The Effects of a Cognitive-Behavioral Group Therapy Program for Social Anxiety in Female Adolescents

여자 청소년의 사회불안 감소를 위한 인지행동집단치료 프로그램의 개발과 효과 - 2년 추후연구 -

  • Kim, Jung-Min (Dept. of Child Development and Education, Myongji Univ.)
  • Published : 2008.04.30

Abstract

The aim of the present study was to develop a cognitive-behavioral group therapy program for social anxiety in Korean adolescents and to examine its efficacy through pre-, post- and 2-year follow-up tests. The program included cognitive restructuring, exposure training and social skills training. KSAS-A and SASC-R were administered to 588 1st grade middle-school female students to assess their social anxiety levels. On the basis of double criteria procedure(top 10% scores on both scales), 59 students were selected initially. Individuals currently receiving clinical treatment were excluded. Finally, 40 students were selected and randomly assigned to either a treatment group or a wait-list control group. The program consisted of 12 weekly sessions, approximately 1.5-2 hours in duration. Whereas pre- and post-tests were administered to both groups, follow-up tests were administered to the treatment group only. The collected data were statistically analyzed through independent t-test and paired t-test. The results of the study were as follows: 1) At post-test students in the treatment group showed a very significant reduction in social anxiety and fear of negative evaluation by others in comparison with those in the wait-list group. 2) At post-test students in the treatment group showed a significant reduction in negative automatic thoughts in comparison with those in the wait-list group. 3) At post-test students in the treatment group showed a significant improvement in overall social skills in comparison with those in the wait-list group. 4) At post-test students in the wait-list group showed a significant increase in both social anxiety and negative automatic thoughts in comparison with those in the treatment group. 5) At 3-month, 1-year and 2-year follow-ups, the program's effectiveness was maintained.

