Social skills training

CBT (exposure therapy, cognitive restructuring, relaxation training, and social skills training) and pharmacotherapy are considered equally effective in SAD, but CBT can lead to a greater likelihood of maintaining response after treatment termination. Even after response, most patients continue to experience more than minimal residual symptoms. 

CBT and social skills training are effective in children with SAD. Evidence supports the efficacy of SSRIs and serotonin norepinephrine reuptake inhibitors in children 6 to 17 years of age. Individuals up to 24 years of age should be closely monitored for increased risk of suicidality. 

Spence, S.H., Donovan, C., and Brechman-Toussaint, M. (2000) The treatment of childhood social phobia the effectiveness of a social skills training-based, cognitive-behavioral intervention, with and without parental involvement. J Child Psychol Psychiatry 41 713-726. 

Hoggarty, G.E., Anderson, C.M., Reiss, D.J., Kornblith, S.J., Green-wald, D.P., Javna, C.D., and Madonia, M.J. (1986) Family psychoeducation, social skills training and maintenance chemotherapy in the aftercare treatment of schizophrenia. I. One-year effects of a controlled study on relapse and expressed emotions. Arch Gen Psychiatry 43 633-642. 

This type of program should offer cognitive-behavioral group therapy and individual therapy. It should be able to provide medication if necessary, structured meals, and nutritional counseling and meal planning. Group therapies, e.g., social skills training, are also useful. 

Although early anecdotal reports suggested the usefulness of this class of agents, overall studies of (3-blockers in clinical populations have not been supportive of their efficacy in social phobia. Falloon et al. [1981] compared propranolol and placebo, both used in conjunction with social skills training. This study failed to find any difference between the two treatment groups. However, the study was compromised by small sample size and failure to select subjects using specific diagnostic criteria for social phobia. 

Bellack, A.S., Hersen, M. Himmelhoch, J. Social skills training compared with pharmacotherapy and psychotherapy in the treatment of unipolar depression. Am. J. Psychiatry 138, 1562-1567, 1981. 

An important implication of this observation is the suggestion that early intervention in schizophrenia could substantially alter the natural course of the illness. To investigate this idea, early-intervention projects have been developed. In one, primary physicians were trained to recognize the early symptoms of a mental disorder and to arrange consultation with an intervention team who assessed and treated the disorder. If early symptoms were present, the functional psychotic disorder was treated with low doses of the appropriate medication, often for a relatively short period of time (i.e., several weeks), and then tapered when symptoms abated while psychosocial intervention was continued. In some patients, symptoms returned and medication was reinstituted. The psychosocial program, social skills training, and social casework were continued for some time, and all patients were monitored for at least 2 years. Epidemiological data established that over the lifetime of this project, 7.5 new cases would be expected for 100,000 patients (227, 228). 

Foy, D.W., Miller, P.M., Kislcr, R.M., and O Toole, D.H. (1976) Social skills training to teach alcoholics to refuse drinks effectively Journal of Alcohol Studies, 37 1340-5. 

More pervasive forms of social anxiety (and avoidant personality disorder) may be treated with MAO inhibitors or SSRIs (see chapter 14), in addition to psychotherapy and social-skills training. 

Application of social learning principles to reduce or eliminate alcohol consumption. Specific treatments include relapse prevention (discussed later in this chapter), community reinforcement, and social skills training (SST)—teaching the individual to use nonalcohol ways of coping with interpersonal situations. 

SAD can present in children of preschool to elementary school age. If the disorder is not treated, it can persist into adulthood and increase the risk of depression and substance abuse. CBT and social skills training are effective nonpharmacological therapies in children. Pharmacological evidence is limited to case studies or open-label trials. SSRIs are considered first-line therapy because of tolerability and effectiveness. Fluoxetine, fluvoxamine, sertraline, and paroxetine were effective in children with SAD. Headache, nausea, drowsiness, insomnia, jitteriness, and stomach aches were reported in children receiving SSRIs. 

Other applications assertiveness training, social skills training, preparing children for various frightening or painful medical or surgical procedures... 

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