Advances in behavioral-cognitive therapy of social phobia.

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.