Effects of Acceptance and Commitment Therapy and Interpersonal Therapy on Reduction of Social Anxiety Disorder Among In-School Adolescents In Rivers State

Effects of Acceptance and Commitment Therapy and Interpersonal Therapy on Reduction of Social Anxiety Disorder Among In-School Adolescents In Rivers State

     Effects of Acceptance and Commitment Therapy and Interpersonal Therapy on Reduction of Social Anxiety Disorder Among In-School Adolescents In Rivers State




Umoh, Eme Camillus and Iruloh B.N.

Department of Educational Psychology

Guidance and Counselling

Faculty of Education

University of Port Harcourt

Port Harcourt, Nigeria

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            This study examined the effects of Acceptance and Commitment Therapy and Interpersonal Therapy on Reduction of Social Anxiety Disorder (SAD) among in-school adolescents in Rivers State. The quasi-experimental design was adopted for the study. A sample of 60 in school adolescents from 3 public secondary schools was drawn using purposive sampling technique. A-24 item standardized instrument on fear and avoidance titled Liebowitz Social Anxiety Scale (LSAS) was used to elicit information on social interaction from the respondents. Reliability of the instrument was established using the Cronbach alpha which yielded a coefficient of .867 and .890 for the 2 subscales. Data generated was analyzed with mean, standard deviation and paired t-test. Result from findings revealed that both psychotherapeutic techniques effectively reduced social anxiety. Suggestions were made based on the findings.



Social Anxiety Disorder (SAD) also called Social Phobia is an impairing and often chronic anxiety disorder that has adverse consequences on the quality of life and adaptive functioning of the affected individual. It is strongly associated with several other debilitating psychological and psychiatric conditions. SAD is a mental health condition characterized by intense, persistent fear of being watched and judged negatively by others. It is capable of inhibiting an individual maximizing his/her full potential. Anxiety impacts a student’s working memory and makes it difficult to learn and retain information. An anxious student works and thinks less efficiently and this significantly affects the student’s learning capability.

Diagnostic and statistical manual of mental disorders (DSM-V) defines social anxiety disorder as marked fear and anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others.  Such situations include social interactions, having a conversation, meeting unfamiliar people, being observed, for example: eating or drinking, and performing in front of others (like giving a speech). The individual is afraid of negative evaluation, perceiving he/she will be humiliated or embarrassed.

Bernstein, Penner, Clarke-Stewart and Roy (2006) defines SAD as anxiety about being criticized by others or acting in a way that is embarrassing or humiliating. The anxiety must be intense and persistent that it impairs the person’s normal functioning. Santrock (2005) views anxiety as a vague, highly unpleasant feeling of fear and apprehension capable of significantly impairing adolescents’ abilities to achieve or excel in tasks. Impairment in social skills is seen as one of the paramount aspects of social anxiety disorder. Myer (2002) agreed with other definitions and also sees social phobia as an intense fear of being scrutinized by others that leads to the person avoiding potentially embarrassing social situations but added that social phobia is shyness taken to an extreme.

DSM-V, (2013, p.202) outlined the following diagnostic criteria for social anxiety disorder:

  • Marked fear about one or more social situations in which the individual is exposed to possible scrutiny by others; social interactions, being observed and performing in front of others.
  • The person is afraid that he or she will act in a way or show anxiety symptoms that will be negatively evaluated.
  • The social situations always provoke fear.
  • Social situations are avoided or endured with intense fear or anxiety.
  • The anxiety is out of proportion to the actual threat posed by the social situation.
  • The fear or avoidance is not better explained by the symptoms of another mental disorder such as panic disorder, autism spectrum disorder, etc.
  • If another medical condition e.g. obesity, disfigurement from burns or injury is present, the fear, anxiety or avoidance is clearly unrelated or is excessive.

People with the performance-only-type of social anxiety disorder have performance fears that are typically most impairing in their professional lives e.g. musicians, performers or in roles that need regular public speaking. Performance fears can also manifest in school, work or academic settings in which frequent public presentations are required. Individuals with performance-only social anxiety do not avoid or fear non-performance social situations. Symptoms of SAD according to (mayoclinic.org) can be classified into two groups: emotional / behavioural symptoms and physical symptoms.

