Confronting fears, changing lives

Researchers in the Department of Psychology have demonstrated that a highly effective technique for treating social anxiety can be exported from where it was developed and taught successfully to less experienced therapists, allowing for widespread use of the method.

“Such ‘dissemination’ of practice techniques from specialty clinics to the community would provide treatment opportunities for more people who suffer from the disorder,” Robert Simons, professor of psychology, says.

He says UD researchers have used the method to treat seven people, many of whom made “enormous changes in their lives” as a result. “I don’t want to use the word ‘miraculous,’ but in some cases, the results were close to that. In cases where it was successful, it really made a difference in how people were able to function,” Simons says.

Social anxiety, he says, is different from mere shyness. In people for whom fear of social situations has become a phobia, their extreme anxiety severely restricts their lives, he says. People who suffer from the condition may be afraid to talk to a clerk in a store, to ask or answer a question in class, to eat in the lunchroom where they work or even to answer their home telephone.

“Some of those things might be just a little scary for them, but other things—like speaking at a business meeting or attending a big party or having house guests—are terrifying,” Simons says. In addition to limiting them socially, the anxiety can prevent sufferers from applying for jobs or promotions and harm them financially as well, he says.

Edna Foa, director of the University of Pennsylvania’s Center for the Treatment and Study of Anxiety, and her associates spent years of research in developing a 16-week treatment plan for those who suffer from social anxiety. The center tested the treatment method, found it effective and wanted to explore whether it could be implemented in other settings if practitioners were trained to administer it.

“We decided to test it at Delaware,” says Simons, who spent a 2001 sabbatical at Penn when the treatment was being developed. “Both the lab at Penn and our clinical group here are interested in manualized, empirically validated treatments. Those are treatments that have been demonstrated to work and that consist of specific techniques that are documented in such a way that they can be explained to and then implemented by others.”

He says the University was particularly interested in participating because the treatment was new and because social anxiety is a relatively common condition. Jason Moser, who had been a research assistant at Penn and now is a doctoral student at UD, has assisted Simons with the project for the past year.

During that time, seven individuals have completed the treatment program at UD, with Moser and a few other clinical graduate students serving as therapists. Simons says that all seven clients made improvements. Four of the seven did especially well in overcoming their anxiety. Overall, the UD clients showed a 50 percent reduction in their symptoms of social anxiety, a result that is identical to that found by the Penn researchers.

“Some of them improved so much that they actually seek out opportunities now for social interaction,” Moser says.

The treatment begins with the therapist educating the client about how common social phobias are and the various ways people cope with them. Simons says the two aspects of social anxiety are an extreme internal focus of attention, in which individuals are so worried about their behavior and about embarrassing themselves that they are unable to pay adequate attention to other people, and so-called “safety behaviors.” Those are actions the individual takes in social situations to try to feel more comfortable, but they often backfire.

For example, Moser says, a person may be so worried about saying something wrong in a group that he or she spends long periods of time thinking about exactly how to phrase a comment. As a result, the conversation often moves on, and the person never has a chance to participate.

In the treatment sessions, therapists have the clients confront their fears, beginning with the least frightening situations and gradually working up to more difficult ones. Meeting weekly, for about an hour or 90 minutes at a time, therapists have accompanied a client to a store while the client asks the clerk for information. They have brought other students and faculty members into a room, allowing the client to practice making conversation in a group. Some sessions are videotaped so the clients can see themselves behaving in different ways in social situations.

“We want to help them see that many of the things they’re doing in terms of their safety behaviors are actually counterproductive and getting in their way,” Moser says. “We want them to become more externally focused in the way they behave.”

Simons says the videotape itself is “a powerful tool” because it shows clients that they are not behaving stupidly, as they had feared, but that instead they look very much like everyone else.

“Clients have to work hard during the treatment,” Moser says. “They’re confronting their fears during every session.”

The UD research has shown that therapists other than those who developed the technique can learn and use it effectively with clients, Simons says.

“The goal is not to make someone anxiety-free but to bring their anxiety levels down into the normal range,” he says. “This is a very effective treatment for a disorder that’s prevalent and that doesn’t usually go away on its own.”

Simons says he would like to continue and expand the research by working with additional clients. The therapists have worked with University students and also with members of the community of all ages, including at least one teenager, through UD’s Psychological Services Training Center. The center is a community-based mental-health clinic that serves as the psychology department’s training facility for graduate students enrolled in the department’s clinical training program.

“We would like to get the word out that this is a treatment we can do,” Simons says. “It’s an effective service we can provide to the community, and it’s a good clinical skill for our own students to learn.”

For more information about participating in the treatment, contact Simons at (302) 831-2389 or e-mail [rsimons@udel.edu].

—Ann Manser, AS ’73, CHEP ’73