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The Effectiveness of Acceptance and Commitment Therapy for Social Anxiety Disorder

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The Effectiveness of Acceptance and Commitment Therapy for Social Anxiety Disorder Int. J. Life Sci. Pharma Res. 2018 Oct; 8(4): (L) 1-9 Original Research Article Psychology ISSN 2250-0480 THE EFFECTIVENESS OF ACCEPTANCE AND COMMITMENT THERAPY FOR SOCIAL ANXIETY DISORDER BANAFSHEH GHARRAEE1, KOMEIL ZAHEDI TAJRISHI2*, ABAS RAMAZANI FARANI3, JAFAR BOLHARI4 AND HOJJATOLLAH FARAHANI5 1Ph.D. in Clinical Psychology, Associate Professor, Department of Clinical Psychology, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran. 2Ph.D. Candidate in Clinical Psychology, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Science, Tehran, Iran. 3Ph.D. in Clinical Psychology, Assistant Professor, Department of Clinical Psychology, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran. 4Psychiatrist, Professor, Department of Community Psychiatry, Spiritual Health Research Center, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran., Schoolof Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Science, Tehran, Iran. 5Ph.D. in Psychology, Assistant Professor, Department of Psychology, TarbiatModares University, Tehran, Iran. ABSTRACT One of the most common anxiety disorders is the Social Anxiety Disorder (SAD) which is characterized by intolerable anxiety and self-consciousness in daily social situations. Although a large body of study is conducted on the treatment for this disorder, further studies are required on new psychological therapies. The present study aims to evaluate the effectiveness of Acceptance and Commitment Therapy (ACT) on patients with SAD. The present randomized controlled trial (RCT) study is done along with pre-test, post-test and follow-up with control group. Based on the Structured Clinical Interview for DSM (SCID), the 34 subjects who were prone to social anxiety disorder on the basis of DSM-5but had no other severe psychiatric disorders were distributed randomly and equally into experimental and control groups. The experimental group was treated with 12 weekly CFT sessions whereas the control group did not receive any treatment. In the initial phase of the research work especially after 12 weeks and after a follow- up period of 8 weeks, all subjects were evaluated with AAQ-II, MAAS, LOSC, SCS, WHOQOL-BREF and LSAS instruments. In addition to descriptive statistics, repeated measure analysis of variance (RM-ANOVA) was used in order to analyze the findings.Byusing SPSS-21 software, all analyses were conducted. Based on the RM-ANOVA, Acceptance and Commitment Therapy was found more effective than the control group in all of the studied variables in post- test and follow-up. All the observed differences between the two groups were significant (P < 0.01). Acceptance and commitment therapy (ACT) seems to play an essential role in reducing symptoms and in improving the quality of the life of patients with social anxiety disorder (SAD). KEYWORDS: Acceptance and Commitment Therapy (ACT), Mindfulness, Social Anxiety Disorder (SAD), Social Phobia * KOMEIL ZAHEDI TAJRISHI Ph.D. Candidate in Clinical Psychology, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Science, Tehran, IR Iran. Received on: 19-06-2018 Revised and Accepted on: 13-07-2018 DOI: http://dx.doi.org/10.22376/ijpbs/lpr.2018.8.4.L1-9 This article can be downloaded from www.ijlpr.com L-1 Int. J. Life Sci. Pharma Res. 2018 Oct; 8(4): (L) 1-9 INTRODUCTION associated with certain cognitive impairments11. One of the main processes that is targeted in ACT Social anxiety disorder (SAD) is one of the most is "experiential avoidance." This phenomenon common anxiety disorders which is characterized occurs when a person avoids specific personal by intolerable anxiety in social situations. This experiences (for example, bodily sensations, disorder usually begins in childhood and emotions, thoughts, memories, etc.) and tries to adolescence when friendly communications with take steps to change the type and frequency of these peer groups increases. This disorder begins between events as well as the context in which these events 12 the ages of 14 and 16 on average. It is estimated happen . Therefore, ACT's purpose, as opposed to that 8-13% of the general population suffers from traditional CBT, is not to change the frequency and SAD1-2. Cognitive factors play an important role in content of thoughts or feelings, but to teach the full the prognosis and continuity of SAD. Patients with and non-defensive experience in order to achieve this disorder have inefficient thoughts and beliefs individual goals and values. In addition, ACT does