Incorporating distress tolerance into exposure-based cognitive behavioral therapy for social anxiety disorder: A case study

Abstract

Social anxiety disorder (SAD) is common and can significantly undermine an individual’s ability to participate effectively in social, occupational, and professional activities. Several cognitive behavioral therapy (CBT) strategies are implemented to treat SAD, including exposure therapy, social skills training, cognitive restructuring, and relaxation training. However, many people with SAD engage in substantial avoidance, which may be associated with difficulties in distress tolerance. This case study examined the utility of implementing distress tolerance skills into a manualized 13-session exposure-based CBT protocol for SAD with a female young adult. Distress tolerance skills were used to specifically target avoidance associated with strong physiological symptoms. Data suggested a significant reduction in SAD symptoms over the course of treatment, and these reductions persisted even amid other life stress that occurred toward the end of treatment. Additionally, follow-up data indicated that the client’s low level of avoidance was sustained after treatment, which might underscore the potential utility of improving distress tolerance in SAD treatment to reduce avoidance and maintain treatment gains. This case study provides evidence for incorporating distress tolerance skill training into manualized, exposure-based CBT for SAD.