Person-Centred/Experiential
Approaches to Social Anxiety:
Initial outcome results
Robert Elliott & Brian Rodgers
University of Strathclyde
Why Study Social Anxiety
(SA)?
Some research on PTSD/trauma and
Generalized Anxiety, but social anxiety
neglected
Common but debilitating problem, affects
social adjustment, work functioning
Relevance to government initiatives targetting
anxiety/depression in chronic unemployment
Risk factor for depression, substance misuse
(self-medication)
What is Social Anxiety?
(DSM-IV)
A. Marked and persistent fear
One or more social or performance situations
The individual fears that he or she will act in a
humiliating or embarrassing way
B. Consistency: Exposure to feared social situation
almost invariably provokes anxiety
C. Recognition: Person experience fear as excessive
or unreasonable
D. Avoidance, or endurance with intense
distress
E. Interference: interferes significantly with
functioning or wellbeing
Why Person-Centred-Experiential
(PCE) Therapies for Social Anxiety?
This client group has been virtually ignored
by humanistic psychotherapies
PCEs shown to be effective with Major
Depression
SA Commonly accompanied with clinical
depression, substance abuse, employment
problems
Resonance with key theoretical formulations:
Standard Person-Centred Therapy: Conditions of
worth
Emotion-Focused Therapy: Anxiety splits:
externalized inner critic
SA: Driven by Powerful
Emotion Processes
Key emotions: primary maladaptive
(overgeneralized) shame and fear
Organized by core emotion schemes:
 Self as socially defective
 Others as harshly judging/rejecting (=internalized
critic)
 SA organized around core emotion scheme
of Self as socially defective
 Basis of SA: Fear that this core defective self
will be seen & negatively judged by others
Core Defective Self-scheme
Socially Defective Self (Experiencer)
Typically grounded in early
physical/emotional/sexual abuse or
rejection/bullying
Organized around primary maladaptive
shame/fear
Symbolized by one or more key
phrases/images, e.g., “rubbish”, “crazy”,
“stupid”, “ugly”, “a freak”
Shaming Internalized Critic
Scheme
Complementary emotion scheme:
Harsh, shaming internal Critic
 Introject of early rejection/abuse
 Emotion scheme primes monitoring for social
dangers
 Attribution to current others
 But: also has protective function (prevent social
rejection)
Motivates social withdrawal/avoidance &
emotional avoidance
Strathclyde PCE Therapy for
Social Anxiety Project
Therapy development/ Pilot study
Open clinical trial
In progress; n = 19 completers to date
Two arms of study (non-randomized but
unsystematic):
Standard Person-centred (PCT)
Including nondirective & broader relational versions
Emotion-focused therapy (EFT)
PCT + active tasks: Focusing, Unfolding, Chairwork
Method: Clients
Community sample
Brief telephone screening
Face-to-face diagnostic assessment (2 X 2 hrs):
SCID-IV
Personality Disorders Questionnaire (PDQ)
Create Personal Questionnaire
Inclusion criteria:
Consider self to have problem with social anxiety
Meet DSM-IV criteria for social anxiety
Willingness to be recorded, fill out forms
Method: Clients
Specific SA (one specific situation:
public speaking): 49%
Generalized (multiple situations):
51%
Axis 2: mean 3.3 Axis 2 diagnoses
Avoidant Personality pattern: 92%
Borderline: 35%
Mean Problem Duration Ratings of
Personal Questionnaire Items
n
Mean
SD
• “6.2”: somewhat more than 6 to 10 years
• Client presenting problems = chronic
17
6.24
0.78
Method: Therapy & Research
Parameters
Up to 20 sessions; less if client feels finished
Assessments/data collection at:
Pre
Mid: After session 8
Post (end of therapy)
6- & 18-mo follow-ups
Method: Outcome measures
 1. Personal Questionnaire(PQ):
Individualized/weekly problem distress; used for
progress monitoring
 2. CORE-Outcome Measure (CORE): General
