Continuing Communication Anxiety & Avoidance from a CBT Approach
Written by: Shalyn Isaacs / Communication Coaching / November 22, 2021 / 10 minutes read
This blog post is part of my 2-part series on clinical literature review-based articles that highlight the effectiveness of CBT for treating communication anxiety and social avoidance tendencies. Please not assume that I do not aim to suggest a pathologizing mental health approach to those struggling with anxiety and social avoidance. The scholarly articles I have reviewed often involve clinical samples of those with diagnosed personality disorders. I have aimed to focus on analyzing the ways that CBT is used in these articles as a clinical method for treating anxiety and social avoidance symptoms that may happen to share similarities with other mental health issues that the articles discuss. This blog post series is intended to highlight the diverse array of CBT-based approaches that can support the healing and wellness of those struggling with communication anxiety and social avoidance.
An article by Alden (1989) compared three different Group Cognitive Behavior Therapy treatments for individuals struggling with avoidant personality tendencies to a control group. The first group consisted of exposure exercises with little cognitive components. The second group consisted of ‘standard GCBT’ in addition to social skills training and the third group was also a standard GCBT but that incorporated intimacy-focused skills training. It is important to note that all of these cognitive behavior therapy treatments produced improvements in anxiety, depression, and behavioral problems, as well as enhanced behavior in social situations. The effects were shown to be maintained over a 3 month period following treatment. The results also showed that patients who received intimacy-focused skills training in the group experienced the most improvement from all the conditions, demonstrating greater “involvement and enjoyment of social activities.” The authors make the important claim that most patients continued to experience symptomatic behaviors and thought patterns and note that this could be due to the short-term nature of GCBT. This article is particularly important to my original question asked in this blog post series because it highlights how CBT can address a specific symptom of anxiety and avoidance, which is difficulty experienced with forming and maintaining relationships.
A study by Emmelkamp et al., (2004) compares the effectiveness of Brief Dynamic Psychotherapy and Cognitive Behavior Therapy to the treatment of avoidant personality patterns in social situations. It was found that CBT reduced symptoms of avoidance significantly and that this form of therapy improved interpersonal problems. 62 participants were randomly assigned to attend 20 weekly sessions that offered either Brief Dynamic Therapy treatment or Cognitive Behavior Therapy treatment, while some were assigned to a wait list control group. CBT was found to be more effective than BDP and the control group overall. In fact, 91% of participants demonstrated a significant reduction in avoidant symptoms that remained consistent after follow-ups and 9% continued to demonstrate symptoms of anxiety and avoidance after treatment. What this study lacks is specific information regarding how the CBT sessions were conducted, how certain thoughts patterns were altered, and in what ways the participants’ lived improved after receiving treatment. This study was also markedly different from the studies listed above because it focuses solely on standard CBT rather than incorporating social skills training and exposure exercises like the prior studies.
It is important to note that all of the cognitive behavior therapy treatments produced improvements in anxiety, depression, and behavioral problems, as well as enhanced behavior in social situations.
Although a study by Heimberg (2002) was a literature review that focuses primarily on the effectiveness of CBT for treating social anxiety disorder, it does make reference to the prevalence of studies that acknowledge the significant similarities between SAD and APD and also clearly articulates the specificities of the different classes of CBT, including cognitive reconstructing, social skills training, and exposure exercises, which the other articles above lack. Since these classes of CBT have proven to be effective, it is crucial that a clear understanding of all of them is demonstrated for the purposes of this research paper. Heimberg describes the first class of CBT ‘cognitive restructuring’ as patients examining their thought patterns surrounding feared situations and the internal beliefs that may be causing such fearful reactions to certain stimuli. The process of cognitive reconstructing includes:
identifying thoughts that occur before, during, and after situations that elicit a fearful response,
assess the validity of these beliefs through Socratic questioning and
construct more adaptive thoughts based on the information derived.
Exposure exercises involve the patient and therapist constructing a list of anxiety-provoking situations and having the patient engage in the feared situations from the least to most anxiety provoking ones through using imagination, role play, or actual confrontation of the situation outside of therapy. Lastly, social skills training involves “therapist modeling, behavioral rehearsal, corrective feedback, social reinforcement, and homework assignments.”
REFERENCES
Alden, L. (1989). Short-term structured treatment for avoidant personality disorder. Journal of Consulting and Clinical Psychology,57(6), 756-764. doi:10.1037/0022-006x.57.6.756
Emmelkamp, P., Benner, A., Kuipers, A., Feiertag, G., Koster, H., & Apeldoorn, F. (2004). Comparison of brief dynamic Comparison of brief dynamic andcognitivebehaviouraltherapies in avoidant personality disorder. British Journal of Psychiatry,189, 60-64. doi:10.1192/bjp.bp.10 5.012153
Heimberg, R. G. (2002). Cognitive-behavioral therapy for social anxiety disorder: Current status and future directions. Biological Psychiatry,51(1), 101-108. doi:10.1016/s0006-3223(01)01183-0
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