An Acceptance and Mindfulness‐Based Approach to Social Phobia: A Case Study

Over the past few years, there has been a proliferation of theoretical discussions and empirical research on the use of acceptance and mindfulness-based therapies to treat anxiety disorders. Because these treatment approaches are in their infancy, many clinicians may still be uncertain about how to apply such treatments in their work with clients. This case study demonstrates the successful use of an acceptance-based approach for the treatment of social anxiety disorder in a student in a college counseling center. ********** Over the last decade, there has been an abundance of theoretical discussions and empirical studies on the use of acceptance and mindfulness-based psychotherapy for a variety of conditions, including depression, anxiety, stress, and pain (Hayes, Masuda, Bissett, Luoma, & Guerrero, 2004). Acceptance and mindfulness-based therapies purport that underlying all anxiety disorders is an unwillingness to experience one's internal events (thoughts, feelings, sensations), as well as efforts directed toward altering the experience of these events (Hayes, Wilson, Gifford, Follette, & Strosahl, 1996). One prominent acceptance-based therapy, acceptance and commitment therapy (ACT; Hayes, Strosahl, & Wilson, 1999), has demonstrated positive outcomes with a variety of disorders, including social phobia (Hayes et al., 2004). Thus, ACT will be discussed as it relates to the treatment of social phobia. The intention of this case study is to demonstrate the use of an acceptance and mindfulness-based approach for the treatment of social phobia, also referred to as social anxiety disorder (SAD), in a student at a college counseling center. Literature Review SAD is an anxiety disorder characterized by an excessive fear of social evaluation that typically develops in adolescence or early adulthood (American Psychiatric Association [APA], 2000). The Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR; APA, 2000) designates the following criteria for SAD: (a) a significant and persistent fear of social situations in which the person fears that he or she will be evaluated negatively by others, (b) exposure to the feared situations elicits anxiety, (c) the individual recognizes that his or her fear is excessive, (d) the feared social situations are often avoided or endured with intense distress, (e) the avoidance or distress interferes significantly with the individual's life, and (f) the symptoms have been present for at least 6 months. Individuals with SAD experience intense anxiety in social situations, leading to avoidance and dysfunction in a variety of life domains, such as interpersonal relationships and occupational and academic performance (Davidson, Hughes, George, & Blazer, 1993). A recent replication of the National Comorbidity Survey found that 12.1% of individuals in the general population will experience SAD in their lifetimes (Ruscio ct al., 2008). It is the second most common psychiatric disorder behind specific phobia (Kessler, Chiu, Demler, & Walters, 2005). Studies of college populations in particular have found elevated rates of SAD, including among students not attending campus counseling centers (Stewart & Mandrusiak, 2007). Stewart and Mandrusiak (2007) examined SAD in college students and found that 49% of the clinical sample and 42% of the nonclinical sample had clinically significant scores on the Social Phobia Inventory (Connor et al., 2000). SAD may be particularly difficult for college students, because they face many new social situations. These new social demands occur while students may be away from their previous familiar family and social supports and also while they are learning to manage academic, family, and other contemporaneous stressors associated with the college experience. Individuals with SAD are also at a higher risk of developing other psychiatric illnesses, such as depression and substance use disorders, as well as experiencing health problems and an overall reduced quality of life (Kessler, 2003). …