Manualized Group Cognitive-Behavioral Therapy for Social Anxiety in At-Risk Mental State and First Episode Psychosis: A Pilot Study of Feasibility and Outcomes

ABSTRACT

Social anxiety has received scant attention in studies of schizophrenia and related psychoses. However, some data suggest it may be an obstacle to vocational and functional outcome. This pilot study investigated the feasibility of a group-based cognitive behavioral therapy (CBGT) to reduce social anxiety in those at risk for developing psychosis or in the early phase. Twenty-nine patients with first-episode psychosis (FEP) or at ultra high risk for developing psychosis or often referred to as at-risk mental state (ARMS) with comorbid social anxiety attended a CBGT intervention weekly for 14 weeks in 90-minute sessions. Baseline, post-treatment, and follow-up ratings of social anxiety were measured using the Social Interaction Anxiety Scale, the Social Phobia Inventory, and the Brief Social Phobia Scale. Psychotic symptoms and general psychopathology were also measured before and after the intervention. Results suggest that the proposed CBGT is feasible and beneficial for socially anxious patients at risk, or with experience of, psychosis. Participants significantly improved on three outcome measures of social anxiety after completing this intervention (all p’s < .002). Participants who completed treatment also showed a significant reduction on measures of depression and negative symptoms. Future research should examine the relative efficacy of this brief manualized CBGT intervention for the treatment of social anxiety and psychotic symptoms in a larger randomized controlled trial.

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Notes on contributors

Tina C. Montreuil

Tina C. Montreuil is an Associate Professor in the Department of Educational and Counselling Psychology and Associate Member of the Faculty of Medicine, Department of Psychiatry at McGill University. A licensed psychologist and credentialed member of the Canadian Association of Cognitive-Behavioural in a private practice. Ashok K. Malla is the Director of the Prevention and Early Intervention Program for Psychoses (PEPP-Montréal) at the Douglas Institute as well as a Professor in the Department of Psychiatry at McGill University. Ridha Joober is the Assistant Director of the Prevention and Early Intervention Program for Psychoses (PEPP-Montréal) as well as a Senior Researcher at the Douglas Institute, and a Professor in the Department of Psychiatry at McGill University. Claude Bélanger is a Professor in the Department of Psychology at the University of Québec in Montréal and Assistant Professor in the Department of Psychiatry of McGill University, and a Licensed Psychologist at a private practice. Gail Myhr is an Associate Professor of psychiatry at McGill University. Martin Lepage is a James McGill Professor in the Department of Psychiatry and Adjunct Professor in the Department of Psychology at McGill University. He is also a Clinical Psychologist at the Prevention and Early Intervention Program for Psychoses (PEPP – Montreal) at the Douglas Mental Health University Institute.

Ashok K. Malla

Tina C. Montreuil is an Associate Professor in the Department of Educational and Counselling Psychology and Associate Member of the Faculty of Medicine, Department of Psychiatry at McGill University. A licensed psychologist and credentialed member of the Canadian Association of Cognitive-Behavioural in a private practice. Ashok K. Malla is the Director of the Prevention and Early Intervention Program for Psychoses (PEPP-Montréal) at the Douglas Institute as well as a Professor in the Department of Psychiatry at McGill University. Ridha Joober is the Assistant Director of the Prevention and Early Intervention Program for Psychoses (PEPP-Montréal) as well as a Senior Researcher at the Douglas Institute, and a Professor in the Department of Psychiatry at McGill University. Claude Bélanger is a Professor in the Department of Psychology at the University of Québec in Montréal and Assistant Professor in the Department of Psychiatry of McGill University, and a Licensed Psychologist at a private practice. Gail Myhr is an Associate Professor of psychiatry at McGill University. Martin Lepage is a James McGill Professor in the Department of Psychiatry and Adjunct Professor in the Department of Psychology at McGill University. He is also a Clinical Psychologist at the Prevention and Early Intervention Program for Psychoses (PEPP – Montreal) at the Douglas Mental Health University Institute.

