Further Reflections on the Complexities of Therapeutic Change Mechanisms in a Case Study of Social Phobia

Abstract

The paper is a response to a commentary by Rogojanski and Rego (2013) on our case study of Sara (Jensen, Hougaard, & Fishman, 2013). Sara was a client who achieved a remarkable and durable change in her longstanding social phobia (SP) after short-term group cognitive-behavior therapy (CBT). Our response deals with the following topics: (1) safety behavior; (2) the idiographic arrangement of exposure as behavioral experiments; (3) acceptance as a mechanism of action in CBT; (4) the specific format of the Aarhus treatment program; and (5) recent advances in quantitative research on change mechanisms in CBT for anxiety disorders. We conclude that Rogojanski and Rego's commentary and our further reflections underline the original conclusion from our case study: that generally, change mechanisms in psychotherapy are highly complex, and that specifically, the data from Sara’s case could be consistent with several disparate theories of change mechanisms in CBT, revealing a high degree of overlap and intertwining among the theories.