, and alcohol use: Discovery of a suppressor effect ☆

Abstract Despite anecdotal evidence that shyness is associated with alcohol use, studies have failed to show a reliable relation between these variables. The present study tested the hypothesis that expectancies about alcohols positive consequences in social evaluative situations moderate the relation between shyness and drinking. In hierarchical regression analyses, peer influence, shyness, and alcohol expectancies made significant contributions to predicting alcohol use, but the shyness by alcohol expectancy interaction did not increase prediction of drinking. Also, it was found that alcohol expectancies operated as a suppressor variable. Although the simple correlation between shyness and alcohol use was near zero, inclusion of expectancies in the regression removed irrelevant variance in shyness leading to a significant, inverse relation between shyness and drinking. Results are discussed relative to how shyness problems may relate to minimal drinking activity and how alcohol expectancy findings are consistent with recent tests of the alcohol expectancy model.

The validity of the social avoidance and distress scale and the fear of negative evaluation scale with social phobic patients

Turner, McCanna and Beidels (1987) recent evaluation of the Social Avoidance and Distress Scale (SADS) and the Fear of Negative Evaluation Scale (FNE) with anxiety disordered patients concluded that the SADS and FNE lacked discriminant validity and may be inappropriate for subject selection or outcome evaluation in studies of social phobia. This paper raises some concerns with the interpretation of the data presented by Turneret at. (1987) and presents additional data from studies in our laboratories that may qualify their conclusions. It is asserted that (a) the SADS and FNE are not appropriate for diagnostic screening of social phobic patients, (b) Turner et al.s findings may have been the result of clinically meaningful social anxiety in several of the anxiety disorders, (c) significant differences among the anxiety disorders may have been hidden by heterogeneity among patients who receive the diagnosis of social phobia, and (d) the distribution of FNE scores in Turner et al.s sample may have been unusually depressed.

Focus of attention and social anxiety: The role of negative self-thoughts and perceived positive attributes of the other

Using a thought-listing protocol that directed subjects to separately list their thoughts for self and an interaction partner, this study tested the unique contribution of perceptions of the other person to social anxiety when interacting with a stranger. After viewing a picture of their partner in an upcoming interaction, undergraduate men completed two thought-listing protocols and then engaged in a 5-min conversation with an attractive female confederate. Multivariate hierarchical regression indicated that the percentage of negative self-thoughts was inversely related to self-efficacy ratings collected prior to and early during the conversation and positively related to subjective anxiety at the end of the interaction. After controlling for self-thoughts, perceptions about the partners positive attributes contributed to prediction of behavioral signs of anxiety, but not self-efficacy or subjective anxiety. The results are consistent with the hypothesis that an attentional focus on positive attributes of the other person may increase ones social anxiety beyond that attributable to negative self-thoughts. Possible mechanisms that may account for this relationship are discussed.

Cognitive specificity in social anxiety and depression: Supporting evidence and qualifications due to affective confounding

Previous studies of cognitive specificity in social anxiety and depression have not directly compared data from measures of thought content varying in their relevance to either disorder. The current research compared subjects high in both social anxiety and depression (i.e., mixed) to groups high in only social anxiety or depression, or neither affect, on five cognitive content scales. Negative thoughts specific to depression covaried only with dysphoria, while negative thought content specific to social anxiety covaried with both social anxiety and dysphoria, although both dysphoric and socially anxious groups differed from controls. However, on most cognitive measures the mixed group was the most dysfunctional, replicating Ingrams (1989a, 1989b) evidence of confounding between the affective states of social anxiety and depression. In a second study, the significance of affective confounding in a clinical sample was evaluated by assessing differences in thought content specific to social anxiety among social phobics varying in depressive affect. High dysphoric social phobics reported a lower percent of positive thoughts and significantly more negative thoughts than did nondysphoric social phobics. Limitations of the present research as well as implications for future research on cognitive specificity and affective confounding are discussed.

Evaluating the states of mind model: Comparison to an alternative model and effects of method of cognitive assessment

Two studies were conducted evaluating aspects of the States of Mind (SOM) Model proposed by Schwartz (1986; Schwartz & Garamoni, 1986, 1989) with a sample of social phobic subjects. First, the SOM ratio [positive thoughts/(positive + negative thoughts)] based on a thought listing task was compared to a ratio based on Kendall and Hollons (1981) “power-of-nonnegative-thinking” model [negative thoughts/(positive +negative +neutral thoughts)], and the relationship of each ratio to criterion measures was assessed. The two ratios were highly correlated and related to several criterion measures, raising questions about the role of neutral thoughts in the internal dialogue. Second, SOM ratios derived from a thought listing task and from the Social Interaction Self-Statement Test (SISST) were compared to assess the reactivity of the SOM ratio and classification scheme to method of cognitive assessment. In that study, large differences were detected. SISST SOMs were less likely to classify subjects in the more pathological SOM categories and more likely to be significantly related to criterion measures. Findings are discussed in the context of the validity of the SOM model and the effects of cognitive assessment methodology on the magnitude of derived self-statement ratios.

Social Phobia and Difficulties in Occupational Adjustment.

This study examined whether social phobics differed from nonanxious controls in occupational adjustment. Results indicated that generalized and nongeneralized social phobics, in contrast to controls, were underemployed and believed that their supervisor would rate them as less dependable. Nongeneralized social phobics and controls believed their supervisor would rate them higher in work role conformance and likelihood of advancement than did generalized social phobics. Generalized socially phobic women, in contrast to nongeneralized and control group women, were more likely to be employed in noninterpersonally oriented jobs. Generalized social phobics were more anxious than controls when starting their current job but did not differ in job satisfaction. Results are discussed relative to the nature of social phobia, subtype differences, and counseling services.