The emotional symptoms include:

  • Fear of situations that require judgment.
  • Worry or fear about embarrassing or humiliating self.
  • Intense fear of interacting or communicating with strangers.
  • Worry that people notice one’s anxiety.
  • Fear of physical symptoms that may cause embarrassment.
  • Avoidance of situations where one might be at the center.
  • Having anticipated anxiety.
  • Enduring a social situation with intense fear.
  • Evaluating one’s performance and identifying flaws.
  • Expecting the worst possible outcome from a negative experience during a social situation.

            Individuals with SAD consciously avoid interacting with unfamiliar people, parties or social gatherings, going to school or work, starting conversations, eating in front of others, dating, making eye contact, dry mouth and throat, shaking and trembling, walk disturbance.

Though not much had been done on SAD in Nigeria, the few researches on it in Nigeria showed a high rate of prevalence. The 12 months prevalence estimate in the United States is approximately 7%, median prevalence in Europe is 2.3%. Prevalence rates in children and adolescents are comparable to those in adults (DSM – 5).

Social anxiety disorder has a media onset age of 13 years and 75% have an age at onset between 8 and 15 years. Onset may follow a stressful or humiliating experience e.g. being. Adult onset is relatively rare and is likely to occur after a stressful humiliating experience or after life changes that require new social roles e.g. marrying someone from a different social class. Adolescents exhibit a broader pattern of fear and avoidance including but not limited to dating compared with younger children.

Biological or psychological factors may cause SAD. Biologically, social anxiety sometimes runs in families though it is still a mystery how some individual with same parent do not have while others do. Kendler (as cited in Bernstein et al; 2006). The tendency may be due to environmental factors that affect members of the same family but also suggests that people may inherit a predisposition to develop anxiety disorder. Traits that predispose individuals to SAD such as behavioural inhibition are strongly genetically influenced. Also, it is subject to gene–environment interaction. Social anxiety disorder is heritable though less for performance only anxiety. People who display anxiety disorders most likely have inherited an autonomic nervous system that is over-sensitive to stress, thus susceptible to reacting with anxiety to a wide range of situations Zinbarg & Barlow (1996).

Psychotherapeutic technique acts as a road for psychologists guiding them through the process of understanding clients, their problems and developing solutions to them. Frank (1982) viewed psychotherapy as a planned, emotionally charged, confiding interaction between a trained, socially sanctioned healer and a sufferer. All treatments for psychological disorders share common features. There must be a client or patient, a therapist who is agreed as capable of helping the client and they should be an establishment of a special relationship or rapport between the client and the therapist (Bernstein, 2006). Treatments are based on some theory about likely causes of the client’s problems. The overall aim of treatment providers is to assist troubled people change their thinking, feeling and behaviour such that discomfort is relieved, happiness promoted and total functioning improved. Barlow, Nathan, Gorman, & Salkind as cited in (Davison and Neale, 2003) defined psychotherapy as the use of some psychological techniques and the therapist / client relationship to produce emotional, cognitive and behaviour change.

Acceptance and Commitment Therapy (ACT) is a type of psychotherapy that helps one accept the difficulties that come in life.  ACT is a form of mindfulness-based therapy, theorizing that greater well-being can be attained by overcoming negative thoughts and feelings. The main goal is to accept negative thoughts instead of eliminating or reducing them. From the third generation of behaviour therapies, ACT is a contextual approach challenging clients to accept their thoughts and feelings and still commit to change (Dewane, 2008). It thus suggests that a person can take action without first changing or eliminating feelings associated with behaviour, a person can observe oneself as having the feeling but still acts (Mattaini, 1997).

The goal of ACT is to help clients consistently choose to act effectively-concrete behaviours as defined by their values in the presence of difficult or disruptive “private” (cognitive or psychological) events (Dewane 2008). ACT as an acronym describes what takes place in therapy: accept the effects of life’s hardship choose directional values and take action. It is a unique psychotherapeutic approach based on relational frame theory (RFT).

According to ACT, fighting emotions makes them worse. “If you can’t accept the feeling for now, you will be stuck with it but if you can, you can change your world so you will not have that feeling later” (Hayes & Wilson, 1994). In the view of Mattaini (1997), ACT does not mean we ask client to accept every situation, for instance, abusive relationship, but that some circumstances should ultimately be accepted for example, historical event, physical reality. Acceptance should be temporary and with expectation of eventual change. Mattaini (1997) cautions that the initial work is to identify areas that can and cannot be changed. For instance, physical handicaps and past trauma cannot be changed and so best accepted. ACT shifts from the content of experience to the context of experience. Hayes (2005) describes six core processes of ACT to be acceptance, cognitive defusion, being present, self as context, valuing and committed action.

