What You Can Change _. And What You Can't - Martin E. Seligman [141]
7. L. Ost, U. Steiner, and J. Fellenius, “Applied Tension, Applied Relaxation, and the Combination in the Treatment of Blood Phobia,” Behaviour Research and Therapy 2.7 (1989): 109–21. More recent reports suggest close to 100 percent cure with this procedure.
8. There are few noncase report studies of cognitive therapy for phobias. Those that exist show gains, but behavior therapy is added, so it is not possible to sort out any additional usefulness of the cognitive component. There are undeniable cognitive distortions in phobias, but I doubt that they can be countered directly by cognitive techniques. See G. Thorpe, J. Hacker, L. Cavallaro, and G. Kulberg, “Insight Versus Rehearsal in Cognitive-Behaviour Therapy: A Crossover Study with Sixteen Phobics,” Behavioural Psychotherapy 15 (1987): 319–36.
9. In one study, 79 percent of agoraphobic patients who received cognitive therapy plus extinction for panic were panic free, as against only 39 percent with extinction alone. In L. Michelson and K. Marchione, “Cognitive, Behavioral, and Physiologically-based Treatments of Agoraphobia: A Comparative Outcome Study.” Paper presented at the annual meeting of the American Association for the Advancement of Behavior Therapy, Washington, D.C., November 1989.
R. Mattick and L. Peters, “Treatment of Severe Social Phobia: Effects of Guided Exposure With and Without Cognitive Restructuring,” Journal of Consulting and Clinical Psychology 56 (1988): 251–60, suggest possible benefits of cognitive therapy with social phobias as well.
10. There are about a half dozen reasonably well done recent studies of the effects of various drugs on social phobias. See J. Gorman and L. Gorman, “Drug Treatment of Social Phobia,” Journal of Affective Disorders 13 (1987): 183–92; A. Levin, F. Scheier, and M. Liebowitz, “Social Phobia: Biology and Pharmacology,” Clinical Psychology Review 9 (1989): 129–40; M. Versiani, F. Mundim, A. Nardi, et al., “Tranycypromine in Social Phobia,” Journal of Clinical Psychopharmacology 8 (1988): 279–83; M. Liebowitz, J. Gorman, A. Fryer, et al., “Pharmacotherapy of Social Phobia: An Interim Report of a Placebo-Controlled Comparison of Phenelzine and Atenolol,” Journal of Clinical Psychiatry 49 (1988): 252–57; J. Reich and W. Yates, “A Pilot Study of the Treatment of Social Phobia with Alprazolam,” American Journal of Psychiatry 145 (1988): 590–94; and M. Liebowitz, R. Campeas, A. Levin, et al., “Pharmacotherapy of Social Phobia,” Psychosomatics 28 (1987): 305–8.
Most of these studies show a 60 to 75 percent level of improvement with drugs (the MAO inhibitors are particularly effective). Unfortunately, most of these studies do not report what happens to the patients after drugs are discontinued. Those that do (Versiani et al., “Tranycypromine in Social Phobia;” Reich and Yates, “A Pilot Study”) report very high relapse rates. R. Noyes, D. Chaudry, and D. Domingo, “Pharmacologic Treatment of Phobic Disorders,” Journal of Clinical Psychiatry 47 (1986): 445–52, review this literature and conclude with two major cautions: A high dropout rate with drugs and a high relapse rate after drug discontinuation are likely. It is on this basis that I conclude that the drugs have only a cosmetic effect on social anxiety.
11. See C. Zitrin, D. Klein, M. Woerner, and D. Ross, “Treatment of Phobias I: Comparison of Imipramine Hydrochloride and Placebo,” Archives of General Psychiatry 40 (1983): 125–38, versus I. Marks, S. Gray, D. Cohen, et al., “Imipramine and Brief Therapist-Aided Exposure in Agoraphobics Having Self-Exposure Homework,” Archives of General Psychiatry 40 (1983): 153–62.
This is still rather a heated controversy, with the benefits of antidepressants alone and of exposure (extinction) alone in some doubt. One serious worry is the high relapse rate, perhaps over 50 percent, when drugs are stopped (see R. Noyes, M. Garvey, B. Cook, and L. Samuelson, “Problems with Tricyclic Anti-Depressant