Thesis (PhD)--Stellenbosch University, 2000. / ENGLISH ABSTRACT: The objective of this study was to investigate and compare the effectiveness of a combined exposure and
cognitive restructuring programme versus exposure only in the treatment of social phobia.
The 44 participants in the study met the DSM-IV diagnostic criteria for social phobia at pre-treatment
assessment, and presented mainly with general interactional social fears. They were allocated to a group
which received a combined exposure and cognitive restructuring treatment (n = 15), a group treated with
exposure only (n = 15), and a waiting-list control group (n = 14). For treatment purposes, both treatment
groups were subdivided into two smaller groups of 7 and 8 participants each.
The effects and differential effects of the treatments were compared in terms of four broad categories of
variables: target phobia variables (anxiety/avoidance/escape in relation to a specific target phobia), social
phobia variables (associated with the degree, nature, aspects and/or consequences of social phobia),
cognitive variables (thought functionality, fear-of-negative-evaluation, and attentional bias), and severity
of depression.
Participants were individually assessed before treatment, immediately after treatment, and at follow-up
after three months. Treatment were conducted by two co-therapists in 12 weekly group sessions of two
hours each.
Compared to a waiting-list control condition, both treated groups showed a significant improvement of the
target phobia variables at post-treatment and, with the exception of target phobia anxiety for the exposure
only condition, the significant effects were maintained at follow-up after three months.
As for the social phobia variables, cognitive restructuring and exposure combined showed a significantly
larger improvement compared to the waiting-list control condition on four of the variables (social phobia
avoidance, social phobia observation anxiety, social phobia general symptomatology, and social phobia
disturbance/disablement), and these significant effects were maintained at follow-up. The exposure only
group showed significantly larger effects on only two variables (social phobia avoidance and social phobia
disturbance/disablement) and only the effects on social phobia avoidance were maintained for the followup
period of three months.
With regard to the cognitive variables, the combined treatment led to significanly larger improvements in
thought functionality compared to the waiting-list control condition and these effects were maintained at
follow-up. No other significant differences between the effects of any of the treatments and the waiting-list
control condition were demonstrated at post-treatment or at follow-up on any of the cognitive variables.
Only the combined treatment resulted in significantly larger reductions in the severity of depression, The
effects were maintained for the follow-up period of three months. Compared to the waiting-list control condition, the combined treatment resulted in improvement over a
broader spectrum of social phobia symptomatology than exposure only at post-treatment and follow-up.
The two treatments were also directly compared in terms of their effects on each of the dependent
variables and the differences were largely insignificant at both post-treatment and follow-up. Only in terms
of thought functionality tentative indications of a possible larger effect for the combined treatment were
found. However, if this was the case, the differences were cancelled out at follow-up.
It seems that both the combined treatment and exposure only were effective treatments for social phobia
and that the combined treatment might have demonstrated slightly better results. These findings support
the emerging view that the most important cognitive-behavioral treatments of social phobia do not differ
greatly in terms of efficacy. It also offer support for the view of prominent researchers on social phobia
outcome, namely that treatment effects are less dependent on procedural variations than on other critical
elements, such as the length and frequency of treatment sessions, and exposure to the critical elements
of patients' social fears. / AFRIKAANSE OPSOMMING: Die doel van hierdie studie was om die effektiwiteit van 'n gekombineerde blootstelling en kognitiewe
herstruktureringsprogram teenoor blootstelling alleen in die behandeling van sosiale fobie te ondersoek
en te vergelyk.
Die 44 deelnemers aan die studie het voor behandeling aan die DSM-IV diagnostiese kriteria vir sosiale
fobie voldoen en met oorwegend algemene interaksionele vrese gepresenteer. Hulle is verdeel in 'n
groep wat met kognitiewe herstrukturering en blootstelling gekombineerd behandel is (n = 15), 'n groep
wat slegs blootstelling ontvang het (n = 15), en 'n waglys-kontrolegroep (n = 14). Vir
behandelingsdoeleindes is die behandelingsgroepe in twee subgroepe van onderskeidelik 7 en 8
deelnemers elk verdeel.
Die effekte en differensiële effekte van die behandelings is in terme van die volgende vier breë kategorieë
veranderlikes ondersoek: teikenfobie-veranderlikes (angslvermyding/ontsnapping ten opsigte van 'n
spesifieke fobie), sosialefobie-veranderlikes (wat verband hou met die graad, aard, aspekte en/of gevolge
van sosiale fobie), kognitiewe veranderlikes (gedagte-funksionaliteit, vrees-vir-negatiewe-evaluasie en
aandagsverdraaiing), en graad van depressie.