Techniques in ACT have metaphors, paradoxes and experiential exercises frequently in use. Many interventions are playful, creative and clever. ACT protocols vary from short interventions to long-term sessions. Myriad techniques categorized under five protocols are assembled by Gifford, Hayes and Stroshal (2005). They are:

  • Facing the current situation (creative hopelessness). Encourage clients to draw what they want to make better.
  • Acceptance - geared towards reducing the motivation to avoid certain situations.
  • Cognitive defusion or deliteralization:- redefines thinking and experiencing as an ongoing behavioural process not an outcome. In the view of Blackledge (2007), techniques are designed to demonstrate that thoughts are just thoughts and not necessarily realities.
  • Valuing a choice:- Clients should clarify what they value, what gives them meaning. It helps clients distinguish a value from a goal, choose and declare their values and set behavioural tasks linked to these values.
  • Self as context:- teaches client to view his/her identity as separate from the content of his/her experience.

      ACT has been empirically tested and believed to be beneficial for a treatment of variety of disorders. Preliminary research suggested it to be useful for at-risk adolescents, mood disorders and substance abuse (Wilson, 1996). Yadegari, Hashemiyan and Abolmaali (2014) studied the effect of acceptance and commitment therapy on young people in Tehran. The result showed that ACT effectively reduced symptoms of social anxiety among young people. In like manner, Toghiani, Ghasemi and Samovei (2018) investigated the effectiveness of acceptance and commitment group therapy on social anxiety in female dormitory residents in Isfahan university, Iran. The findings showed that acceptance and commitment therapy had a positive effect on the female students.  

Interpersonal Psychotherapy (IPT) is a specific type of therapy used for treatment of numerous mental health disorders including depression, anxiety disorder, substance abuse and others. It is a time limited, focused, evidence-based approach to treat mood disorders with the main aim of improving the quality of a client’s interpersonal relationships and social functioning to help reduce their stress. Interpersonal Therapy (IPT) is a psycho-dynamically informed psychotherapy that has the goals of symptom relief and improving interpersonal functioning (Robertson, Ruston & Wurm 2008). Their major concerns being with the interpersonal context that is the relational factors that predispose, precipitate, and perpetuate the patient’s distress. Interpersonal relationships are the focus of therapeutic attention as the means of bringing about change aimed at helping patients change their expectations about them. The treatment assists patients to improve their social support network so that they can better manage their current interpersonal distress (Stuart & Robertson, 2003). IPT first appeared as the control treatment studies investigating efficacy of anti-depressant medications (Klerman, Weissman, Rounasaville & Chevron, 1984). It was found to be of comparable efficacy and earned itself a place alongside Aaron Beck’s cognitive behaviour therapy. Until the late 1990s when there was an increased interest in IPT, it was little known outside the academic cycles.

            John, Markowitz, Joshua and Milrod (2014) carried out a review of outcome research on interpersonal psychotherapy for anxiety disorders in New York. The literature search identified six open and five controlled trials on IPT for SAD. Findings showed IPT yielded positive results in open trials for three diagnoses.

            There are observable cases of individual’s inability to function optimally in social situations which eventually deprive them of potential benefits. Be it job opportunities, appointment, and others. It is certain that the problem must have developed over time, probably before or from adolescence. As a coping strategy, sufferers revert to drugs in order to face those life challenges. It is common knowledge that effects of drugs wear out over time and so repeated use leads to dependence and addiction. Since drugs do not provide lasting solution, and to the best of the researcher’s knowledge, no study had been carried out to ascertain the effectiveness of these psychotherapies in Rivers State, the researcher dimmed it imperative to fill this gap by finding an alternative which could contribute to solving the problem, hence the study on the effects of acceptance and commitment therapy and interpersonal therapy on reduction of social anxiety disorder among in-school adolescents in Rivers State.

Aim and Objectives of the Study

            The aim of this study was to determine the effects of ACT and IPT on reduction of SAD among adolescents. Specifically, this study was designed to achieve the following objectives:

  1. Find out the effect of ACT on reduction of SAD of in-school adolescents in Rivers State based on the pretest and post-test mean scores.
  2. Determine the effect of IPT on reduction of SAD of in-school adolescents as measured by the pre-test and post-test mean scores.


