Successful interdisciplinary intervention with an initially treatment-resistant social phobic.

Despite very successful treatments for social phobia, with many studies reporting as many as 75% of social phobics making clinically significant gains with 3 months of treatment or less, some social phobics fail to respond to treatment. This case presents a women with social phobia who received several trials of treatment for severe public-speaking fears but failed to improve, as demonstrated by persistent reports of fear and avoidance equal to those before treatment. With the assistance of a speech language pathologist, this client received combined therapy that included cognitive-behavioral therapy to treat her public-speaking fear and avoidance and voice therapy to treat excessive muscle contractions in the respiratory and phonatory systems. Overall, the combined treatment was successful, with the client's self-reported levels of fear and avoidance of public speaking decreasing dramatically. Specific improvements during voice therapy and implications for the treatment of social phobia are also discussed.