Treatment of fear of blushing, sweating, or trembling. Results at long-term follow-up.
CBT for fear of blushing, sweating, or shaking keeps working 18 months later no matter which ingredient you present first.
01Research in Context
What this study did
The team treated adults who feared blushing, sweating, or shaking in public.
All clients got CBT: some started with exposure, others with cognitive work, others got both mixed.
No control group was used; the plan was simply to watch people for a year and a half after therapy ended.
What they found
Fear dropped after treatment and stayed low for 18 months.
Changing the order of exposure and cognitive steps made no clear difference.
After the 18-month mark, scores held steady—no further gains or losses.
How this fits with other research
Dall et al. (1997) ran a tight trial the next year. They showed that adding cognitive restructuring to exposure helped more than exposure alone, yet the boost did not carry into later exposure sessions.
That finding seems to clash with “order does not matter,” but the 1996 study compared different CBT sequences, not CBT versus exposure-only. The two papers together tell us: include cognitive work, but do not worry about when.
Zeiler (1999) tracked adults with body-dysmorphic disorder for two years. A six-month maintenance program kept relapse low, hinting that booster contact could stretch the 18-month stability seen here.
Gershkovich et al. (2017) moved the same CBT elements online. Gains matched in-person results, proving the package travels well to telehealth.
Why it matters
You can reassure anxious clients that CBT skills stick for at least a year and a half. Stop sweating the session order—pick the sequence that fits your clinic calendar. If you want extra insurance against relapse, add a brief maintenance phase like Zeiler (1999) did.
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02At a glance
03Original abstract
This study investigated the long-term effectiveness of cognitive-behavioral treatments for patients with a specific type of social phobia: fear of showing bodily symptoms (blushing, sweating, or trembling). Patients were reassessed 18 months after they had finished one of the following treatments: (a) exposure in vivo followed by cognitive therapy, (b) cognitive therapy followed by exposure in vivo, or (c) a cognitive-behavioral treatment in which both strategies were integrated from the start. All patients were individually treated. Self-report assessments were held before and after treatment and at 3-month and 18-month follow-ups. Repeated measures MANOVAs for the patients who completed the 18-month follow-up (n = 26) demonstrated significant time effects from pretest to follow-up, indicating overall improvement. Between the posttest and the 18-month follow-up, no significant change was observed. No differences among the treatment packages were found, although the cognitive-exposure treatment showed a trend to be less effective than both other treatments.
Behavior modification, 1996 · doi:10.1177/01454455960203006