July 17, 2024
Dear Colleagues,
The National Social Anxiety Center (NSAC) provides information about relevant and current research in the service of disseminating and promoting evidence-based treatment. This month’s summary is written by Katy Manetta, PhD, A-CBT, representing NSAC-Long Beach and examines a review article by Andino, Garcia and Richey (2024) exploring the use of Dialectical Behavior Therapy Skills Group (DBT-SG) in the treatment of Social Anxiety Disorder (SAD) with suicidal ideation.
SAD is associated with increased rates of suicidal ideation (SI) and suicide attempts compared to other anxiety disorders. Cognitive behavior therapy (CBT) is currently considered a first line treatment for SAD. However, CBT appears to result in modest rates of remission leaving a large number of clients symptomatic. Dialectical Behavior Therapy–Skills Group (DBT-SG) has proven to be a promising treatment for many psychiatric disorders that involve high rates of suicidal ideation and behaviors.
This article presents a brief review of the current research on DBT-SG for social anxiety disorder (SAD) with suicidal ideation (SI). Additionally, the article explores additional recommendations regarding the application of DBT-based skills to cognitive maintenance factors associated with SAD. The authors assess DBT’s applicability in addressing SI in various diseases and examine the correlation between SAD and SI. They then apply this understanding to examine how DBT-SG skills could be used to target particular SAD related factors, concentrating on four primary themes: interpersonal effectiveness, mindfulness, emotion regulation, and distress tolerance.
The authors conclude that DBT-SG may be helpful in lowering SI and SAD symptoms which impact social and emotional functioning. The review highlights DBT-SG as a potentially promising intervention for SAD, particularly considering its complexity, comorbid conditions, and maintenance factors contributing to SI. The authors propose that DBT-SG for SAD may help reduce SI and specific cognitive maintenance factors of SAD, including high social standards, perceived poor social skills, poorly defined social goals, lack of perceived control, negative self-perception, heightened self-focused attention, post-event rumination and avoidance, and safety behaviors.
Limitations in the current field include the scarcity of intervention work involving social anxiety populations using DBT principles and the lack of treatment consideration of SI in SAD. This limits conclusions that can be drawn about differences in treatment responses based on symptom severity and complex presentations. Future research may address the direct impact of DBT-SG on SAD with a specific focus on SI.
For clinicians: What components and skills from DBT have you found beneficial with clients with SAD?
Villalongo Andino, Mara; Garcia, Katelyn; and Richey, John (2024). Can dialectical behavior therapy skills group treat social anxiety disorder? A brief integrative review. Frontiers in Psychology, vol. 14.
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Katy Manetta, PhD, A-CBT
Representing NSAC-Long Beach
(Belmont Psychological Services)