Cognitive-Behavioral Treatment of Social Anxiety Disorder and Comorbid Paranoid Schizophrenia

We report on the cognitive-behavioral treatment (CBT) of a patient with comorbid social anxiety disorder (SAD), schizophrenia, and major depressive disorder, complicated by alcohol abuse. Symptoms included auditory hallucinations that commented on the patient's behavior and paranoid thoughts. The paranoid symptoms affected his social interactions as this included the fear that his thoughts may be heard and judged by others. Therapeutic activities raised awareness as to how avoidance interferes with and perpetuates the cycle of depression and psychosis while maintaining symptoms of SAD. Psychoeducation was provided about factors that maintain social anxiety and increase social isolation. New skills were obtained by helping the patient discover alternative ways to view social situations, experimentation, and real-world application to disprove notions about others' predicted behavior. Treatment led to a great reduction in social anxiety, depression, and suspicious thinking. This case study demonstrates that SAD symptoms in a patient experiencing psychosis can be effectively treated using CBT.