Social Anxiety Psychological Rx — MRCPsych Paper B MCQ

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ModerateAnxiety & Stress-Related DisordersSocial Anxiety Psychological RxMRCPsych Paper B

A 30-year-old adult has social anxiety disorder characterised by marked fear of negative evaluation, avoidance of social interactions and significant occupational impairment. They would like psychological treatment. Which intervention should be offered as the initial treatment?

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Correct answer: C — Individual cognitive behavioural therapy specifically developed for social anxiety disorder, such as the Clark and Wells model

NICE recommends offering adults with social anxiety disorder individual CBT specifically developed for the disorder. Appropriate protocols include the Clark and Wells model and the Heimberg model; therefore, B is the best answer. These interventions directly address maintaining processes such as self-focused attention, safety behaviours, distorted self-imagery, negative beliefs and avoidance. Generic CBT is less appropriate because NICE specifies a manualised, social-anxiety-specific intervention. EMDR is principally used for trauma-related disorders and is not a recommended initial treatment for social anxiety disorder. Interpersonal psychotherapy and systemic family therapy are also not recommended first-line psychological treatments for an adult with this condition. If disorder-specific CBT is declined, NICE recommends CBT-based supported self-help as the next psychological option.

Reference: National Institute for Health and Care Excellence. Social anxiety disorder: recognition, assessment and treatment (CG159), recommendations 1.3.2 and 1.3.13–1.3.14. 2013. https://www.nice.org.uk/guidance/cg159/chapter/recommendations