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FrancoAngeli Journals

Sez. generale - Casi Clinici

N. 51 (2022)

Un caso clinico di ansia sociale

DOI
https://doi.org/10.3280/qpc51-2022oa15184
Inviata
9 gennaio 2023
Pubblicato
18-01-2023

Abstract

In questo articolo viene presentato il caso clinico di Monica, una donna di 32 anni che richiede una psicoterapia per un Disturbo di ansia sociale che sta mettendo a rischio il suo nuovo lavoro. L’ansia sociale è definita come una sindrome cognitivo-affettiva contraddistinta da apprensione e intensa paura che si manifesta in situazioni sociali in cui la persona è sottoposta alla valutazione oppure allo sguardo degli altri (Grimaldi, 2008; Leary & Kowalski, 1995). Gli approcci cognitivisti hanno studiato e approfondito le tematiche dell’ansia sociale, con la formulazione di diverse teorie e modelli (Beck & Emery, 1985; Clark & Wells, 1995; Hofmann, 2007; Moscovitch, 2009; Orazi & Mancini, 2011; Rapee & Heimberg, 1997; Rapee, 2010; Schlenker & Leary, 1982b; Stopa, 2009). A partire da questi modelli, sono stati implementati trattamenti efficaci per l’ansia sociale, tra cui i protocolli di trattamento della terapia cognitivo-comportamentale che sono ad oggi i più validati e statisticamente più efficaci. Tuttavia, questi modelli si focalizzano sui meccanismi di mantenimento, senza indicare come essi potrebbero svilupparsi, né specificare una base eziologica del disturbo (Wong et al., 2017), con ripercussioni sull’impostazione del trattamento. Il caso di Monica viene di seguito formulato facendo riferimento al Modello Cognitivo Integrato (Grimaldi, 2019) basato appunto sull’integrazione di modelli e ricerche provenienti da diversi ambiti al fine di costruire un modello psicopatologico che spieghi lo sviluppo e il mantenimento dei vari disturbi d’ansia sociale, e sulla base del quale mettere a punto un intervento terapeutico maggiormente efficace.

