Efficacy of a cognitive-behavioral group therapy in patients with fear of blushing

Introduction. - Cognitive behavioral therapy (CBT) has shown to be effective in the treatment of social anxiety disorders (SAD). However, fear of social blushing is almost never measured as a therapeutic outcome variable, even though some data suggest that this dimension constitutes a specific syndrome in social anxiety spectrum, justifying specific therapeutic strategies. For these reasons, we developed a group therapy program including a combination of task concentration training (TCT) and other CBT strategies targeting fear of blushing. Aim. - We aimed to investigate the efficacy of this program in an open trial conducted in 55 patients suffering from SAD (Diagnostic and statistical manual of mental disorders IV criteria) with fear of blushing. Method. - Throughout a program including eleven weekly sessions, systematic measurements of fear of blushing and other anxiety and personality dimensions were performed at inclusion, at the end of the therapy and 3 months later, in order to explore the therapeutic effects of the program on fear of blushing, social anxiety, and other dimensions (Liebowitz social anxiety scale, blushing propensity questionnaire, Rathus assertiveness scale, Rosenberg self-esteem scale, Hospital anxiety and depression scale, Sheehan disability scale). The statistical analyses compared the scores of all measurements at inclusion, at the end of the therapy, and 6 months Later. We also calculated the effect size obtained after treatment, and performed a logistic regression to determine the factors associated with a remission of fear of blushing after therapy. Results. - The main outcome criterion the Salpetriere fear of blushing questionnaire (SFBQ) score - was significantly reduced after treatment (P < 0.001) and remained stable at follow up. A satisfying effect size was obtained on this score after treatment (1.7), and 57.6% of subjects were considered in remission on the basis of a SFBQ score of 6 or less. Other measurements of blushing propensity, social anxiety, assertiveness, self-esteem, anxiety, depression and disability showed significant improvement after treatment and reductions remained stable at 3-month follow-up. To be a female and to have a low SFBQ score at inclusion appeared as two independent predictors of good improvement. Discussion. - Despite the preliminary nature of this study, our results suggest the efficacy of this specific group therapy program for erythrophobia. Further controlled and comparative trials are now required to confirm the program efficacy including a comparison between group and individual therapies. (C) L'Encephate, Paris, 2012.