Social Skills Training Encourages a Patient with Social Anxiety Disorder to Undertake Challenging Behavioral Experiments

Abstract

Introductions: Cognitive models of social anxiety disorder (SAD), such as that developed by Clark & Wells, conceptualize the attention to, and misinterpretation of, internal information as a key maintaining factor. Social skills training (SST), a frequently used cognitive therapy (CT) technique for various mental disorders, is often justified according to a skills-deficit model of SAD, which assumes that anxiety arises from inadequate social interaction skills. However, the evidence largely suggests little to no skills deficit in this patient group, indicating that SST is not necessarily a technique to be used in CT for most SAD patients. In this study, we present a patient with SAD who negatively perceived her social skills abilities, and who benefitted from SST. We also discuss the role of brief SST in CT treatment. Presentation of Case: The patient was a Japanese female with excessive fear of social interactions who negatively perceived her own social skills. Cognitive therapy mainly consisted of case formulation, behavioral experiments, and opinion surveying based on the Clark & Wells model. As the patient felt too anxious to attempt behavioral experiments, due to her negative perception of her own social skills, SST was briefly employed in the course of CT. Discussion and Conclusion: As the patient’s actual social skills abilities were never formally assessed, it is impossible to know if she had any social skills deficits prior to treatment, and, if so, if they were improved by the SST provided. However, SST encouraged the patient to try challenging tasks, notably behavioral experiments and homework centering on feared social situations. Although SST should not necessarily be included in CT for SAD patients, SST can help patients to decrease their excessive fear of being negatively perceived due to poor social skills, making it easier for them to try challenging behavioral experiments in feared social situations.