آموزش دوباره خودارزیابی در طول بازخورد ویدئویی برای اضطراب اجتماعی:آیا عمق پردازش مهم است؟
|کد مقاله||سال انتشار||مقاله انگلیسی||ترجمه فارسی||تعداد کلمات|
|33198||2010||10 صفحه PDF||سفارش دهید||9113 کلمه|
Publisher : Elsevier - Science Direct (الزویر - ساینس دایرکت)
Journal : Behaviour Research and Therapy, Volume 48, Issue 8, August 2010, Pages 728–737
Video feedback (VF) with cognitive preparation (CP) has been widely integrated into cognitive-behavioral therapy (CBT) protocols for social anxiety disorder (SAD) due to its presumed efficacy in improving negative self-perception. However, previous experimental studies have demonstrated that improvements in negative self-perception via VF + CP do not typically facilitate anxiety reduction during subsequent social interactions – a troubling finding for proponents of cognitive models of social anxiety. We examined whether VF + CP could be optimized to enhance participants’ processing of corrective self-related information through the addition of a post-VF cognitive review (CR). Sixty-eight socially anxious individuals were randomly assigned to perform two public speeches in one of the following conditions: a) exposure alone (EXP); b) CP + VF; and c) CP + VF + CR. Those in the CP + VF + CR condition demonstrated marginally significant reductions in anxiety from speech 1 to speech 2 relative to those who received EXP – an improvement not shown for those in the CP + VF condition. Furthermore, only those who received CP + VF + CR demonstrated significant improvements in self-perception and performance expectations relative to EXP. Decreases in anxiety among participants who received CP + VF + CR relative to EXP were fully mediated by improvements in self-perception. Implications are discussed in the context of cognitive models of social anxiety and mechanisms of exposure-based learning.
Research in support of influential cognitive models of social anxiety (Clark and Wells, 1995 and Rapee and Heimberg, 1997) has shown that socially anxious and phobic individuals possess excessively negative representations of self that are characterized by significant underestimations of social performance abilities (e.g. Ashbaugh et al., 2005, Moscovitch and Hofmann, 2007, Norton and Hope, 2001 and Rapee and Lim, 1992). Negative self-perception is considered by cognitive theorists to be the lens through which socially anxious individuals process information during social threat (e.g., Hirsch & Clark, 2004) and, therefore, the driving force behind the persistent, and often debilitating, somatic and behavioral symptoms that are characteristic of social anxiety. Of paramount interest to those engaged in improving therapeutic interventions for social anxiety is the question of how best to facilitate the modification of self-representations so that they contain more accurate and positive self-relevant information (e.g., Brewin, 2006 and Moscovitch, 2009). Theory and research on the behavioral principles of extinction learning suggest that changes in mental representations of self occur when individuals are presented with corrective information that is incompatible with their current self-schemas (Foa and Kozak, 1986 and Foa and McNally, 1996; see Moscovitch, Antony, & Swinson, 2009 for a review). Presumably, once corrective information is encoded and processed, new and more accurate self-representations are consolidated into memory, which then compete with prior representations for activation in subsequent situations (Bouton, 2002 and Brewin, 2006). A growing body of research has begun to investigate whether an efficacious method for improving self-perception in individuals with social anxiety disorder (SAD) is to confront them directly with images of their own performance via video feedback (VF). Now widely integrated into contemporary cognitive-behavioral therapy (CBT) protocols for SAD (e.g., Clark et al., 2003 and Hofmann and Scepkowski, 2006), VF involves providing individuals with video playback of their social performance following their participation in a social task, such as a public speech or a one-on-one conversation. It is hoped that the experience of viewing video recordings of their own social performances will enable socially anxious individuals to correct underestimations of their social abilities, which in turn, will lead to reduced symptoms of anxiety in anticipation of future social events (Harvey et al., 2000, Rapee and Hayman, 1996, Rodebaugh, 2004a and Rodebaugh, 2004b). When used in the context of some CBT protocols for SAD, VF is both preceded and followed by cognitive exercises designed to help patients glean new self insights. For example, therapeutic protocols based on Clark and Wells’ (1995) cognitive model of SAD (Clark et al., 2003 and Mortberg et al., 2007) include both a pre-VF cognitive preparation phase (based on Harvey et al.’s (2000) experimental procedure) and a post-VF review or discussion. During the preparation phase, patients are asked to predict in detail how they will appear in the video, such that they may be more likely to notice upon watching the video the discrepancies between how they predicted they would appear and how they actually appeared. Patients are also prepared beforehand on how to watch the video through the eyes of an “objective observer.” During the post-VF review, patients spend considerable time discussing the accuracy of their own self-views with the therapist. In the majority of experimental studies in the literature on VF in social anxiety, however, the post-VF review phase is conspicuously absent. As summarized in Table 1, experimental research on social anxiety and VF has typically examined the efficacy of VF on its own (i.e., with neither a pre-VF preparation phase nor a post-VF review phase; Rapee and Hayman, 1996 and Rodebaugh and Chambless, 2002), or with the addition of a pre-VF cognitive preparation phase only (Harvey et al., 2000, Kim et al., 2002, Rodebaugh, 2004a, Rodebaugh, 2004b and Smits et al., 2006). These studies have found that, a) VF was efficacious in improving self-perception (e.g. Harvey et al., 2000, Rodebaugh, 2004a and Rodebaugh, 2004b) and b) VF with cognitive preparation led to changes in self-perception that generalized to a second speech situation (Kim et al., 2002). However neither VF alone nor VF with cognitive preparation succeeded in facilitating significant reductions in social anxiety symptoms above and beyond exposure alone (Rapee and Hayman, 1996, Rodebaugh, 2004a, Rodebaugh, 2004b and Smits et al., 2006).