Metacognitive Therapy for Social Anxiety Disorder: An A-B Replication Series Across Social Anxiety Subtypes.

Henrik Nordahl,Adrian Wells

doi:10.3389/fpsyg.2018.00540

Abstract

Cognitive behavioural therapy (CBT) is the treatment of choice for Social anxiety disorder (SAD). However, factors additional to those emphasised in CBT are the primary cause of psychological disorder according to the metacognitive model. Metacognitive Therapy (MCT) aims to target a perseverative thinking style named the cognitive attentional syndrome and its underlying metacognitive beliefs (beliefs about cognition). The present study aimed to explore the effects of generic MCT for SAD. Treatment related effects were evaluated using direct replication single case (A–B) methodology across three patients with different subtypes of SAD; performance type, generalised and generalised plus avoidant personality disorder, representing increasing SAD severity/complexity. All patients responded during treatment and achieved substantial symptom reductions which were largely maintained at 6 months’ follow-up. Metacognitive therapy appears to be a suitable treatment and was associated with positive outcomes for patients with different presentations of SAD.

Highlights

Social anxiety disorder (SAD) or Social phobia is characterised by a marked or intense fear of social situations in which the individual may be scrutinised by others (American Psychiatric Association, 2013)
SAD can be viewed on a severity continuum ranging from the performance type characterised by fear of negative evaluation in specific performance situations, to the generalised type characterised by fear of negative evaluation in most social situations, to the generalised type with comorbid Avoidant personality disorder (AvPD) (Bögels et al, 2010; American Psychiatric Association, 2013; Heimberg et al, 2014)
Cognitive self-beliefs and use of safety behaviours showed a substantial decrease from pre to post-treatment, even though these components were not addressed in treatment

Summary

Introduction

Social anxiety disorder (SAD) or Social phobia is characterised by a marked or intense fear of social situations in which the individual may be scrutinised by others (American Psychiatric Association, 2013). The model Clark and Wells (1995) draws on concepts from cognitive (e.g., Beck, 1976) and metacognitive (Wells and Matthews, 1994) theory It proposes that on entering social situations people with social anxiety experience negative automatic thoughts and shift attention to self-focus on a biassed and Metacognitive Therapy for Social Anxiety Disorder distorted inner image of the self. Anticipatory worry and post-event rumination before and after social encounters contributes to problem maintenance. This pattern of processing can be traced back to underlying negative beliefs and assumptions about the social self (e.g., “I’m boring”)

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