Emotion Regulation Therapy for Social Anxiety Disorder Comorbid with Major Depressive Disorder: A Case Study

Document Type: Original Article

Authors

Department of Clinical Psychology, Faculty of Psychology and Educational Sciences, Shiraz University, Shiraz, Iran

Abstract

Introduction: Emotion Regulation Therapy (ERT) was firstly developed for treating Generalized Anxiety Disorder (GAD) and comorbid Major Depression Disorder (MDD). Social Anxiety Disorder (SAD) was also addressed regarding its high comorbidity with GAD and MDD. Despite the preliminary evidence for the utility of this treatment, its efficacy for SAD, particularly when it is accompanied by co-occurring depression, it has not yet been examined.
Method: The purpose of this study was to investigate the effect of ERT in an individual suffering from SAD and comorbid MDD. Due to the complexity of clinical presentation in patients suffering comorbid disorders, and also the novelty of ERT, the case study method was applied. The subject was a 29 year old woman who had been diagnosed with MDD and SAD by using Social Interaction Anxiety Scale and Beck Depression Inventory and also clinical interview based on DSM-V. The ERT was implemented in 16 sessions during 4 months. The process of changes was examined by re-completing the questionnaires and clinical interview during and at the end of the treatment.
Results: Results showed reductions in social anxiety and depression symptoms and increased use of emotion regulation strategies (attending, allowance, decentering, reframing). The score of psychological wellbeing had also increased.
Conclusion: Emotion Regulation Therapy (ERT) can be effective on reducing symptoms of SAD and comorbid MDD through increasing the motivational awareness, developing regulatory capacities and new contextual learning repertoires. Meanwhile, further research is needed to confirm the findings of the present study.

Keywords


References

1.    Kessler RC, Petukhova M, Sampson NA, Zaslavsky AM, Wittchen HU. Twelve‐month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. International journal of methods in psychiatric research. 2012;21(3):169-84.

2.    Fehm L, Pelissolo A, Furmark T, Wittchen H-U. Size and burden of social phobia in Europe. European neuropsychopharmacology. 2005;15(4):453-62.

3.    Mohammadi MR, Ghanizadeh A, Mohammadi M, Mesgarpour B. Prevalence of social phobia and its comorbidity with psychiatric disorders in Iran. Depression and anxiety. 2006;23(7):405-11.

4.    Byers AL, Yaffe K, Covinsky KE, Friedman MB, Bruce ML. High occurrence of mood and anxiety disorders among older adults: The National Comorbidity Survey Replication. Archives of general psychiatry. 2010;67(5):489-96.

5.    Ohayon MM, Schatzberg AF. Social phobia and depression: prevalence and comorbidity. Journal of Psychosomatic Research. 2010;68(3):235-43.

6.    Jazaieri H, Morrison AS, Goldin PR, Gross JJ. The role of emotion and emotion regulation in social anxiety disorder. Current psychiatry reports. 2015;17(1):531.

7.    Mennin DS, McLaughlin KA, Flanagan TJ. Emotion regulation deficits in generalized anxiety disorder, social anxiety disorder, and their co-occurrence. Journal of anxiety disorders. 2009;23(7):866-71.

8.    Mennin DS, Fresco DM. Emotion regulation therapy. Handbook of emotion regulation. 2014;2:469-90.

9.    Fresco DM, Mennin DS, Heimberg RG, Ritter M. Emotion regulation therapy for generalized anxiety disorder. Cognitive and Behavioral Practice. 2013;20(3):282-300.

10.  Abasi I. The Fitness of Emotion Dysregulation Model and Effectiveness of Emotion

Regulation Therapy in Social Anxiety Disorder: University of Social Welfare and Rehabilitation Sciences; 2017.

11.  Hofmann SG, Sawyer AT, Fang A, Asnaani A. Emotion dysregulation model of mood and anxiety disorders. Depression and anxiety. 2012;29(5):409-16.

12.  Mennin DS, Fresco DM. ERT 2.1 therapist manual. 2018.

13.  First MB, Williams JB, Karg RS, Spitzer RL. Structured Clinical interview for DSM-5 Disorders2017.

14.  Gall M, Gall J, Borg W. Educational research: An introduction. 8th ed. Boston: Allyn and Bacon; 2007.

15.  Heimberg RG, Mueller GP, Holt CS, Hope DA, Liebowitz MR. Assessment of anxiety in social interaction and being observed by others: The Social Interaction Anxiety Scale and the Social Phobia Scale. Behavior therapy. 1992;23(1):53-73.

16.  Dabson K, Mohammadkhani P. Psychometric properties of the Beck Depression Inventory-II in a large sample of patients with major  depressive  disorder.  . Journal of Rehabilitation in Disease and Mental Disorders. 2007;8(3).

17.  Farchione TJ, Fairholme CP, Ellard KK, Boisseau CL, Thompson-Hollands J, Carl JR, et al. Unified protocol for transdiagnostic treatment of emotional disorders: a randomized controlled trial. Behavior therapy. 2012;43(3):666-78.

18.  Norton AR, Abbott MJ, Norberg MM, Hunt C. A systematic review of mindfulness and acceptance‐based treatments for social anxiety disorder. Journal of clinical psychology. 2015;71(4):283-301.

19.  Goldin PR, Morrison A, Jazaieri H, Brozovich F, Heimberg R, Gross JJ. Group CBT versus MBSR for social anxiety disorder: A randomized controlled trial. Journal of Consulting and Clinical Psychology. 2016;84(5):427.

20.  Mennin DS, Fresco DM, Ritter M, Heimberg RG. An open trial of emotion regulation therapy for generalized anxiety disorder and cooccurring depression. Depression and anxiety. 2015;32(8):614-23.

21.  Taherifar Z, Frdowsi S, Mootabi F, Mohammad-Ali M, Fata L. Emotion regulation therapy for generalized anxiety disorder comorbid with Major Depressive Disorder: A case study. International Journal of Behavioral Sciences. 2016;10(1):60-5.