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Self-practice, Self-reflection (SP/SR) & David Clark's treatment for social anxiety: introduction (1st post)

Self-practice/Self-reflection (SP/SR) is an approach to training in cognitive-behavioural therapy (CBT) that involves practising CBT methods on oneself (self-practice - SP) and then reflecting on what one can learn from this experience (self-reflection - SR).  SP/SR is at the interface between more standard training approaches (such as lectures, videos, role plays) and personal therapy (recommended as part of therapist training by many - particularly non CBT - psychotherapy schools).  In the current draft copy of their "Self-practice/self-reflection workbook", authors James Bennett-Levy, Richard Thwaites, Beverly Haarhoff & Helen Perry write "While the primary focus of personal therapy is on personal development, the rationale and purpose of SP/SR is to use your personal experience of CBT to develop better understanding and use of CBT with patients. It is true that some people - particularly those who engage well with SP/SR - often report significant personal insights, and changes in ways of being in the world. However, we see this as an added extra, rather than a central reason for doing SP/SR ... Practising on yourself (SP) provides a unique perspective on the CBT process ‘from the inside'. Reflecting on the experience (SR) concretizes the experience, and enables you to examine the implications not only for yourself, but also for your work with patients and your understanding of cognitive and behavioural theory."

Well, this is a nice theory.  How well does it work?  There is a Self-practice/Self-reflection website that gives a better overview of the approach, including free access to a downloadable book chapter & several relevant articles.  My involvement is that I've been asked to be one of a small group of CBT therapists trying out & reporting back to the authors on a new SP/SR workbook that's due to be published next year.  I'm kind of "killing two birds with one stone".  I'm interested in more experiential approaches to learning (hence SP/SR) and I would like to build on a fine workshop on social anxiety taught by David Clark that I went to back in July.  As an added bonus, I personally occasionally get episodes of "social anxiety" so there's some potentially juicy material that I can practise on! 

The SP/SR manual is set out as a series of modules.  I believe we'll also have access to an online discussion forum.  The manual's authors describe the links between workbook reflections & the discussion forum in the following way: "There are various ways to do SP/SR. Here we are using the workbook method, which is the most researched (there is also a ‘limited co-therapy' method in pairs). With the workbook method, you have some set exercises each week or fortnight. You use the workbook to reflect on your experience - this is for your eyes only, and will include personal information e.g. the negative thoughts you are testing.  Once you have reflected on your experience in the workbook, you are then in a position to contribute to the Discussion Forum. The Discussion Forum is the place where the group can discuss their experiences and you can see how your own experience of the CBT process was similar or different from others. In turn, this is helpful in seeing to what extent your experience is likely to be reflected in the experiences of your patients.  We have found that written reflections are central to the process of SP/SR. In written reflections in the public domain there is no need to reveal any personal information (unless you wish to do so). The focus is on your experience of the process/technique, and how this might inform your work with patients."

So much for introducing SP/SR, what about David Clark's July workshop on social anxiety? David has been evolving his fine treatment of this common anxiety disorder for many years. In 1998 I went to a one day workshop with him on this approach at the BABCP conference in Durham - 15 years ago!  I attended this year's workshop with him in London to see how the treatment has evolved over the years. I was also impressed by his CBT approach's ringing endorsement in May's new NICE guidance on social anxiety treatment.  As I wrote in a couple of blog posts back in May: "There is a huge need for effective recognition & treatment: "Social anxiety disorder (previously known as 'social phobia') is one of the most common of the anxiety disorders. Estimates of lifetime prevalence vary but according to a US study, 12% of adults in the US will have social anxiety disorder at some point in their lives, compared with estimates of around 6% for generalised anxiety disorder (GAD), 5% for panic disorder, 7% for post-traumatic stress disorder (PTSD) and 2% for obsessive-compulsive disorder. There is a significant degree of comorbidity between social anxiety disorder and other mental health problems, most notably depression (19%), substance-use disorder (17%), GAD (5%), panic disorder (6%), and PTSD (3%)."

A linked BMJ article - "Recognition, assessment and treatment of social anxiety disorder: summary of NICE guidance" - does a good job of overviewing the new guideline.  The authors highlight that social anxiety "can severely impair a person's daily functioning by impeding the formation of relationships, reducing quality of life, and negatively affecting performance at work or school. Despite this, and the fact that effective treatments exist, only about half of people with this condition seek treatment, many after waiting 10-15 years.  Although about 40% of those who develop the condition in childhood or adolescence recover before adulthood, for many the disorder persists into adulthood, with the chance of spontaneous recovery then limited compared with other mental health problems."  I personally was troubled by blushing as a teenager and still, nearly fifty years later, I can get episodes where I slip into sweaty embarrassment.  Mostly I'm a rather ebullient extrovert, but I think I understand shyness well enough to be able to use my personal experience helpfully with the Self-practice/Self-reflection (SP/SR) style of learning.   

In tomorrow's post I'll look at "assessment" of social anxiety disorder, of skill with David Clark's treatment approach, and of the start of SP/SR.

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