Riferimenti bibliografici

  1. Allen, J.G. (2003). Mentalizing. Bulletin of the Menninger Clinic, 67(2): 91-112. DOI: 10.1521/bumc.67.2.91.23440.
  2. Baldwin, M.W. & Fergusson, P. (2001). Relational schemas: The Activation of Interpersonal Knowledge Structures in Social Anxiety. In W.R. Crozier & L.E. Alden (eds.), International Handbook of Social Anxiety. Hoboken: Wiley & Sons.
  3. Beck, A.T. & Emery, R.E. (1985). Anxiety Disorders and Phobias: A Cognitive Perspective. New York: Basic Books.
  4. Bruch, M.A., Heimberg, R.G., Berger, P. & Collins, T.M. (1989). Social phobia and perceptions of early parental and personal characteristics. Anxiety Research, 2(1): 57-65. DOI: 10.1080/08917778908249326.
  5. Brumariu, L.E. & Kerns, K.A. (2008). Mother-child attachment and social anxiety symptoms in middle childhood. Journal of Applied Developmental Psychology, 29(5): 393-402. DOI: 10.1016/j.appdev.2008.06.002.
  6. Brumariu, L.E. & Kerns, K.A. (2013). Pathways to Anxiety: Contributions of Attachment History, Temperament, Peer Competence, and Ability to Manage Intense Emotions. Child Psychiatry & Human Development, 44(4): 504-515. DOI: 10.1007/s10578-012-0345-7.
  7. Buhlmann, U., Wacker, R. & Dziobek, I. (2015). Journal of Anxiety Disorders Inferring other people’s states of mind: Comparison across social anxiety, body dysmorphic, and obsessive-compulsive disorders. Journal of Anxiety Disorders, 34: 107-113. DOI: 10.1016/j.janxdis.2015.06.003.
  8. Campbell-Sills, L., Barlow, D.H., Brown, T.A. & Hofmann, S.G. (2006). Acceptability and suppression of negative emotion in anxiety and mood disorders. Emotion, 6(4): 587-595. DOI: 10.1037/1528-3542.6.4.587.
  9. Canton, J., Scott, K. & Glue, P. (2012). Optimal treatment of social phobia. systematic review and meta-analysis. Neuropsychiatric Disease and Treatment, 8: 203-215. DOI: 10.2147/NDT.S23317.
  10. Caster, J.B., Inderbitzen, H.M. & Hope, D. (1999). Relationship Between Youth and Parent Perceptions of Family Environment and Social Anxiety. Journal of Anxiety Disorders, 13(3): 237-251. DOI: DOI: 10.1016/S0887-6185(99)00002-X.
  11. Clark, D.M. & Wells, A. (1995). A cognitive model of social phobia. In R.G. Heimberg, M.R. Liebowitz, D.A. Hope & F.R. Schneier (eds.), Social phobia: Diagnosis, assessment, and treatment. (pp. 69-93). New York: The Guilford Press.
  12. Cortina, M. & Liotti, G. (2006). Building on Attachment Theory : Toward a Multimotivational and Intersubjective Model of Human Nature. Paper presented on June 11, 2005, at the Annual Meeting of the Rapaport-Klein Study Group, 1-40.
  13. Cozolino, L. (2002). The neuroscience of psychotherapy. New York: W.W. Norton.
  14. Cozolino, L. (2006). Il cervello sociale. Milano: Raffaello Cortina.
  15. Cozolino, L. (2010). The Neuroscience of Psychotherapy: Healing the Social Brain. New York: W.W. Norton.
  16. Cozolino, L. (2016). Why Therapy Works: Using Our Minds to Change Our Brains. New York: W.W. Norton.
  17. De Castella, K., Goldin, P., Jazaieri, H., Ziv, M., Heimberg, R.G. & Gross, J.J. (2014). Emotion beliefs in social anxiety disorder: Associations with stress, anxiety, and well-being. Australian Journal of Psychology, 66(2): 139-148. DOI: 10.1111/ajpy.12053.
  18. Eugène, F., Cooney, R.E., Gotlib, I.H., Atlas, L.Y. & Joormann, J. (2006). Amygdala activation in the processing of neutral faces in social anxiety disorder: Is neutral really neutral? Psychiatry Researchearch: Neuroimaging, 148(1): 55-59. DOI: 10.1016/j.pscychresns.2006.05.003.
  19. Fonagy, P., Gergely, G., Jurist & Target, M. (2002). Affect regulation, mentalization and development of the self. New York: Other Press.
  20. Fonagy, P. & Target, M. (1997). Attachment and reflective function: their role in self-organization. Development and Psychopathology, 9(4): 679-700. DOI: 10.1017/S0954579497001399.
  21. Fonagy, P. & Target, M. (2006). The mentalization-focused approach to self pathology. Journal of Personality Disorders, 20(6): 544-576. DOI: 10.1521/pedi.2006.20.6.544.