Deelnemers is individueel beoordeel voor behandeling, onmiddellik na afloop daarvan en na 'n 3-
maande-opvolgperiode. Behandeling deur twee ko-terapeute het in 12 weeklikse groepsessies van twee
uur elk geskied.
In vergelyking met die waglys-kontrolekondisie, het beide behandelings tot 'n beduidende verbetering van
die teikenfobie-veranderlikes by nameting gelei en, met uitsondering van teikenfobie-angs by die
blootstellingsbehandeling, is die beduidende effekte vir 'n opvolgperiode van drie maande volgehou.
Wat die sosialefobie-veranderlikes betref, het kognitiewe herstrukturering plus blootstelling 'n beduidend
groter verbetering in vergelyking met die waglys-kontrolekondisie op vier veranderlikes (sosialefobievermyding,
sosialefobie-observasie-angs, sosialefobie-algemenesimptomato/ogie, en sosialefobieongemak/
belemmering) tot gevolg gehad en is die beduidende effekte vir 'n opvolgperiode van drie
maande volgehou. Daarenteen het die blootstellingsgroep slegs ten opsigte van twee veranderlikes
(sosialefobie-vermyding en sosialefobie-ongemak/belemmering) tot beduidend groter effekte aanleiding
gegee, waarvan die effekte net op een van die twee veranderlikes (sosialefobie-vermyding) vir 'n
opvolgperiode van drie maande in stand gehou is.
Ten opsigte van die kognitiewe veranderlikes, het kognitiewe herstrukturering plus blootstelling, in
vergelyking met die waglys-kontrolekondisie, tot 'n beduidende verbetering van gedagte-funksionaliteit
gelei wat vir 'n opvolgperiode van drie maande in stand gehou is. Geen ander beduidende verskille
tussen die effekte van behandelings en die waglys-kontrolekondisie is vir enige van die ander kognitiewe
veranderlikes by nameting of opvolg gedemonstreer nie. Slegs die gekombineerde behandeling het tot beduidend groter verlagings van die graad van depressie
gelei wat vir 'n opvolgperiode van drie maande gehandhaaf is.
In vergelyking met die waglys-kontrolekondisie, het die gekombineerde behandeling dus tot 'n
beduidende verbetering oor 'n breër basis van sosialefobie-simptomatologie as blootstelling alleen by
nameting en opvolg aanleiding gegee.
Die twee behandelings is ook direk met mekaar in terme van effekte op elkeen van die afhanklike
veranderlikes vergelyk en die verskille was by nameting en opvolg grootliks onbeduidend. Dit is slegs ten
opsigte van gedagte-funksionaliteit dat daar tentatiewe aanduidings was dat die gekombineerde
behandeling moontlik 'n beduidend groter verbeterende effek as blootstelling alleen kon gehad het, maar
indien dit so was, was hierdie verskille by die opvolgmeting reeds uitgewis.
Dit wil dus voorkom asof beide die gekombineerde behandeling en blootstelling alleen effektiewe
behandelings vir sosiale fobie was en dat eersgenoemde dalk effens beter resultate kon gelewer het.
Hierdie resultate ondersteun die standpunt wat tans besig is om op grond van navorsing te ontwikkel,
naamlik dat daar nie betekenisvolle groot verskille in die effektiwiteit van die belangrikste kognitiefgedragsterapeutiese
behandelings van sosiale fobie is nie. Dit bied ook steun vir die standpunt van
prominente navorsers op die gebied van sosiale fobie uitkomsnavorsing dat behandelingseffek minder
afhang van verskille in prosedure-variasies as van ander kritieke elemente, soos byvoorbeeld die lengte
en frekwensie van die behandelingsessies en blootstelling aan die kritieke elemente van die sosiale
vrese.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:sun/oai:scholar.sun.ac.za:10019.1/51810 |
| Date | 12 1900 |
| Creators | Nortje, Charl |
| Contributors | Moller, A. T., Stellenbosch University. Faculty of Arts and Social Sciences. Department of Psychology. |
| Publisher | Stellenbosch : Stellenbosch University |
| Source Sets | South African National ETD Portal |
| Language | af_ZA |
| Detected Language | Unknown |
| Type | Thesis |
| Format | xxi, 253 pages |
| Rights | Stellenbosch University |
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