اثرات تعدیل از بازخورد ویدئویی برای اختلال اضطراب اجتماعی
|کد مقاله||سال انتشار||مقاله انگلیسی||ترجمه فارسی||تعداد کلمات|
|33204||2010||9 صفحه PDF||سفارش دهید||8151 کلمه|
Publisher : Elsevier - Science Direct (الزویر - ساینس دایرکت)
Journal : Journal of Anxiety Disorders, Volume 24, Issue 7, October 2010, Pages 663–671
Despite initially positive results, video feedback for social anxiety has never been shown to reduce social anxiety in a controlled experiment with diagnosed participants, and only once with undiagnosed participants. Previous studies arguably did not detect such an effect because of limited assessment of anxiety and potential moderators. We tested video feedback with cognitive preparation among treatment-seeking participants with a primary diagnosis of social anxiety disorder. In Session 1, participants gave an extemporaneous speech and either received the intervention or not. In Session 2, 6–14 days later, participants gave a second extemporaneous speech. The intervention improved self-perception of performance, particularly for those participants with the most unrealistically negative impressions of their performance (i.e., high self-observer discrepancy). In addition, the intervention reduced anticipatory anxiety for the second speech for participants with high self-observer discrepancy. These findings extend previous results regarding video feedback and suggest that the intervention may be useful for people with social anxiety disorder and higher self-observer discrepancies for a specific task.
Higher social anxiety is associated with interpersonal behaviors that are generally maladaptive and detectable in a variety of ways (e.g., Creed and Funder, 1998, Voncken et al., 2008 and Walters and Hope, 1998). People who have higher social anxiety are clearly more likely to display maladaptive interpersonal behaviors, yet it is also clear that they generally believe they come across worse than observers believe they do (Heimberg et al., 1990, Rapee and Lim, 1992 and Stopa and Clark, 1993). Cognitive behavioral models of social anxiety disorder (Clark and Wells, 1995 and Rapee and Heimberg, 1997) suggest that this discrepancy between perception of performance and actual performance helps to maintain social anxiety.Video feedback (VF) has therefore been suggested as a method to enhance the effects of exposure through having the person with social anxiety disorder view a videotape of his or her social performance (e.g., Clark & Wells, 1995). Authors recommending the use of VF typically suggest preparing the recipient of the feedback, most notably with cognitive preparation (CP; Harvey, Clark, Ehlers, & Rapee, 2000). CP was designed to accomplish two goals: (a) help the participant clarify what he or she expected to see on the videotape (through a semi-structured interview using self-ratings of specific behaviors), maximizing the potential for participants to observe discrepancies between their beliefs and their videotaped performances and (b) encourage participants to watch the videotape in an objective fashion and avoid re-activating memories of the event that would interfere with attending to the videotape. Promising results have been reported for cognitive therapy for social anxiety disorder, which contains VF with CP among many elements (Clark et al., 2003, Clark et al., 2006 and McManus et al., 2009; although see Aderka, 2009). In contrast, controlled studies of VF and VF with CP have been somewhat less promising. VF alone is not necessarily sufficient to improve self-perception of performance in people who are socially anxious (compare Rapee & Hayman, 1996 with Rodebaugh & Chambless, 2002), but CP increases the effects of VF, producing a robust change in self-perception of performance (Harvey et al., 2000, Kim et al., 2002 and Rodebaugh, 2004). Despite the fact that this type of preparation increases the effects of VF, Rodebaugh (2004) reported that it failed to show an effect on anxiety, confidence, or willingness to approach a subsequent speaking task. Similarly, Smits, Powers, Buxkamper, and Telch (2006) found that adding VF with CP to an exposure therapy for social anxiety disorder failed to confer any added benefit for anxiety-related measures over exposure alone. In contrast, a recent study investigating VF with CP for socially anxious adolescents found evidence for reduction in anticipatory anxiety over exposure alone ( Parr & Cartwright-Hatton, 2009). Neither Rodebaugh's (2004) study nor the study by Smits and colleagues was designed to assess for effects on anticipatory anxiety. The VF with CP literature has several gaps that might explain such inconsistent results. Parr and Cartwright-Hatton's (2009) study may be the only controlled test of VF with CP that demonstrates reduction in anxiety because other studies failed to specifically assess anticipatory anxiety. A study that assesses both anticipatory anxiety and anxiety during speech performance would therefore be helpful. Further, only one controlled study assessed participants with social anxiety disorder (Smits et al., 2006), and participants in this study were largely recruited from a screened student sample and therefore not representative of a typical treatment-seeking sample. It would be useful to have available a test of VF with CP among treatment-seeking participants. Finally, relatively few studies have examined the possibility that VF with CP might reduce anxiety only among some individuals. Predictors of response to VF with CP would be useful to clinicians seeking to determine whether particular clients would be likely or unlikely to respond well to the intervention, which requires a nontrivial amount of time to conduct. The most promising candidate for a predictor of response to VF with CP appears to be self-observer discrepancy, defined as the degree to which observer ratings fail to predict self-ratings. Participants with higher self-observer discrepancies differ more strongly from observer predictions when rating themselves, indicating that their beliefs about their performances are particularly distorted. Although self-observer discrepancy can occur in either direction (i.e., a person can believe he or she looks much worse or much better than observers would predict), it seems likely that participants who believe they look far worse than they actually do should benefit the most from VF with CP. In this paper, we use the term higher self-observer discrepancy to refer to these participants. Several studies have examined the possibility that self-observer discrepancy predicts response to VF (with and without CP). Rodebaugh and Chambless (2002) found that higher self-observer discrepancy predicted response to VF alone, such that only participants with higher self-observer discrepancy showed beneficial effects for VF in a second speech task. Similarly, upon re-analyzing the data from Rapee and Hayman (1996), Rodebaugh and Rapee (2005) found that self-observer discrepancy showed similar predictive power in that dataset. Finally, in a third, independent sample, Rodebaugh (2004) found additional evidence that self-observer discrepancy predicted response. However, in each of these examinations, the only outcome variable affected was self-perception of performance. No study has demonstrated that self-observer discrepancy moderates the effects of VF on anxiety in subsequent social tasks. However, none of these studies assessed anticipatory anxiety. Further, the only controlled experiment to examine the effects of VF on participants diagnosed with social anxiety disorder did not test the moderating effects of self-observer discrepancy (Smits et al., 2006).2 Our clinical experience suggests to us that VF is a useful intervention for anxiety, at least for some participants. Our impression is that most clinicians who are aware of the technique believe it is effective for reducing anxiety. It may therefore come as a surprise that the literature is not conclusive on this issue, with only one controlled experiment offering direct support and no controlled experiment offering support in regard to reducing anxiety in participants with social anxiety disorder. To take a step in the direction of resolving this issue, we conducted a study of VF with CP in treatment-seeking participants with social anxiety disorder. We compared VF with CP to exposure alone to maximize the power of the intervention and because there was little reason to believe that either VF or CP alone would be particularly effective. Sessions were conducted 6–14 days apart to more closely mimic the usual course of psychotherapy and allow greater generalizeability to a therapy context. We also assessed anticipatory anxiety, as well as anxiety at the end of the social task, to test the possibility that the intervention might have an effect only on some aspects of the anxiety response. Finally, we tested for the moderating effects of self-observer discrepancy. Our hypotheses were that the intervention would produce changes in self-perception of performance and anticipatory anxiety (but not necessarily anxiety at the end of the speech) and that self-observer discrepancy would moderate these effects