  22. Fraley, R.C., Roisman, G.I., Booth-LaForce, C.L., Owen, M.T. & Holland, A.S. (2013). Interpersonal and genetic origins of adult attachment styles: a longitudinal study from infancy to early adulthood. Journal of Personality and Social Psychology, 104(5): 817-838. DOI: 10.1037/a0031435.
  23. Gilbert, P. (1989). Human Nature and Suffering. London: Routledge.
  24. Gilbert, P. (1992). Counseling for depression. Thousand Oaks: Sage publications.
  25. Gilbert, P. (2000). The relationship of shame, social anxiety and depression: the role of the evaluation of social rank. Clinical Psychology & Psychotherapy, 7(3): 174-189. DOI: 10.1002/1099-0879(200007)7:3<174::AID-CPP236>3.0.CO;2-U.
  26. Gilbert, P. (2001). Genes on the Couch. London: Routledge.
  27. Gilbert, P. (2009). Introducing compassion-focused therapy. Advances in Psychiatric Treatment, 15(3): 199-208. DOI: 10.1192/apt.bp.107.005264.
  28. Gilbert, P., Broomhead, C., Irons, C., McEwan, K., Bellew, R., Mills, A., Gale, C. & Knibb, R. (2007). Development of a striving to avoid inferiority scale. British Journal of Social Psychology, 46(3): 633-648. DOI: 10.1348/014466606X157789.
  29. Gilbert, P. & Grimaldi, P. (2011). Lo sviluppo psicopatologico dell’ansia sociale: motivazioni, desiderabilità e attrattiva. In M. Procacci, R. Popolo & N. Marsigli (a cura di), Ansia e ritiro sociale. Valutazione e trattamento. Milano: Raffaello Cortina.
  30. Gilbert, P. & Procter, S. (2006). Self-Criticism : Overview and Pilot Study of a Group Therapy Approach. Clinical Psychology, 379: 353-379. DOI: 10.1002/cpp.
  31. Gilbert, P. & Trower, P. (2001). Evolution and process in social anxiety. In W.R. Crozier & L. Alden (eds.), International handbook of social anxiety: Concepts, research and interventions relating to the self and shyness. Hoboken: Wiley & Sons.
  32. Greenberg, L. (2007). Emotion in the therapeutic relationship in emotion-focused therapy. In P. Gilbert & R.L. Leahy (eds.), The Therapeutic Relationship in the Cognitive Behavioral Psychotherapies. London: Routledge.
  33. Grimaldi, P. (2008). A quale timidezza appartieni? Comprendere e prevenire le varie forme di ansia sociale. Milano: FrancoAngeli.
  34. Grimaldi, P. (2019). Un modello cognitivo integrato per l’ansia sociale. In P. Grimaldi (a cura di), Ansia sociale. Clinica e terapia in una prospettiva cognitivista integrata. Milano: FrancoAngeli.
  35. Gross, J.J. (1998). The Emerging Field of Emotion Regulation: An Integrative Review. Review of General Psychology, 2(3): 271-299. DOI: 10.1037/1089-2680.2.3.271.
  36. Gross, J.J., Richards, J.M. & John, O.P. (2007). Emotion Regulation in Everyday Life. In D.K. Snyder, J. Simpson & J.N. Hughes (eds.), Emotion regulation in couples and families: Pathways to dysfunction and health (pp. 13-35). American Psychological Association. DOI: 10.1037/11468-001.
  37. Heimberg, R.G. (2002). Cognitive-behavioral therapy for social anxiety disorder: Current status and future directions. Biological Psychiatry, 51(1): 101-108. DOI: 10.1016/S0006-3223(01)01183-0.
  38. Hermann, C., Ofer, J. & Flor, H. (2004). Covariation bias for ambiguous social stimuli in generalized social phobia. Journal of Abnormal Psychology, 113(4): 646-653. DOI: 10.1037/0021-843X.113.4.646.
  39. Hezel, D.M. & McNally, R.J. (2014). Theory of mind impairments in social anxiety disorder. Behavior Therapy, 45(4): 530-540. DOI: 10.1016/j.beth.2014.02.010.
  40. Hirsch, C.R., Clark, D.M., Mathews, A. & Williams, R. (2003). Self-images play a causal role in social phobia. Behaviour Research and Therapy, 41(8): 909-921. DOI: 10.1016/S0005-7967(02)00103-1.
  41. Hofmann, S.G. (2004). Cognitive mediation of treatment change in social phobia. Journal of Consulting and Clinical Psychology, 72(3): 392-399. DOI: 10.1037/0022-006X.72.3.392.
  42. Hofmann, S.G. (2007). Cognitive Factors that Maintain Social Anxiety Disorder: a Comprehensive Model and its Treatment Implications. Cognitive Behaviour Therapy, 36(4): 193-209. DOI: 10.1080/16506070701421313.
