4. Case examples

Shirotsuki has described a 23-year-old man named A with SAD [48] who was treated with VF.

A was helping the family business by working in their factory as a self-employed person. At the factory, he was often required to communicate with customers about repairing their products. A felt excessive anxiety on these occasions. Because of his anxiety, he often spoke fast and could not sufficiently express what he intended to say. Therefore, he avoided talking with customers as much as possible. He was also taking the prescription medications Paroxetine and Landsen. A CBGT program was conducted for A on eight occasions to treat his SAD. Psychological education was given in the first therapy session; exposure focused on speech, cognitive restructuring, and video feedback (VF) were conducted at the second, third, and fourth sessions, respectively; and exposure using conversation settings, cognitive restructuring, and VF were conducted at the fifth, sixth, and seventh sessions, respectively.

After making a speech for the first time, A had the following impression; "I thought it would be all right to make a speech even in front of an audience if the topic were pre-decided. However, somehow, I became awkward and felt I might be the worst speaker." After implementing the program, he thought "It seems like I am improving, but cannot feel the improvement." Video feedback was given during the fourth therapy session. "A" seemed rather nervous about observing the videos, similar to the other participants. After the observation, he thought "I was not as bad as I thought I would be." Regarding his speech, he thought "I could make the speech rather smoothly because I was relaxed. I will also do my best in the future." This case study suggests that A felt confident about his own behavior as a result of VF. After finishing the CBCT program, A was able to talk to people that he was acquainted with without excessive feelings of tension. He could also become involved with first-time customers without being too defensive.

Shirotsuki et al. have presented another case study that illustrated the treatment process of a SAD patient who participated in a CBGT program and was reinstated in his former office after treatment [49]. The patient was in his 40s and was feeling difficulties about working in his office because it had a negative environment. He was also afraid of his colleagues because they often reproached him. As a result, he gradually became uncomfortable in the office. Moreover, he became scared of getting involved with people because he was afraid that he might make others feel unpleasant. Furthermore, he thought that he might be smelling bad. His depressive symptoms increased, and as a result, he took a leave of absence and attended therapy to treat his anxiety and depression. A CBGT program was initiated because his anxiety about involvement with other people increased. The patient was afraid that he might be acting strangely or making the audience unpleasant before VF during the CBGT program. After watching his own video, he was able to see that he was not as unpleasant as he had thought. On the other hand, he mentioned a sense of burden when watching videos of himself. Although he knew that he could see himself objectively, he was somewhat afraid that he might look strange, and this sense of anxiety increased before VF. Therefore, a discussion was held before watching the video to reduce his anxiety. However, the anxiety was not completely alleviated by the discussion.

As a result of the CBGT program, the client's anxiety, avoidance, and cost bias in social situations had been decreased. In addition, negative self-perception improved as a result of speech and conversation exposure. Along with the improvement in SAD symptoms, the client gradually began the process of reinstatement. These findings indicate the effectiveness of CBGT program and the process of reinstatement of SAD patients. These case examples suggest the reality of video feedback sessions. In most cases, the clients reported benefits as well as difficulties in viewing the video. Although VF sessions are highly effective, participants simultaneously feel a heavy burden. Clinicians need to recognize both these aspects of VF and take steps in advance to reduce the feeling of resistance.