Ridha Joober

Tina C. Montreuil is an Associate Professor in the Department of Educational and Counselling Psychology and Associate Member of the Faculty of Medicine, Department of Psychiatry at McGill University. A licensed psychologist and credentialed member of the Canadian Association of Cognitive-Behavioural in a private practice. Ashok K. Malla is the Director of the Prevention and Early Intervention Program for Psychoses (PEPP-Montréal) at the Douglas Institute as well as a Professor in the Department of Psychiatry at McGill University. Ridha Joober is the Assistant Director of the Prevention and Early Intervention Program for Psychoses (PEPP-Montréal) as well as a Senior Researcher at the Douglas Institute, and a Professor in the Department of Psychiatry at McGill University. Claude Bélanger is a Professor in the Department of Psychology at the University of Québec in Montréal and Assistant Professor in the Department of Psychiatry of McGill University, and a Licensed Psychologist at a private practice. Gail Myhr is an Associate Professor of psychiatry at McGill University. Martin Lepage is a James McGill Professor in the Department of Psychiatry and Adjunct Professor in the Department of Psychology at McGill University. He is also a Clinical Psychologist at the Prevention and Early Intervention Program for Psychoses (PEPP – Montreal) at the Douglas Mental Health University Institute.

Claude Bélanger

Tina C. Montreuil is an Associate Professor in the Department of Educational and Counselling Psychology and Associate Member of the Faculty of Medicine, Department of Psychiatry at McGill University. A licensed psychologist and credentialed member of the Canadian Association of Cognitive-Behavioural in a private practice. Ashok K. Malla is the Director of the Prevention and Early Intervention Program for Psychoses (PEPP-Montréal) at the Douglas Institute as well as a Professor in the Department of Psychiatry at McGill University. Ridha Joober is the Assistant Director of the Prevention and Early Intervention Program for Psychoses (PEPP-Montréal) as well as a Senior Researcher at the Douglas Institute, and a Professor in the Department of Psychiatry at McGill University. Claude Bélanger is a Professor in the Department of Psychology at the University of Québec in Montréal and Assistant Professor in the Department of Psychiatry of McGill University, and a Licensed Psychologist at a private practice. Gail Myhr is an Associate Professor of psychiatry at McGill University. Martin Lepage is a James McGill Professor in the Department of Psychiatry and Adjunct Professor in the Department of Psychology at McGill University. He is also a Clinical Psychologist at the Prevention and Early Intervention Program for Psychoses (PEPP – Montreal) at the Douglas Mental Health University Institute.

Gail Myhr

Tina C. Montreuil is an Associate Professor in the Department of Educational and Counselling Psychology and Associate Member of the Faculty of Medicine, Department of Psychiatry at McGill University. A licensed psychologist and credentialed member of the Canadian Association of Cognitive-Behavioural in a private practice. Ashok K. Malla is the Director of the Prevention and Early Intervention Program for Psychoses (PEPP-Montréal) at the Douglas Institute as well as a Professor in the Department of Psychiatry at McGill University. Ridha Joober is the Assistant Director of the Prevention and Early Intervention Program for Psychoses (PEPP-Montréal) as well as a Senior Researcher at the Douglas Institute, and a Professor in the Department of Psychiatry at McGill University. Claude Bélanger is a Professor in the Department of Psychology at the University of Québec in Montréal and Assistant Professor in the Department of Psychiatry of McGill University, and a Licensed Psychologist at a private practice. Gail Myhr is an Associate Professor of psychiatry at McGill University. Martin Lepage is a James McGill Professor in the Department of Psychiatry and Adjunct Professor in the Department of Psychology at McGill University. He is also a Clinical Psychologist at the Prevention and Early Intervention Program for Psychoses (PEPP – Montreal) at the Douglas Mental Health University Institute.

Martin Lepage

Tina C. Montreuil is an Associate Professor in the Department of Educational and Counselling Psychology and Associate Member of the Faculty of Medicine, Department of Psychiatry at McGill University. A licensed psychologist and credentialed member of the Canadian Association of Cognitive-Behavioural in a private practice. Ashok K. Malla is the Director of the Prevention and Early Intervention Program for Psychoses (PEPP-Montréal) at the Douglas Institute as well as a Professor in the Department of Psychiatry at McGill University. Ridha Joober is the Assistant Director of the Prevention and Early Intervention Program for Psychoses (PEPP-Montréal) as well as a Senior Researcher at the Douglas Institute, and a Professor in the Department of Psychiatry at McGill University. Claude Bélanger is a Professor in the Department of Psychology at the University of Québec in Montréal and Assistant Professor in the Department of Psychiatry of McGill University, and a Licensed Psychologist at a private practice. Gail Myhr is an Associate Professor of psychiatry at McGill University. Martin Lepage is a James McGill Professor in the Department of Psychiatry and Adjunct Professor in the Department of Psychology at McGill University. He is also a Clinical Psychologist at the Prevention and Early Intervention Program for Psychoses (PEPP – Montreal) at the Douglas Mental Health University Institute.