  43. Hofmann, S.G. & Smits, J.A.J. (2008). Cognitive-Behavioral Therapy for Adult Anxiety Disorders: a Meta-Analysis of Randomized Placebo-Controlled Trials. The Journal of Clinical Psychiatry, 69(4): 621-32. DOI: 10.4088/jcp.v69n0415.
  44. Hudson, J.L. & Rapee, R.M. (2000). The origins of social phobia. Behavior Modification, 24(1): 102-129. DOI: 10.1177/0145445500241006.
  45. Joormann, J. & Gotlib, I.H. (2006). Is this happiness I see? Biases in the identification of emotional facial expressions in depression and social phobia. Journal of Abnormal Psychology, 115(4): 705-714). DOI: 10.1037/0021-843X.115.4.705.
  46. Kashdan, T.B. & Steger, M.F. (2006). Expanding the topography of social anxiety an experience-sampling assessment of positive emotions positive events, and emotion suppression. Psychological Science, 17(2): 120-128. DOI: 10.1111/j.1467-9280.2006.01674.x.
  47. Kennedy-Moore, E. & Watson, J.C. (2001). Expressing Emotion Myths, Realities, and Therapeutic Strategies. New York: Guilford Press.
  48. Kim, K.I. & Markman, A.B. (2004). Fear of Isolation, Cultural Differences, and Recognition Memory. Proceedings of the Annual Meeting of the Cognitive Science Society, 26: 684-689. DOI:10.1016/J.JESP.2005.06.005.
  49. Leahy, R.L. (2005). A social-cognitive model of validation. In P. Gilbert (ed.), Compassion: Conceptualisations, research and use in psychotherapy. London: Routledge.
  50. Leahy, R.L. (2008). The Therapeutic Relationship in Cognitive-Behavioral Therapy. Behavioural and Cognitive Psychotherapy, 36(6): 769-777. DOI: 10.1017/S1352465808004852.
  51. Leary, M.R. & Kowalski, R.M. (1995). The self-presentation model of social phobia. In R.G. Heimberg, M.R. Liebowitz, D.A. Hope & F.R. Schneier (eds.), Social phobia: Diagnosis, assessment, and treatment (pp. 94-112). New York: The Guilford Press.
  52. Li, Z., Tong, L., Guan, M., He, W., Wang, L., Bu, H., Shi, D. & Yan, B. (2016). Altered Resting-State Amygdala Functional Connectivity after Real-Time fMRI Emotion Self-Regulation Training. BioMed Research International. DOI: 10.1155/2016/2719895.
  53. Liotti, G. (1994). La dimensione interpersonale della coscienza. Roma: Carocci.
  54. Liotti, G. (2001). Le opere della coscienza. Psicopatologia e psicoterapia nella prospettiva cognitivo-evoluzionista. Milano: Raffaello Cortina.
  55. Liotti, G. & Farina, B. (2011). Sviluppi traumatici. Eziopatologia, clinica e terapia della dimensione dissociativa. Milano: Raffaello Cortina.
  56. Liotti, G., Fassone, G. & Monticelli, F. (2017). L’evoluzione delle emozioni e dei sistemi motivazionali. Teoria, ricerca, clinica. Milano: Raffaello Cortina.
  57. Liotti, G. & Monticelli, F. (2008). I sistemi motivazionali nel dialogo clinico. Milano: Raffaello Cortina.
  58. Marsigli, N. & Grimaldi, P. (2011). La terapia cognitiva della fobia sociale. In M. Procacci, R. Popolo & N. Marsigli (a cura di), Ansia e ritiro sociale. Valutazione e trattamento. Milano: Raffaello Cortina.
  59. Mayer, J.D., Salovey, P. & Caruso, D.R. (2004). Emotional intelligence: Theory, findings, and implications. Psychological Inquiry, 15(3): 197-215. DOI: 10.1207/s15327965pli1503_02.
  60. Monticelli, F., Imperatori, C., Carcione, A., Pedone, R. & Farina, B. (2018). Cooperation in psychotherapy increases metacognitive abilities: A single-case study. Rivista di Psichiatria, 53(6): 336-340. DOI: 10.1708/3084.30768.
  61. Morrison, A.S. & Heimberg, R.G. (2013). Social Anxiety and Social Anxiety Disorder. SSRN, 9: 249-274. DOI: 10.1146/annurev-clinpsy-050212-185631.
  62. Moscovitch, D.A. (2009). What Is the Core Fear in Social Phobia? A New Model to Facilitate Individualized Case Conceptualization and Treatment. Cognitive and Behavioral Practice, 16(2): 123-134. DOI: 10.1016/j.cbpra.2008.04.002.
  63. Ollendick, T.H. & Benoit, K.E. (2012). A Parent-Child Interactional Model of Social Anxiety Disorder in Youth. Clinical Child and Family Psychology Review, 15(1): 81-91. DOI: 10.1007/s10567-011-0108-1.
  64. Orazi, F. & Mancini, F. (2011). Processi Cognitivi e Meccanismi di Mantenimento. In M. Procacci, R. Popolo & N. Marsigli (a cura di), Ansia e ritiro sociale. Milano: Raffaello Cortina.
