States of Mind Model and Cognitive Change in Treated Social Phobics

The applicability of Schwartz and Garamoni’s (1986, 1989) States of Mind (SOM) model for assessing the influence of cognitive-behavioral therapy on cognitive functioning was evaluated with social phobics. The SOM model states that a positive dialogue (i.e., a 2:1 ratio of positive to negative thoughts) is optimal for effective coping. Social phobics receiving either a cognitive-behavioral or educational-supportive group treatment were compared for SOM change, as were subjects meeting criteria for improvement or nonimprovement. Also the study compared the predictability of the SOM ratio with a ratio based on percent of negative thoughts. Subjects in both treatments evidenced negative monologue (i.e., a preponderance of negative thoughts) at pretreatment. A significant Treatment × Time interaction showed that, although the groups did not differ at posttreatment, those in the cognitive treatment reached positive dialogue at a 6-month follow-up while the other group did not. Improvers also attained positive dialogue at follow-up while nonimprovers did not. The SOM and the negative thought ratios performed similarly in predicting most outcome measures, suggesting that neutral thoughts (the only distinction between the two) serve little function for persons with problems of social phobia

The Validity of the Social Avoidance and Distress Scale and the Fear of Negative Evaluation Scale with Social Phobic Patients

Turner, McCanna and Beidel’s (1987) recent evaluation of the Social Avoidance and Distress Scale (SADS) and the Fear of Negative Evaluation Scale (FNE) with anxiety disordered patients concluded that the SADS and FNE lacked discriminant validity and may be inappropriate for subject selection or outcome evaluation in studies of social phobia . This paper raises some concerns with the interpretation of the data presented by Turner et al. (1987) and presents additional data from studies in our laboratories that may qualify their conclusions. It is asserted that (a) the SADS and FNE are not appropriate for diagnostic screening of social phobic patients, (b) Turner et al.’s findings may have been the result of clinically meaningful social anxiety in several of the anxiety disorders, (c) significant differences among the anxiety disorders may have been hidden by heterogeneity among patients who receive the diagnosis of social phobia. and (d) the distribution of FNE scores in Turner et al.’s sample may have been unusually depressed

Cognitive-Behavioral Group Therapy versus Phenelzine in Social Phobia: Long-Term Outcome

To evaluate the effects of maintenance treatment and durability of gains after treatment discontinuation, responders to either phenelzine (PZ) or cognitive-behavioral group therapy (CBGT) from an acute trial comparing these two treatments as well as pill placebo and a psychotherapy control (educational supportive group therapy) were enrolled into maintenance and treatment-free follow-up phases. Experimental design: Responders to an acute trial contrasting PZ and CBGT entered a six-month maintenance phase. Patients who continued to respond through the maintenance phase entered a six-month treatment-free phase. Patients receiving pill placebo or educational supportive group therapy in the acute trial did not enter the long-term study. Principal observations: PZ patients entered maintenance more improved than CBGT patients, and nonrelapsing PZ patients maintained their superior gains throughout the study. Relapse during maintenance did not differ between treatments. However, PZ patients showed a trend toward greater relapse during treatment-free follow-up. There was a greater relapse among patients with generalized social phobia with phenelzine. Conclusions: PZ and cognitive-behavioral group therapy may differ in their long-term effects. The superiority seen with PZ on some measures in the acute study persisted in patients who maintained their gains over the course of maintenance and treatment-free follow-up. However, CBGT may lead to a greater likelihood of maintaining response after treatment has terminated. Replication with larger samples is needed, as is a study of the acute and long-term efficacy of combined PZ and CBGT

States of Mind Model and Cognitive Change in Treated Social Phobics

The applicability of Schwartz and Garamoni’s (1986, 1989) States of Mind (SOM) model for assessing the influence of cognitive-behavioral therapy on cognitive functioning was evaluated with social phobics. The SOM model states that a positive dialogue (i.e., a 2:1 ratio of positive to negative thoughts) is optimal for effective coping. Social phobics receiving either a cognitive-behavioral or educational-supportive group treatment were compared for SOM change, as were subjects meeting criteria for improvement or nonimprovement. Also the study compared the predictability of the SOM ratio with a ratio based on percent of negative thoughts. Subjects in both treatments evidenced negative monologue (i.e., a preponderance of negative thoughts) at pretreatment. A significant Treatment × Time interaction showed that, although the groups did not differ at posttreatment, those in the cognitive treatment reached positive dialogue at a 6-month follow-up while the other group did not. Improvers also attained positive dialogue at follow-up while nonimprovers did not. The SOM and the negative thought ratios performed similarly in predicting most outcome measures, suggesting that neutral thoughts (the only distinction between the two) serve little function for persons with problems of social phobia

