Posted by zeugma on January 15, 2004, at 16:38:08
In reply to Re: CBT versus drugs » Kon, posted by Ame Sans Vie on January 15, 2004, at 7:19:40
In my opinion, each person suffering from social phobia is either one of the ones who will respond to medication, or one of those who will respond to some form of talk therapy. Through my own experience and the experiences of others with whom I've spoken over the years, CBT seems to be effective only if no avoidant symptoms are present. Many people consider avoidant personality disorder to be just a fancy way of saying "really bad social phobia", but the avoidant behaviors exhibited by those of us afflicted with it (myself included) are quite separate, it seems, from the anxiety in many cases. APD is often misdiagnosed as simple social phobia, but the two are absolutely separate entities (though they most often coexist).
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> Obviously a propensity toward avoidance makes for a very difficult time adhering to the principles put forth in cognitive behavioral therapy (not to mention even getting out of the house and going to your therapist in the first place!).
I believe I have avoidant personality disorder, and I was not helped by CBT. I found it too focused on the 'consequences' of social interactions, as if my fears of interacting with others were somehow founded on some kind of risk-benefit calculation, with the avoidance triggered by a fear of 'adverse' consequences. But I found (and still find) that social interaction unsettles me, regardless of the objectively determined outcome.More on avoidant personality disorder:
Can J Psychiatry. 1990 Oct; 35(7): 596-9. Related Articles, Links
Attachment pathology and low social skills in avoidant personality disorder: an exploratory study.Sheldon AE, West M.
Behavioral Sciences Research Group, Faculty of Medicine, University of Calgary, Alberta.
The criterion of desire for affection and acceptance was eliminated from the definition of avoidant personality disorder in the DSM-III-R. But clinical experience in our setting suggests that attachment pathology related to such desires is an important diagnostic feature and a frequent focus of clinical intervention with avoidant individuals. Forty-seven patients receiving a clinical diagnosis of avoidant personality disorder completed a brief questionnaire which rated desire for an attachment relationship, fear of an attachment relationship and level of social skills. The results support our hypotheses that attachment security is distinct from general social skills and that desire for but fear of an attachment relationship is more characteristic of those diagnosed with avoidant personality disorder than a low level of social skills.
This paradoxical "desire for but fear of an attachment relationship" can color even the most superficial interactions and make them difficult, and I found that CBT was predicated on there being a pathology of cognition, not of emotion, central to the social phobia symptoms. But if cognition is intact, and the problem lies elsewhere, trying to fix the problem with CBT will only make things worse.
poster:zeugma
thread:300957
URL: http://www.dr-bob.org/babble/20040114/msgs/301332.html