References

  1. 김정민(2006). 청소년의 사회불안 감소를 위한 인지행동집단상담 프로그램의 효과. 한국상담학회지, 7(2), 541-556
  2. 문경주.오경자.문혜신(2002). 한국판 아동, 청소년용 자동적 사고척도(K-CATS)의 타당화 연구. 한국심리학회지: 임상, 21(4), 955-963
  3. 문혜신.오경자(2002). 한국판 아동.청소년용 사회 불안 척도의 타당화 연구. 한국심리학회지: 임상, 21(2), 429-443
  4. 박난숙(1992). Methyphenidate 치료가 주의력 결핍 과잉활동아의 인지, 행동 및 사회, 학습, 정서적 적응에 미치는 효과. 연세대학교 석사학위 청구논문
  5. 조용래.이경선.황경남(2005). 사회불안장애 청소년에 대한 집단인지행동치료 효과의 예비연구. 한국심리학회지: 임상, 24(1), 243-253
  6. Albano, A. M., DiBartolo, P. M., Holt, C. S., Heimberg, R. G., & Barlow, D. H. (1995). Cognitive-behavioral group treatment for social phobia in adolescents: A preliminary study. The Journal of Nervous and Mental Disease, 183, 649-656 https://doi.org/10.1097/00005053-199510000-00006
  7. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders(4th ed.). Washington, DC: APA
  8. Angold, A, Costello E. J., Burns B. J., Erkanli, A., & Farmer, E. M. Z. (2000). Effectiveness of nonresidential specialty mental health services for children and adolescents in the "real world". J Am Acad Child Adolesc Psychiatry, 39, 154-160 https://doi.org/10.1097/00004583-200002000-00013
  9. Barrett, P. M., Dadds, M. R., & Rapee, R. M. (1996). Family treatment of childhood anxiety: A controlled trial. Journal of Consulting and Clinical Psychology, 64, 333-342 https://doi.org/10.1037/0022-006X.64.2.333
  10. Beck, A. T., Emery, G., & Greenberg, R. L. (1985). Anxiety disorders and phobias: A cognitive perspective. N.Y.: Basic Books
  11. Beidel, D. C. (1991). Social phobia and overanxious disorder in school-age children. J Am Acad Child Adolesc Psychiatry, 30, 545-552 https://doi.org/10.1097/00004583-199107000-00003
  12. Beidel, D. C. (1998). Social anxiety disorder: Etiology and clinical presentation. Journal of Clinical Psychiatry, 59, 27-31
  13. Beidel, D. C., Christ M. G., & Long, P. J. (1991). Somatic complaints in anxious children. J Abnorm Child Psychol, 19, 659-670 https://doi.org/10.1007/BF00918905
  14. Beidel, D. C., Turner, S. M., & Morris, T. L. (1995). A new inventory to assess childhood social anxiety and phobia: The Social Phobia and Anxiety Inventory for Children. Psychological Assessment, 7, 73-79 https://doi.org/10.1037/1040-3590.7.1.73
  15. Beidel, D. C., Turner, S. M., & Morris, T. L. (1999). Psychopathology of childhood social phobia. J Am Acad Child Adolescc Psychiatry, 38, 643-650 https://doi.org/10.1097/00004583-199906000-00010
  16. Beidel, D. C., Turner, S. M., & Morris, T. L. (2000). Behavioral treatment of childhood social phobia. Journal of Consulting and Clinical Psychology, 68, 1072-1080 https://doi.org/10.1037/0022-006X.68.6.1072
  17. Cartwright-Hatton, S., Hodges, L., & Porter, J. (2003). Social anxiety in childhood: the relationship with self and observer rated social skills. Journal of Child Psychology and Psychiatry, 44(5), 737-742 https://doi.org/10.1111/1469-7610.00159
  18. Chavira, D. A., & Stein, M. B. (2005). Childhood social anxiety disorder: From understanding to treatment. Child and Adolescent Psychiatric Clinics of North America, 14, 797-818 https://doi.org/10.1016/j.chc.2005.05.003
  19. Clark, D. M., & Wells, A. (1995). A cognitive model of social phobia. In R. G. Heimberg, M. R. Liebowitz, D. A. Hope, & F. R. Schneier (Eds.), Social phobia: Diagnosis, assessment, and treatment(pp. 69-93). New York: Guilford Press
  20. Costello, E. J., Angold, A., & Keeler, G. P. (1999). Adolescent outcomes of childhood disorders: The consequences of severity and impairment. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 121-128 https://doi.org/10.1097/00004583-199902000-00010
  21. Costello, E. J., Egger, H. L., & Angold, A. (2004). Developmental epidemiology of anxiety disorders. In: Ollendick, T. H., March, J. S. (Eds.), Phobic and anxiety disorders in children and adolescents (61-91). N.Y.: Oxford University
  22. Dewit, D. J., Ogborne, A., Offord, D. R., & MacDonald, K. (1999). Antecedents of the risk of recovery from DSM-III-R social phobia. Psychological Medicine, 29, 569-582 https://doi.org/10.1017/S0033291799008399
  23. Donovan, C. L., & Spence, S. H. (2000). Prevention of childhood anxiety disorders. Clinical Psychology Review, 20(4), 501-531
  24. Essau, C. A., Conradt, J., & Peterman, F. (1999). Frequency and comorbidity of social phobia and social fears in adolescents. Behavior Research and Therapy, 37, 831-843 https://doi.org/10.1016/S0005-7967(98)00179-X
  25. Friedberg, R. D., & McClure, J. M. (2002). Clinical practice of cognitive therapy with children and adolescents: the nuts and bolts. N.Y.: Guilford
  26. Fresco, D. M., Erwin, B. A., Heimberg, R. G., & Turk, C. L. (2000). Social phobia and specific phobias. In M. G. Gelder, J. Lopez-lbor, & N. C. Andreasen (Eds.), New Oxford textbook of psychiatry(794-807). Oxford, UK: Oxford University Press
  27. Gallagher, H. M., Rabian, B. A., & McCloskey, M. S. (2004). A brief group cognitive-behavioral intervention for social phobia in childhood. Journal of Anxiety Disorders, 18, 459-479 https://doi.org/10.1016/S0887-6185(03)00027-6
  28. Ginsburg, G. S., La Greca, A. M., & Silverman, W. K. (1998). Social anxiety in children with anxiety disorders: Relation with social and emotional functioning. Journal of Abnormal Child Psychology, 26, 175-186 https://doi.org/10.1023/A:1022668101048
  29. Hayward, C., Varady, S., Albano, A. M., Thienemann, M., Henderson, L., & Schatzberg, A. F. (2000). Cognitive-behavioral group therapy for social phobia in female adolescents: Results of a pilot trial. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 721-726 https://doi.org/10.1097/00004583-200006000-00010