Evaluating the States of Mind Model: Comparison to an Alternative Model and Effects of Method of Cognitive Assessment

Two studies were conducted evaluating aspects of the States of Mind (SOM) Model proposed by Schwartz (1986; Schwartz & Garamoni, 1986, 1989) with a sample of social phobic subjects. First, the SOM ratio [positive thoughts/(positive + negative thoughts)] based on a thought-listing task was compared to a ratio based on Kendall and Hollon’s (1981) “power-of-nonnegative-thinking” model [negative thoughts/(positive + negative + neutral thoughts)], and the relationship of each ratio to criterion measures was assessed. The two ratios were highly correlated and related to several criterion measures, raising questions about the role of neutral thoughts in the internal dialogue. Second, SOM ratios derived from a thought-listing task and from the Social Interaction Self-Statement Test (SISST) were compared to assess the reactivity of the SOM ratio and classification scheme to method of cognitive assessment. In that study, large differences were detected. SISST SOMs were less likely to classify subjects in the more pathological SOM categories and more likely to be significantly related to criterion measures. Findings are discussed in the context of the validity of the SOM model and the effects of cognitive assessment methodology on the magnitude of derived self-statement ratios

The Validity of the Social Avoidance and Distress Scale and the Fear of Negative Evaluation Scale with Social Phobic Patients

Turner, McCanna and Beidel’s (1987) recent evaluation of the Social Avoidance and Distress Scale (SADS) and the Fear of Negative Evaluation Scale (FNE) with anxiety disordered patients concluded that the SADS and FNE lacked discriminant validity and may be inappropriate for subject selection or outcome evaluation in studies of social phobia . This paper raises some concerns with the interpretation of the data presented by Turner et al. (1987) and presents additional data from studies in our laboratories that may qualify their conclusions. It is asserted that (a) the SADS and FNE are not appropriate for diagnostic screening of social phobic patients, (b) Turner et al.’s findings may have been the result of clinically meaningful social anxiety in several of the anxiety disorders, (c) significant differences among the anxiety disorders may have been hidden by heterogeneity among patients who receive the diagnosis of social phobia. and (d) the distribution of FNE scores in Turner et al.’s sample may have been unusually depressed

Cognitive-Behavioral Group Therapy versus Phenelzine in Social Phobia: Long-Term Outcome

To evaluate the effects of maintenance treatment and durability of gains after treatment discontinuation, responders to either phenelzine (PZ) or cognitive-behavioral group therapy (CBGT) from an acute trial comparing these two treatments as well as pill placebo and a psychotherapy control (educational supportive group therapy) were enrolled into maintenance and treatment-free follow-up phases. Experimental design: Responders to an acute trial contrasting PZ and CBGT entered a six-month maintenance phase. Patients who continued to respond through the maintenance phase entered a six-month treatment-free phase. Patients receiving pill placebo or educational supportive group therapy in the acute trial did not enter the long-term study. Principal observations: PZ patients entered maintenance more improved than CBGT patients, and nonrelapsing PZ patients maintained their superior gains throughout the study. Relapse during maintenance did not differ between treatments. However, PZ patients showed a trend toward greater relapse during treatment-free follow-up. There was a greater relapse among patients with generalized social phobia with phenelzine. Conclusions: PZ and cognitive-behavioral group therapy may differ in their long-term effects. The superiority seen with PZ on some measures in the acute study persisted in patients who maintained their gains over the course of maintenance and treatment-free follow-up. However, CBGT may lead to a greater likelihood of maintaining response after treatment has terminated. Replication with larger samples is needed, as is a study of the acute and long-term efficacy of combined PZ and CBGT