Task Concentration Training and Fear of Blushing - artikel

Question 1

what is considered to be an important factor in the maintenance of social phobia

Answer 1

self-focused attention (SFA)

Question 2

in welke vorm van social phobia schijnt SFA vooral belangrijk te zijn

Answer 2

erytrophobia (fear of blushing)

Question 3

it is argued that SFA might be especially important in erytrophobia since….

Answer 3

physiological arousal serves to focus attention inwards and heightened SFA may cause a blushing reaction

Question 4

wat voor methode gebruiken ze om SFA te proberen te verminderen voor deze mensen

Answer 4

task concentration training

Question 5

wat waren de resultaten

Answer 5

task concentration training strongly reduced blushing propensity, fear of blushing, avoidance behaviour, and negative beliefs about the consequence of blushing

Question 6

wat houdt SFA in in social anxiety (verhaal)

Answer 6

The idea is that social phobics direct too much attention to themselves during social interactions (to their emotions, self-thoughts, behaviour, physical appearance, arousal) and have little attention for their task, the other
person(s), and their environment. As a result of their internal focus, they become inconveniently aware of their fear and arousal, and of possible flaws in their appearance and behaviour. Lack of outwarddirected attention may result in actually unskilled and even unkind behaviour. Moreover, lack of externally focused information processing will bring social phobics to rely on their own (negative) impressions to evaluate social situations and their own behaviour. Consequently, once developed dysfunctional beliefs will not be disconfirmed.

Question 7

wat houdt SFA in (korte woorden)

Answer 7

social phobics -> too much attention to self -> little attention for tasks/others/environment -> aware of their fear and arousal, and possible flaws -> unskilled or unkind behaviour + rely on their own negative impressions to evaluate -> once developed dysfunctional beliefs will not be disconfirmed

Question 8

wat is de vicieuze cirkel tussen physiological arousal en SFA

Answer 8

It has been found that salient physiological arousal serves to focus attention inwards and heightened SFA, in its turn, increases their awareness and the intensity of physiological reactions, and overestimate the intensity

dus het versterkt elkaar

Question 9

wat is nog een speciale factor aan blushing als physiological arousal

Answer 9

anderen kunnen het zien, waardoor je SFA juist nog hoger gaat

Question 10

wat is het doel van de task concentration training

Answer 10

aims at redirecting erytrophobics attention away from the self and the social task during blushing

Question 11

wat zijn de 3 fasen van TCT

Answer 11

1. getting insight in the attentional processes and the effects of heightened SFA
2. focusing attention outward instead of inward in non-threatening situations
3. focusing attention outward in threatening situations

Question 12

how does the treatment differ from the attentional training developed by Wells

Answer 12

Firstly, in Wells’ procedure the patient is
taught to focus attention outside (e.g. on neutral sounds), whereas in TCT patients are taught to focus attention on the task at hand. Secondly, practising attentional focus in threatening situations (phase 3) is not part of Wells’ procedure.

Question 13

wat wordt aan het begin aan de patienten uitgelegd

Answer 13

• how blushing and SFA mutually reinforce each other
• and therefore cause anxiety, negative self thoughts, problems in concentration and unskilled behaviour.
• Then, patients are taught that by redirecting the attention outward (to the task and environment) they will be able to break through the vicious circle and thereby cope with blushing

Question 14

wat moeten de patienten registreren

Answer 14

Patients are instructed to indicate from day to day in which situations blushing has appeared, how anxious they were, and to estimate the percentage of concentration that was directed towards the self, towards the task, and towards the environment at that moment.

Question 15

SFA is
defined as attention ….

Answer 15

towards aspects of the self which are not necessary to perform the task, such as one’s arousal (am I blushing?), emotions (do I feel anxious?), private self (how am I doing?) or public self (how do others see me?).

Question 16

wat is het verschil tussen task-focused attention en environment-focused attention

Answer 16

Task-focused attention is defined as attention
towards the behaviour that is required in the
specific situation, including attention for the other (relevant) persons in that situation. Environmentfocused attention is focused on those aspects of the environment which are not necessary to perform the task

Question 17

why is the difference between task and environment important

Answer 17

The difference between taskfocused and environment-focused attention is important, since many patients know from experience
the distracting effect of focusing the attention on the environment during blushing (for example watching the T.V. for a moment or blowing one’s nose when blushing), which may help for a moment to reduce the blushing reaction, but does not help to cope with blushing in the long term. By registrating
their attentional focus patients are encouraged to study their processing routines in problematic situations (described as ‘meta-cognitive profiling’ by Wells and Mathews, 1994, p. 306). In this way, patients obtain insight into the way they divide their attention in situations that elicit a blush.

Question 18

dus wat was de onderzoeksvraag

Answer 18

whether it is possible to teach social phobics with fear of blushing to explicitly focus their attention outwards, and so reduce their (fear of) blushing

Question 19

tct in therapy sessions=

Answer 19

concentration exercises, build up hierarchically.
1. listening exercise
2.

