Marks I M
Institute of Psychiatry, Bethlem-Maudsley Hospital, London, England.
J Clin Psychiatry. 1995;56 Suppl 5:25-31.
Behavioral-cognitive therapy is a cost-effective treatment for social phobia. The doctor's role is to teach the patient how to do successful self-exposure. The clinician acts as a guide and monitor; there is no need to waste time accompanying the patient into the phobic situation. The patient first reads a self-exposure manual to learn how to confront panic-evoking social cues for prolonged period without avoidance until habituation sets in. This might require an hour daily of self-exposure over weeks or months. As patients habituate to social cues to which they have exposed themselves, they arrange exposure to fresh cues until they become used to all. The patient tracks progress by recording completed exposure-homework tasks in a daily diary. In instances where it is technically difficult to do regular exposure, the patient carries out imagined tape-recorded exposure in his/her own voice. The therapist can briefly help the patient role-play such exposure. Rational role-play enhances outcome of body dysmorphic disorder or delusional disorder somatic type with prominent social phobia. Cognitive therapy can be useful. Most social phobics improve with behavioral-cognitive treatment without medication. When patients have low mood, concurrent antidepressants can be synergistic.
行为认知疗法是治疗社交恐惧症的一种经济有效的方法。医生的职责是教导患者如何进行成功的自我暴露。临床医生充当指导者和监督者；无需浪费时间陪患者进入恐惧情境。患者首先阅读一本自我暴露手册，学习如何长时间面对引发恐慌的社交线索而不回避，直到习惯化形成。这可能需要在数周或数月内每天进行一小时的自我暴露。随着患者对他们所暴露的社交线索习惯化，他们安排接触新的线索，直到习惯所有线索。患者通过在每日日记中记录完成的暴露家庭作业任务来跟踪进展。在定期暴露在技术上困难的情况下，患者用自己的声音进行想象的录音暴露。治疗师可以简短地帮助患者进行这种暴露的角色扮演。合理的角色扮演可提高伴有明显社交恐惧症的躯体变形障碍或躯体型妄想障碍的治疗效果。认知疗法可能有用。大多数社交恐惧症患者通过行为认知治疗而无需药物治疗就能改善。当患者情绪低落时，同时使用抗抑郁药可能有协同作用。
