**3. Treatment of a social anxiety disorder: a case study**

#### **3.1. Setting and treatment conditions**

The therapy consisted of mainly weekly hours of therapy, in sum 25 h. Dyadic sessions took 60 min, and group sessions lasted 120 min.

#### **3.2. Patient data**

**Diagnosis (ICD-10).** Social phobia (F40.1), moderate depressive episode (F32.1)

**Anamnesis.** The 23-year-old medical student reported excessive anxiety, above all when being confronted with fellow students or authorities in performance situations (e.g., blood draw, state exam). He feared to behave unskillfully or to say something stupid and that others evaluate him negatively. Consequently, he tried to avoid such situations or got through them while suffering from extreme anxiety. At his first view in the outpatient clinic, he reported to stay at home all the day and presented intense worries about his future because of feeling much insecurity how to go on with his studies. He had stopped to follow joyful activities and his pleasure, felt much "blues," could not sleep, felt exhausted, had difficulties to concentrate, and make any decision. This state already lasted 8 months.

The patient never was in psychotherapy or pharmacotherapy before. Psychosomatic disorders in his family were unknown. The patient reported minor alcohol use in positive social situations (e.g., a beer with a friend on Saturday evening). He denied the use of any additional legal or illegal drugs, at present and in the past.

**Life history.** The patient described himself to be the third oldest child of a six-person family (father: engineer; mother, house wife; sisters: +8 years and +6 years; brother: −5 years). The very busy, successful, and well-known father was not often seen at home since the patient's 17th birthday. The development of a secure and trustful father-son contact thus firstly started 9 years ago. The mother was described as a very caring and calm person. The patient felt good contact to his siblings. Age differences however made it hard to establish secure and close ties.

The patient grew up in a highly performance- and achievement-oriented family. He was almost always best at school ("Merit is not my problem!") and developed a couple of good friendship in elementary school and in puberty. In the development of these relationships, time was very important so that the patient got into contact and became intimate with his friends step by step. At all times, he concurrently felt much shyness and great nervousness when being confronted with strangers. He chose the medical studies by his own interest and felt much enthusiasm if there were not "these painful heart attacks."

Currently, the patient lived in a shared apartment with fellow students. He did sports, liked cooking, and spent his weekends with his family and friends at home.