that make them perceive social situations as not focus on reducing symptoms although it is 13 hazardous and dangerous and they are also anxious expected to be successful in treating this problem . and they try to avoid themselves from society3.. In SAD, experiential avoidance is demonstrated as These people attach great importance to the evident and hidden behavioral avoidance that 14 perspectives of others and usually receive others' contradicts individual values . Therefore, opinions with criticism and humiliation. They interventions such as ACTs that clearly aim to believe that they are inclined to l make mistakes change the experiential avoidance may be useful in which will have terrible consequences. These treating SAD. Over the past few years, there has beliefs exacerbate their negative emotions and been a growing interest in the third-wave cognitive create a false cycle. According to this description, behavioral therapy, especially ACT. In this regard, some of the most important cognitive features of many studies including more than 100 randomized these individuals include low self-esteem, low self- clinical trials (RCTs) have been conducted that efficacy, high dependence and high self criticism4-5. indicate the effectiveness of this treatment for Many psychological treatments have been used to various mental disorders, especially anxiety 15-16 treat this disorder. In the recent days, Cognitive disorders . For example, various studies have behavioral therapy (CBT) which includes exposure shown the effectiveness of ACT for obsessive- 13 14, 17- exercises, is empirically recommended for curing compulsive disorder , social anxiety disorder 18 16 Social anxiety disorder (SAD)6-7. While there is , panic disorder and generalized anxiety 19 widespread support for the use of traditional CBT disorder . In addition, studies have shown that for social anxiety disorder, attention is focused ACT evinces better performance even among 20 more on the patients’ poor progress and their patients who are resistant to treatment . continuous dissatisfaction with life8. Acceptance Acceptance and commitment therapy (ACT) can 13 and commitment therapy (ACT) is a third-wave also be as effective as traditional CBT . However, cognitive behavioral therapy (CBT) that focuses on there have always been criticisms in the the function of psychological phenomena. The methodological problems as well as the low effect 21 conceptualization of psychopathology in the ACT size of ACT studies . Considering the relatively approach is based on the Relational Framework new nature of this treatment, further studies are Theory (RFT) which provides a contextual and a needed to reduce the contradictions in the research. comprehensive theory for behavioral processes in For this purpose, the present study aims to evaluate the cognitive and linguistic context9. This theory the effectiveness of ACT on patients with social assumes that the core of language and cognition is anxiety disorder (SAD). to learn the ability to communicate arbitrarily between events and thereby change the function of MATERIALS AND METHODS events based on their relationship with other events10. RFT theorists have shown that the In order to conduct the research after receiving the formation of relational frameworks begins in the Code of Ethics for research from the Iran infancy and children need to learn the natural University of Medical Sciences (IR.IUMS.REC language. Practicing these frameworks will result in 1396.9211521214) and the necessary coordination language acquisition and other higher level skills at the site. The sampling was performed based on like empathy. Some of the clinical disorders have inclusion and exclusion criteria. According to certain impairments in the framework. The deficits individual sessions of the treatments, each member in the relational framework can be closely of the sample was assigned to one of the groups This article can be downloaded from www.ijlpr.com L-2 Int. J. Life Sci. Pharma Res. 2018 Oct; 8(4): (L) 1-9 randomly after the inclusion criteria were and self-report. This instrument is designed in such confirmed. The ACT experimental group received a way to include the two areas of functional 12 hourly treatment sessions based on Eifert and situations and social interactions of people with Forsyth protocol (2005)16. According to this social anxiety. This instrument has 24 items of protocol, treatment begins by psychoeducation and which 13 are function-related (e.g., participation in discusses acceptance. The subsequent sessions were a small group) and 11 are related to social devoted to creative hopelessness, mindfulness and interactions (e.g., attending a party).
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