  30. Hofmann, S. G., Albano, A. M., Heimberg, R. G., Tracey, S., Chorpita, B. F., & Barlow, D. H. (1999). Subtypes of social phobia in adolescents. Depress Anxiety, 9, 15-18 https://doi.org/10.1002/(SICI)1520-6394(1999)9:1<15::AID-DA2>3.0.CO;2-6
  31. Kendall, P. C., Flannery-Schroeder, E., Panichelli- Mindel, S. M., Southam-Gerow, M., Henin, A., & Warman, M. (1997). Therapy for youths with anxiety disorders: A second randomized clinical trial. Journal of Consulting and Clinical Psychology, 65, 366-380 https://doi.org/10.1037/0022-006X.65.3.366
  32. Klein, R. G. (1991). Parent-child agreement in clinical assessment of anxiety and other psychopathology: A review. Journal of Anxiety Disorders, 5, 187-198 https://doi.org/10.1016/0887-6185(91)90028-R
  33. La Greca, A. M., & Stone, W. L. (1993). Social anxiety scale for children-revised: Factor structure and concurrent validity. Journal of Clinical Child Psychology, 22, 17-27 https://doi.org/10.1207/s15374424jccp2201_2
  34. Leary, M. R. (1983). A brief version of the fear of negative evaluation scale. Personality and Social Psychology Bulletin, 9, 371-375 https://doi.org/10.1177/0146167283093007
  35. Masia, C. L., Klein, R. G., Storch, E. A., & Corda, B. (2001). School-based behavioral treatment for social anxiety disorder in adolescents: Results of a pilot study. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 780-786 https://doi.org/10.1097/00004583-200107000-00012
  36. Matson, J. L., Rotatori, A. F., & Helsel W. J. (1983). Development of rating scale to measure social skills in children: The Matson evaluation of social skills with youngsters(MESSY). Behavior Research and Therapy, 21, 335-340 https://doi.org/10.1016/0005-7967(83)90001-3
  37. Morris, T. L., & Masia, C. L. (1998). Psychometric evaluation of the social phobia and anxiety inventory for children: Concurrent validity and normative data. Journal of Clinical Child Psychology, 27, 452-458 https://doi.org/10.1207/s15374424jccp2704_9
  38. Muris, P., Merckelbach, H., & Damsma, E. (2000). Threat perception bias in nonreferred, socially anxious children. Journal of Clinical Child Psychology, 29, 348-359. https://doi.org/10.1207/S15374424JCCP2903_6
  39. Nauta, M. H., Scholing, A., & Emmelkamp, P. M. (2003). Cognitive-behavioral therapy for children with anxiety disorders in a clinical setting: no additional effect of a cognitive parent training. Journal of Child Psychology and Psychiatry, 42, 1270-1278
  40. Rapee, R. M., & Heimberg, R. G. (1997). A cognitive-behavioral model of anxiety in social phobia. Behaviour Research and Therapy, 35, 741-756 https://doi.org/10.1016/S0005-7967(97)00022-3
  41. Schniering. C. A., & Rapee, R. M. (2002). Development & validation of a measure of children's automatic thoughts: The children's automatic thoughts scale. Behavior Research and Therapy: Behavioral Assessment Section, 40, 1091-1109
  42. Spence, S. H., Donovan, C., & Brechman-Toussaint, M. (1999). Social skills, social outcomes, and cognitive features of childhood social phobia. Journal of Abnormal Psychology, 108, 211-221 https://doi.org/10.1037/0021-843X.108.2.211
  43. Spence, S. H., Donovan, C., & 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. Journal of Child Psychology and Psychiatry, 41, 713-726 https://doi.org/10.1111/1469-7610.00659
  44. Stein, M. B., Chavira, D. A., & Jang, K. L. (2001). Bringing up bashful baby: Developmental pathways to social phobia. The Psychiatric Clinics of North America, 24, 661-675 https://doi.org/10.1016/S0193-953X(05)70256-2
  45. Stein, M. B., Fuetsch, M., Muller, N., Hofler, M., Lieb, R., & Wittchen, H. U. (2001). Social anxiety disorder and the risk of depression. Arch Gen Psychiatry, 58, 251-256 https://doi.org/10.1001/archpsyc.58.3.251
  46. Turner, S. M., Beidel, D. C., Cooley, M. R., Woody, S. R., & Messer, S. C. (1994). A multicomponent behavioral treatment for social phobia: Social effectiveness therapy. Behavior Research and Therapy, 32, 381-390 https://doi.org/10.1016/0005-7967(94)90001-9
  47. Van Ameringen, M., Mancini, C., & Farvolden, P. (2003). The impact of anxiety disorders on educational achievement. Journal of Anxiety Disorders, 17, 561-571 https://doi.org/10.1016/S0887-6185(02)00228-1
  48. Verhulst, F. C., van der Ende, J., Ferdinand, R. F., & Kasius, M. C. (1997). The prevalence of DSM- III-R diagnoses in a national sample of Dutch adolescents. Archives of General Psychiatry, 54, 329-336 https://doi.org/10.1001/archpsyc.1997.01830160049008
  49. Wittchen, H. U., & Fehm, L. (2001). Epidemiology, patterns of comorbidity, and associated disabilities of social phobia. The Psychiatric Clinics of North America, 24, 617-641 https://doi.org/10.1016/S0193-953X(05)70254-9
  50. Wittchen, H. U., Nelson, C. B., & Lachner, G. (1998). Prevalence of mental disorders and psychosocial impairments in adolescents and young adults. Psychological Medicine, 28, 109-126 https://doi.org/10.1017/S0033291797005928
  51. Wittchen, H. U., Stein, M. B., & Kessler, R. C. (1999). Social fears and social phobia in a community sample of adolescents and young adults: Prevalence, risk factors and co-morbidity. Psychological Medicine, 29, 309-323 https://doi.org/10.1017/S0033291798008174
  52. Woodward, L. J., & Fergusson, D. M. (2001). Life course outcomes of young people with anxiety disorders in adolescence. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 1086-1093 https://doi.org/10.1097/00004583-200109000-00018