Social Effectiveness Training

Description of the Strategy

Social phobia is a disorder that affects approximately 2% to 8% of the general adult population. Although many people experience mild anxiety when giving speeches or going on job interviews, those with social phobia experience anxiety so intense that it impairs their functioning, leads to avoidance behavior, and/or results in maladaptive coping strategies. There are two types of social phobia. About 30% of those with social phobia report anxiety and distress only in performance situations, such as giving a speech. Individuals with this rather circumscribed pattern of fear are often referred to as having the specific, or nongeneralized, subtype. Those with the generalized subtype (the other 70%) report distress across a broad range of social situations, such as giving a speech, meeting new people, and one-on-one social conversation. Behavioral interventions such as exposure or cognitive behavior therapy appear to be most effective in treating the specific subtype of social phobia, but these treatments appear to have a limited effect for the generalized subtype. Social effectiveness therapy (SET) was designed to improve treatment outcomes for the generalized subtype. SET is a unique combination of psychoeducation, social skills training, imaginal and in vivo exposure, and programmed practice. The goals of SET are to reduce social anxiety, improve interpersonal skills, and enhance social functioning.

As noted, SET is a multifaceted approach that utilizes group social skills training and individualized exposure therapy. SET is designed to be flexible. For example, although its social skills component was initially developed as a group intervention, it could be administered in an individual format. Similarly, the exposure component may be conducted using either imaginal or in vivo modalities. Selecting a particular modality may depend upon the patient's unique fear pattern. For some individuals, imaginal exposure may be necessary because of an inability to replicate the individual's core fear in “real life.”

The SET protocol consists of 28 treatment sessions that span a 4-month period. During the first 3 months, sessions are held twice a week, once for individual exposure and once for group social skills training. In the fourth month, the frequency of the intervention decreases to once per week, utilizing programmed practice. This component assists individuals in transferring their newly acquired skills to a variety of real-life settings. Below, a brief description of an appropriate assessment strategy for social phobia is presented, and then the components of SET are described.