New Developments in Emotion-Focused Therapy for Social Anxiety Disorder.

Ben Shahar

doi:10.3390/jcm9092918

Abstract

Social anxiety disorder (SAD) is a highly complex, chronic, disabling and costly anxiety disorder. Although cognitive-behavioral therapy (CBT) is effective for many patients, many others do not respond to CBT or remain considerably symptomatic at the end of treatment. Pharmacological effects are also modest. More empirically-supported treatment options are needed in order to increase patient access to effective treatment. Emotion-focused therapy (EFT) shows great promise in treating SAD effectively and is particularly suitable for treating SAD because pervasive emotional avoidance, difficulties with emotional differentiation, and high levels of self-criticism, which are central psychopathological processes in SAD, are also primary therapeutic targets in EFT. EFT is based on the assumption that the most efficient way to change a maladaptive emotion is not through reason or skill learning, but through the activation of other, more adaptive emotions. EFT aims to access shame-based emotional memories that underlie SAD, and transform them by exposing them to new adaptive emotional experiences, such as empowering assertive anger, grief, and self-compassion. In this paper, the core features of EFT for SAD are presented, as well as the EFT view of dysfunction in SAD and EFT change processes. Research findings regarding the effectiveness of EFT for SAD are presented together with initial findings regarding mechanisms of change occurring during treatment.

Highlights

Social anxiety disorder (SAD) is characterized by persistent fears in a range of social and performance situations in which the individual might be scrutinized or judged by others [1]
When emotions become maladaptive as a result of trauma, the therapeutic goal is to access and activate trauma-based maladaptive emotion schematic memories in order to transform them
Research on the effectiveness and mechanisms of Emotion-focused therapy (EFT) for SAD is at its initial phase, further developing EFT for this chronic and disabling disorder seems to be an important endeavor

Summary

Introduction

Social anxiety disorder (SAD) is characterized by persistent fears in a range of social and performance situations in which the individual might be scrutinized or judged by others [1]. Numerous randomized control trials and a few meta-analytic studies [14,15,16] have shown that cognitive-behavioral therapy (CBT) is an effective treatment for SAD, but a substantial number of patients do not respond to CBT or remain symptomatic at the end of therapy [17,18,19]. In a study that computed response rates to CBT for different anxiety disorders based on randomized clinical trials conducted between 2000 and 2014, response rates for SAD were 45.3% at post-treatment and 55.5% at follow-up [22]. These studies and others show that a majority of patients benefit from CBT, there is still considerable room for improvement. In order to increase access to evidence-based treatments it is crucial to have several effective, empirically-supported treatment options

Emotion-Focused Therapy

An EFT View of Etiology of Social Anxiety Disorder

The Process of Change in EFT for Social Anxiety

Efficacy of EFT for SAD

Conclusions and Future Directions