problem distress
 3. Social Phobia Inventory (SPIN): Problem specific
 4. Inventory of Interpersonal Problems (IIP):
Interpersonal problem distress
 5. Strathclyde Inventory (Strath): Person-centred
outcome measure
 6. Self-relationship Scale (SR): EFT Outcome
measure (Self-attack, Self-affiliation, Self-neglect)
Results: Post-therapy Outcome for
Combined Sample
Measure
Cut-off Pre-Therapy
value
Post Therapy
n
m
sd
n
m
sd
Effect
Size
(sd)
N
Clients
Reliable
change
PQ
>3.5
18
5.55
.81
18
3.34
1.17
2.20**
14 (18)
CORE
>1.25
17
1.58
.67
15
.95
.72
.91*
8 (11); 1
SPIN
>1.12
17
2.48
.66
14
1.50
.66
1.54**
9 (16)
IIP
>1.5
17
1.89
.66
14
1.26
.54
.96*
7 (13); 1
Strath
<1.95
17
1.94
.50
15
2.66
.56
1.33**
10 (8)
mean Pre-Post ES:
1.39
*p < .05; **p < .01 (using both independent & paired samples t-tests)
n of clients showing reliable improvement (p < .05)
(n of client in clinical range pre-therapy)
n of clients showing reliable deterioration (p < .05)
Clients Showing Reliable
Change X Measures
(Positive Change unless otherwise noted)
Global Change: At least two measures
Some change: At least one measure
Limited Change: One measure but not others
Negative/mixed change (evidence of
deterioration)
No reliable change on any measure
N
10
16
3
2
2
Results: SPIN Outcome Benchmarking
Measure:
PCE
Pre
Post
N
M
SD
M
SD
Prepost
Effect
Size
(sd)
14
2.48
.66
1.40
.67
1.54
2.53
.62
2.16
.81
1.28
2.4
.81
2.16
.75
.31
2.64
.85
1.81
.92
Connor et al 2000:
28
Medication
Placebo 25
Antony et al 2006:
Group CBT 74
.94
Results: SPIN Subscale Analyses (w
Benchmarking)
Subscale:
Pre-therapy
M
SD
Fear
Avoidance
2.80
2.69
Physiological
1.61
Post-therapy
M
.76
.59
1.0
SD
1.55
1.63
0.79
.82
.74
PCE
Effect
Size
(ES)
Antony
2005 ES
(sd)
(sd)
1.64**
.93
1.64**
.81
1.03**
.69
.63
N = 16 (pre), 14 (post)
Significance tests are pre-post for PCE therapy: *p < .05; **p< .001
PCT vs. EFT Pre-post Effect
Sizes
Measure
PCT
EFT
PQ
2.11
2.23
CORE
0.68
1.09
SPIN
1.61
1.68
IIP
0.75
1.21
Strath
0.96
1.22
1.76
1.60
Mean Pre-post ES:
EFT vs. PCT Difference in
ES:
+.37
Worse than expected
Better than expected
Results: Analysis of Drop-out Patterns
PCT EFT
Completers
Early drop-outs (1 -2
sessions)
9
9
4
2
Late drop-outs (3 - 5)
4
0
Changed to other therapy
3
1
Total (re)starts
20
12
% Completers
45%
75%
Late Drop-outs
Quit before indicating they were done
with therapy or finishing 16-20 sessions
Session 3 -5
Pre-therapy mean PQ = 6.24 (vs. 5.59
for completers)
Last session mean PQ = 5.55
Included 3 of the 4 most initially
distressed clients
Clients who changed
therapies
Early drop-outs included 4 clients who
switched between arms of the study
1 client changed from EFT  PCT
Scheduling issue
3 clients changed PCT  EFT
Negative reaction to lack of structure in
session 1
Discussion – General
Conclusion
EFT (also PCT) for Social Anxiety
 Promising new approach
 Substantial change over therapy
On long-standing problems
Comparable to benchmark treatments
(medication, CBT)
Discussion – EFT vs PCT?
Slight advantages to EFT over PCT?
On CORE, IIP, Strath, but not on SPIN, PQ
+.37: Same order as York I study
(Greenberg & Watson, 1998), but smaller
than York II (Goldman et al., 2006)
Some clients react negatively to PCT in
early sessions; fewer drop-outs in EFT
Appears related to greater structure in EFT
Discussion - Cautions
But:
Not statistically significant (low power), but
current best guess
Nonrandomized design
Possibility of treatment diffusion
(Chairwork in PCT condition?)
Some clients refuse EFT Chair work
Need to collect more data: target n = 30
Next Steps
RCT: Primary Care client population
PCE therapy (PCT & EFT) vs. NHS
Primary Care Mental Health Team
Treatment as Usual (group & individual
CBT)
Continue developing EFT therapy for
SA
Piloting PCT & EFT Adherence
Measures
E-mail: Fac0020@gmail.com
Blog: pe-eft.blogspot.com