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Recent theoretical models of social phobia suggest that targeting several specific cognitive factors in treatment should enhance treatment efficacy over that of more traditional skills-based treatment programs. In the current study, 195 people with social phobia were randomly allocated to 1 of 3 treatments: standard cognitive restructuring plus in vivo exposure, an "enhanced" treatment that augmented the standard program with several additional treatment techniques (e.g., performance feedback, attention retraining), and a nonspecific (stress management) treatment. The enhanced treatment demonstrated significantly greater effects on diagnoses, diagnostic severity, and anxiety during a speech. The specific treatments failed to differ significantly on self-report measures of social anxiety symptoms and life interference, although they were both significantly better than the nonspecific treatment. The enhanced treatment also showed significantly greater effects than standard treatment on 2 putative process measures: cost of negative evaluation and negative views of one's skills and appearance. Changes on these process variables mediated differences between the treatments on changes in diagnostic severity. (Contains 1 footnote, 3 tables and 1 figure.)

Objectives: A key feature of blood‐injection‐injury (BII) phobia is activation of disgust responses, in addition to fear. Yet, standard treatments have largely neglected addressing disgust responses. The disorder is further complicated by fainting in 75% of sufferers. Moreover, treatments have been traditionally delivered in an individual format, which may not be as efficient as group treatment. The aim of this study was to develop a group‐based programme for BII phobia, with components targeting fear, disgust, and fainting, to determine feasibility and effectiveness of such an intervention. Methods: Participants took part in an 8‐session, group‐based Cognitive Behavioural Therapy (CBT) programme for BII phobia (N = 40). The key outcome measure was the Multidimensional Blood/Injury Phobia Inventory, which assesses a range of phobic stimuli and responses (including fear, disgust, and fainting). Results: There were significant improvements, with large effect sizes, across symptoms over the course of treatment. Participants with higher disgust sensitivity reported higher pre‐treatment symptom severity and greater life interference than those with lower disgust scores. Despite this, neither pre‐treatment disgust sensitivity nor fainting history impacted on treatment response. For the first time, however, we showed that greater reductions in disgust to BII stimuli were associated with greater overall symptom reductions, highlighting the importance of disgust in the treatment of this disorder, and potentially others. Conclusion: Despite the heterogeneous nature of BII phobia, this group‐based, modified CBT intervention was effective in reducing a variety of phobic responses, including fear, disgust, and fainting. Practitioner points: Disgust is a key maintaining factor in blood‐injection‐injury phobia, which clinicians should consider in their assessment and treatment of this disorder. There is little in the existing literature to guide clinicians in this regard.This study examined a novel group treatment for blood‐injection‐injury phobia which included strategies to target disgust, in addition to traditional CBT strategies to address fear and fainting.The treatment was feasible and acceptable. Symptoms of fear, disgust, and fainting reduced significantly over treatment.Changes in disgust symptoms were associated with overall symptom changes, however a control group is needed to determine the effects of individual treatment components and to make more robust conclusions about the benefits of this enhanced approach. [ABSTRACT FROM AUTHOR]

This study investigated the culture specificity of Taijin-Kyofusho (TK) offensive type by examining whether symptoms of the disorder covary with social phobia and determining the proportion of those who meet criteria for a diagnosis of TK offensive type among Australian socially phobic individuals. The study included a total of 94 participants who met the DSM-IV criteria for social phobia and 39 normal controls who did not meet criteria for any mental disorder. All participants were born in Western countries and resided in Australia. Results showed that levels of offensive worry were significantly elevated in socially phobic individuals and decreased after treatment of their social phobia, pointing to a close relationship between symptoms of TK offensive type and social anxiety. Correlational analysis indicated that TK offensive type and social phobia appear to represent distinct constructs, although the two constructs were clearly strongly related. However, diagnostic examination revealed that the prevalence of reported offensive symptoms (eight out of 94; 8.5%) was extremely low among participants with social phobia in Australia and none of them met the full criteria for TK offensive type. The mixed findings relevant to the existence of TK offensive type among an Australian sample with social phobia are discussed in relation to cultural influences on life interference, referral behaviors, and diagnostic customs. Depression and Anxiety 0:1–8, 2007. © 2007 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]