Substance Abuse

Treatments

Levels of Care             

Treatment Summary: Successful treatment begins with careful diagnosis, especially as we become aware of the values of specific syndromes. Clinicians should expect only partial response to treatment in many cases and should educate patients accordingly. Patients should be warned about periods of recurrent anxiety and agitation and encouraged to try to ride out time-limited episodes using behavioral techniques such as distraction, relaxation, or cognitive strategies, rather than immediately turning to increased medication. 

• Reference: Sadavoy, Joel, LeClair, Kenneth, J. (1997). Treatments of Anxiety Disorders in Late Life. Canadian Journal of Psychiatry. Vol. 42, Suppl 1. 

• Submitter:  

Treatment Summary: Focus issues on the design short forms is used to measure social interaction anxiety scale (SIAS) and social phobia scale (SPS) to discriminate between anxious and non-anxious core latent traits. Treatment Report The two major design short-form instruments are social interaction anxiety scale (SIAS) and social phobia (SPS) were supported by the utilization of non-parametric item response theory method (IRT). Either of the parametric and non-parametric item response models can be utilized when plotting/graphing the mathematical functions of individual items of the basic latent traits. The IRT granted a statistical structure for evaluating likert-type test items by graphically plotting the option characteristic curves (OCC) , the performance of a given items are restrained by clarifying the slope, shape and the functional of the core of the latent traits. The design of a short-form instrument is illustrated by shortening or refining a more erudition measurement in the event to generalized a smaller scale with virtually the same psychometric properties that takes about 10 – 15 minutes to be completed. The two negative forms (SIAS and SP) used are briefly screened the fear of negative evaluation and depression anxiety stress scales in patients. 

• Reference: Peters, L., Matthew, S., and Andrews, G., Rapee, R., M. & Mattick, R. P. (2012). Development of a Short Form Social Interaction Anxiety (SIAS) and Social Phobia Scale (SPS) Using Nonparametric Item Response Theory: The SIAS-6 and the SPS-6. Psychological Assessment, 024(1), 066-076. Retrieve http://www.proquest. 

• Submitter: N/A 

Treatment Summary: The focus of this treatment report is to review the potential treatment options, and their efficacy, for those suffering from Post-Traumatic Stress Disorder (PTSD). Special attention was given to Eye Movement Desensitization and Reprocessing (EMDR) and Prolonged Exposure Therapy (PE), which are the two primary treatment options within the Department of Defense (DoD) and the Veterans Administration (VA). Taylor et al (2003) studied PE, EMDR, and Relaxation Training (RT) in order to determine the most effective treatment for those suffering with PTSD. Their study consisted of 60 participants who met the DSM -IV-TR criteria for PTSD. Summing their study, they concluded the PE and EMDR were the most efficacious treatment protocols for PTSD, with greater results achieved by PE. Sharpless and Barber (2011) studied both pharmacological and psychological approaches to treating PTSD. Their studied concluded that paroxetine (Paxil), and sertraline (Zoloft) were effective pharmacological interventions, while recognizing that not all those suffering with PTSD may be comfortable such treatments for extended periods of time. They examined 11 other psychological treatment models (PE, Cognitive Processing Therapy (CPT), EMDR, Stress Inoculation Training, Exposure Therapy with Virtual Reality, Relaxation Training, Cognitive Behavioral Group Therapies, Psychodynamic Therapy, Interpersonal Psychotherapy, Dialectical Behavioral Therapy, and Hypnosis) and concluded that PE, CPT, and EMDR were the recommended treatment protocols, with priority given to PE Based on the literature reviewed thus far, it appears that the two most effective treatments for PTSD are PE and EMDR. 

• Reference: Sharpless, B.A., Barber, J.P. (2011) A clinician’s guide to PTSD treatments for returning veterans. Professional Psychology: Research and Practice. 42, 1, 8-15. DOI: 10.1037/a0022351 Taylor, S., Fedoroff, I.C., Lovell, K., Maxfield, L., Thordarson, D.S. (2003) Comparative efficacy, speed, and adverse effects of three PTSD treatments: exposure therapy, EMDR, and relaxation training. Journal of Consulting and Clinical Psychology, 71, 2, 330-338. DOI: 10.1037/0022-006X.71.2.330 

• Submitter: N/A 

Applied Relaxation 

Treatment Summary: Applied relaxation works best when written direction is given by the therapist. Muscle relaxation techniques, cue-controlled relaxation, and skill generalization are emphasized. Skill generalization includes involves relaxation training combined with exposure therapy. These instructions are given to the patient with SP, and they are instructed to apply them when they feel that their anxiety over social situations is getting too great. They may leave the area of anxiety to perform the relaxation techniques, but are usually instructed not to leave all together. 

• Reference: Anthony, M., & Rowa, K. (2005). Psychological Treatments for Social Phobia. Canadian Journal of Psychiatry, 50(6), 308-316. Retrieved from Psychology andBehavioral Sciences Collection database. 

• Submitter: Lauren Moore 

Fluoxetine and self-exposure 

Treatment Summary: Patients who were treated with fluoxetine were given 20 mg. In week 2 or 3 the dose was increased to 40 mg and the maximum dose was 60 mg, which was normally administered by week 5 or 6. In addition to fluoxetine the participants were told they needed to expose themselves to social situations that they usually find fearful. Participants did not participate in exposure practice during therapy sessions, which lasted 30-40 minutes. However, the therapist told them what type of situations they needed to expose themselves to. This method showed substantial therapeutic gains. 

• Reference: Clark, D., Ehlers, A., Mcmanus, F., Hackman, A. Fennell, M., Campbell, H., Flower,T., Davenport, C., Louis, B. (2003). Cognitive therapy versus fluoxetine in generalized social phobia: a randomized placebo controlled trial. Journal of Counseling and Clinical Psychology. 71(6) 1058-1067. 

• Submitter: Sherone Smith 

Cognitive Behavioral Therapy 

Summary of Treatment: Cognitive behavioral therapy is one of the most widely used methods to treat social anxiety. It can be offered on an individual or group basis. Individuals with social anxiety disorder often miss positive social cues and misjudge social relational situations which can perpetuate their anxiety. Consequently, there needs to be explicit instruction in helping people identify positive social cues and develop appropriate reactions to them. Alden et al. (2018) reported that direct instruction of how to reduce and modify negatively biased social judgments is instrumental in treating social anxiety. Additionally, while it is ideal to establish a rapport with a single therapist; the study emphasized the importance of having multiple mediators which could help determine the means that help individuals progress in treatment. Different mediators lends itself to different perspectives, opportunities, and ideas about what has been effective or ineffective (Alden et al., 2018). 

• Reference: Alden, L. E., Buhr, K., Robichaud, M., Trew, J. L., & Leili Plasencia, M. (2018). Treatment of social approach processes in adults with social anxiety disorder. Journal of Consulting and Clinical Psychology, 86(6), 505-517. http://dx.doi.org/10.1037/ccp0000306 

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