Question 20

listening exercise

Answer 20

Therapist and patient sit with their backs against each other (so that no eye contact takes place) and the therapist tells the patient a neutral, 2 min story (e.g. about his holiday). The patient is instructed to concentrate on the story (task) and to summarize it afterwards. He also has to estimate the percentage of attention that was directed towards the self, towards the task, and towards the environment, while listening. Furthermore, the patient will estimate the percentage of the story he was able to summarize and so will the therapist.

Question 21

tweede listening exercise

Answer 21

met oogcontact

Question 22

derde listening exercise

Answer 22

patient must distract themselves by thinking about blushing

Question 23

wat is het effect van het denken aan blushing tijdens de luisteropdracht

Answer 23

The effect of the more complex (blushinducing) elements in the exercise is that most patients first become more self-focused as a result, but are able to re-focus on the task after some exercise. Also, the rehearsal of the complex exercises helps them to increase resistance to distraction by elements associated with blushing.

Question 24

Each listening exercise is repeated until the percentage of concentration directed towards the task is at least 51% (more than half of the total).

Answer 24

oke

Question 25

wat gebeurt er na de luisteropdracht

Answer 25

herhalen maar dan via spreken

Question 26

wat deden ze bij TCT in non threatening situations

Answer 26

In this part of the therapy, the patient is instructed to concentrate on the task in non-threatening, everyday situations (door bos lopen, telefoontje plegen etc)

Question 27

TNT in threatening situations

Answer 27

moeten 10 sociale situaties geven waarin ze normaal zouden blushen. het doel is om task concentration aan te houden, en om snel aandacht terug te kunnen focusen naar deze task, als mensen afgeleid worden door te denken aan blushen.

Question 28

wat kregen de patienten na de TCT

Answer 28

cognitive therapy

Question 29

waarom gaven ze CT na TCT

Answer 29

TCT is considered as a coping strategy for excessive blushing, whereas CT intervenes on patients’ basic beliefs about blushing.

Since dysfunctional beliefs about blushing are hypothesized to play an important role in the maintenance of fear of blushing (Edelmann, 1990) modification of these beliefs by means of CT would also be necessary to overcome fear of blushing.

Question 30

waar bestaat de CT uit

Answer 30

• uitleg
• informed about fear evoking and fear maintaining nature of dysfunctional beliefs about blushing and to its catastrophic consequences
• cognitive diaries explore central dysfunctional thoughts

Question 31

wat voor methode gebruiken ze tijdens die CT

Answer 31

These thoughts are then challenged through the so-called Socratic dialogue: by means of posing specific questions, patients are stimulated to think about the tenability of their thoughts and to generate possible alternatives.These thoughts are then tested in everyday life by means of behavioural experiments; small empirical tests set up by the therapist and the patient in order to (dys)confirm predictions about the consequences of blushing.

Question 32

hoelang en hoeveel treatments

Answer 32

The treatment consisted of six sessions of TCT
and six sessions of CT for the first patient. The
second patient received eight sessions of TCT and eight sessions of CT, since we felt that six sessions of each procedure did not give the therapist enough time. Sessions lasted 1 h and were held once a week. Before treatment, between TCT and CT, after treatment, at 1-month follow-up, and at 1-year follow-up, assessments took place. The first two authors served as therapists.

Question 33

waarmee werd blushing gemeten

Answer 33

met Blushing Questionnaire (ook over beliefs baout blushing, disturbances of mental processes as a result of blushing, en de strategieen die gebruikt worden om te stoppen met blushen

Question 34

wat was de eerste case

Answer 34

steve, de medische student

Question 35

wat was de tweede case

Answer 35

Ann, 35 yr old housewife with 2 children, gave up her job bc of the blushing issue

Question 36

resultaten

Answer 36

Figures 1 and 2 show the decrease in conviction of the central dysfunctional thoughts about blushing for both cases. Contrary to expectations, a substantial decrease in the conviction of both patients’ idiosyncratic dysfunctional beliefs occurred during TCT. In Table 1 the results of the self-report assessment are presented. During TCT as well as during CT both patients made substantial progress on all aspects of erytrophobia (fear of blushing, problems in concentration, physical reactions, blushing cognitions, and avoidance behaviour). Moreover, patient 1 improved on the general social phobia measures: FQ, SPAI, and FNE during therapy. At the 1-month and 1-year follow-up, the results were maintained. A year after treatment, patient 2 was also improved on the general social phobia measures FQ and FNE.

Question 37

discussie

Answer 37

The case-studies did not control for possible spontaneous recovery or placebo responses, nor for the order in which the therapies TCT and CT) were presented. Controlled outcome
studies are needed to investigate whether TCT is effective in a larger sample of patients and to compare the results of TCT with existing cognitive behavioural treatment for fear of blushing.

Question 38

A remarkable outcome of the present study is
that the conviction of dysfunctional beliefs about blushing strongly decreased during TCT, as no discussions took place concerning patients’ beliefs.

Answer 38

oke

Question 39

Clark and Wells (1995) stated that social phobics, as a result of being self-focused, use their own (negative) impression of themselves as main evidence for the idea that others evaluate them in a negative way. Re-directing attention outwards may help social phobics to base their views of how others evaluate them when blushing on the objective behaviour of others instead of on their self-impression. Consequently, such objective observations may force them to modify their negative beliefs.

Answer 39

oke