  65. Phelps, J.L., Belsky, J. & Crnic, K. (1998). Earned security, daily stress, and parenting: a comparison of five alternative models. Development and Psychopathology, 10(1): 21-38. DOI: 10.1017/s0954579498001515.
  66. Popolo, R., Procacci, M., Nicoló, G. & Carcione, A. (2011). Stati mentali e metacognizione. In M. Procacci, R. Popolo & N. Marsigli (a cura di), Ansia e Ritiro Sociale. Milano: Raffaello Cortina.
  67. Popolo, R., Salvator G. & Procacci, M. (2011). I modelli psicopatologicidei disturbi di ansia sociale. In M. Procacci, R. Popolo & N. Marsigli (a cura di), Ansia e Ritiro Sociale. Milano: Raffaello Cortina.
  68. Powers, M., Sigmarsson, S. & Emmelkamp, P. (2008). A meta-analytic review of psychological treatments for social anxiety disorder. International Journal of Cognitive Therapy, 1(2): 94-113.
  69. Rachman, S. & Shafran, R. (1999). Cognitive distortions: thought-action fusion. Clinical Psychology & Psychotherapy, 6(2): 80-85.
  70. Rapee R.M. & Heimberg R.G. (1997). A cognitive-behavioral model of anxiety in social phobia. In Behaviour Research and Therapy, 8(5): 741-756. DOI: 10.1016/S0005-7967(97)00022-3.
  71. Richard G. Heimberg Ronald M. Rapee, F.A.B. (2010). A Cognitive Behavioral Model of Social Anxiety Disorder: Update and Extension. In S.G. Hofmann & P.M. DiBartolo (eds.), Social Anxiety. Clinical, Developmental, and Social Perspectives (pp. 396-417). Academic Press.
  72. Safran, J.D. & Muran, J.C. (2000). Negotiating the therapeutic alliance: A relational treatment guide. In Negotiating the therapeutic alliance: A relational treatment guide. New York: Guilford Press.
  73. Safran, J.D. & Muran, J.C. (2003). Teoria e pratica dell’alleanza terapeutica. Roma-Bari: Laterza.
  74. Schlenker, B.R. & Leary, M.R. (1982). Social anxiety and self-presentation: A conceptualization model. Psychological Bulletin, 92(3): 641-669. DOI: 10.1037/0033-2909.92.3.641.
  75. Schore, A.N. (1994). Affect regulation and the origin of the self. New York: Lawrence Erlbaum Associates.
  76. Schore, A.N. (2012). The Science of the Art of Psychotherapy. New York: W.W. Norton.
  77. Semerari, A. & Dimaggio, G. (2003). I disturbi di personalità. Modelli e trattamento. Stati mentali, metarappresentazione, cicli interpersonali. Roma-Bari: Laterza.
  78. Siegel, D. (2012). The developing mind. New York: The Guilford Press.
  79. Singh, J.S. & Hope, D.A. (2009). Cognitive-behavioral approaches to the treatment of social anxiety disorder. Israel Journal of Psychiatry and Related Sciences, 46(1): 62-69.
  80. Stopa, L. (2009). Why is the self important in understanding and treating social phobia? Cognitive Behaviour Therapy, 38(1): 48-54. DOI: 10.1080/16506070902980737.
  81. Trower, P. & Gilbert, P. (1989). New theoretical conceptions of social anxiety and social phobia. Clinical Psychology Review, 9(1): 19-35. DOI: 10.1016/0272-7358(89)90044-5.
  82. Wallin, D.J. (2007). Attachment in Psychotherapy. New York: Guilford Press.
  83. Walsh, J. (2002). Shyness and social phobia: A social work perspective on a problem in living. Health and Social Work, 27(2): 137-144. DOI: 10.1093/hsw/27.2.137.
  84. Werner, K.H., Goldin, P.R., Ball, T.M., Heimberg, R.G. & Gross, J.J. (2011). Assessing emotion regulation in social anxiety disorder: The emotion regulation interview. Journal of Psychopathology and Behavioral Assessment, 33(3): 346-354. DOI: 10.1007/s10862-011-9225-x.
  85. Wong, Q.J.J., Gregory, B., Gaston, J.E., Rapee, R.M., Wilson, J.K. & Abbott, M.J. (2017). Development and validation of the Core Beliefs Questionnaire in a sample of individuals with social anxiety disorder. Journal of Affective Disorders, 207: 121-127. DOI: 10.1016/j.jad.2016.09.020.
  86. Young, J.E. (1999). Cognitive Therapy for Personality Disorders: A Schema-Focused Approach. Sarasota: Professional Resource Press.
  87. Young, J., Klosko, J. & Weishaar, M. (2003). Schema therapy: A practitioner’s guide. New York: Guilford Press.

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