| Twenty-five percent of individuals with social anxiety disorder who undergo cognitive-behavioral treatment are considered non-responders. An examination of the literature on component-controlled dismantling designs that compare exposure with the addition of cognitive interventions to exposure suggests that exposure therapy alone can be an effective treatment for social anxiety disorder. Ridiculous shame-attacking exposures, besides eventually being enjoyable for patients, also eliminate the need for lengthy fear-hierarchies since they ascend directly to high-anxiety situations. Shame-attacking exposures can contribute to cognitive change without the need for explicit cognitive interventions. Experiential acceptance, a willingness to experience thoughts, feelings, and physical sensations in the service of personal goals and values, can do the same. By virtue of its emphasis on personally meaningful values and goals, acceptance and commitment therapy (ACT) is also considered to have the potential to facilitate exposure. A group treatment manual for individuals with social anxiety disorder is proposed that combines shame-attacking exposure exercises with principles from ACT, including experiential acceptance. To date, this is the first known manualized group treatment protocol for shame-attacking exercises. Compared with traditional CBT, combined shame attacking and values-focused therapy may increase functioning and quality of life by inspiring changes in thoughts and behaviors in individuals with social anxiety disorder. |