Research Questions

The following research questions guided this study:

  1. What is the effect of ACT on reduction of SAD of in-school adolescents in Rivers State as determined by their pretest and post test mean scores?
  2. What effect does IPT has on reduction of SAD of in-school adolescents as measured by their pretest and post test mean scores?


Hypotheses of the Study

The following null hypotheses were tested at 0.05 level of significance

  1. There is no significant effect of ACT on reduction of SAD among in-school adolescents in Rivers State as determined by the pre-and post test mean scores.
  2. IPT as a psychotherapeutic intervention does not have a significant effect on the reduction of SAD among in-school adolescent.


The study adopted a quasi-experimental design. Population consisted of all the 63,731 mid in-school adolescents in all the 263 public secondary schools in Rivers State. The study was limited to 3 public SS1 class in senior secondary schools selected from the 3 senatorial districts (1 each) in Rivers State. A total of 60 subjects purposively drawn were clustered into 2 treatment groups of 30 each (ACT and IPT) and within the age range of 14-16 made up the participants. The procedure / treatment was for 6 weeks of 12 sessions (twice weekly). Treatment for ACT was in 3 phases based on the framework of the 6 core processes of ACT which are: contracting the present moment, cognitive diffusion, acceptance, self as context, values and committed action. Also, IPT progressed through three phases consisting of weekly treatment session. Phase 1 - identifying interpersonal areas in life that need attention, phase 2 addressed the problems in relationships and social functioning while phase 3 discussed and reviewed progress in the therapy.

            Instrument used for data collection was an adopted standardized instrument: Leibowitz’s Social Anxiety Scale (LSAS) it is composed of 24 items, divided into 2 subscales. 13 items relate to performance anxiety while 11 items pertain to social situations. They are rated on a 4-points Likert scale from 0 to 3 on fear experienced during situations. Same items equally rated regarding avoidance of situations. Fear is rated none – 0, mild – 1, moderate – 2 and severe – 3, while avoidance is rated never – 0, occasionally – 1, often – 2 and usually – 3. Combined overall maximum score was 144 points and minimum of 0 points. The cut-off point at which SAD is probable being 60 – 144 points. Only subjects that score within this mark range were chosen for the study. The items were scrambled at post-test evaluation to avoid familiarity of questions by subjects. Both the reliability and validity of the instrument were established using Cronbach Alpha and by experts respectively.    


Research question 1: What is the effect of ACT on reduction of SAD among in-school adolescents in Rivers State as determined by their pretest and post means scores?

Hypothesis 1: There is no significant effect of ACT on reduction of SAD of in-school adolescents in Rivers State as determined by the pre-and post-test mean scores.

Table 4.1: Mean Standard Deviation and Paired t-test on the Effect of ACT on SAD.






Mean diff























            In table 4.1, it is revealed that the in-school adolescents who received psychotherapeutic intervention using ACT had the mean scores of 121.17 (SD = 19.26) and 56.90 (SD = 7.62) for their pretest and posttest on LSAS. This is an indication that at post-test the level of SAD reduced by a mean difference of 64.27. Again the results in table 4.1 further revealed that when the mean difference was subjected to paired t-test statistics, a calculated value of 18.35 was obtained at df of 29 and p-value of 0.0005. Since the p-value (0.0005) is less then he chosen alpha level of 0.05, it is then deduced that there is a significant effect of ACT on SAD of in-school adolescents in Rivers State. Thus, the null hypothesis is rejected.

Research question 2: What effect does IPT has on reduction of SAD of the in-school adolescents as measured by their pretest and post test mean scores?

Hypothesis 2: IPT as a psychotherapeutic technique does not have a significant effect on the reduction of SAD of the in-school adolescent.

Table 4.2: Mean, Standard Deviation and Paired t-test analysis on the Effect of IPT on SAD.






Mean diff























            Table 4.2 revealed that the in-school adolescents that were exposed to IPT psychotherapeutic intervention has the mean scores of 103.43 (SD = 13.28) and 71.17 (SD = 12.95) at their pre – and post test level on LSAS. These mean scores further revealed that, at the post test level, the level of SAD among the in-school adolescents that received IPT psychotherapeutic intervention reduced by a mean difference of 32.27. Moreso when this mean difference was subjected to paired t-test, a calculated t-value of 9.63 was obtained at df of 29 and significance (p-value) level of 0.0005. Since the p-value of 0.0005 is less then the 0.05, the chosen level of significant, it is then clear that IPT had a significant reducing effect on SAD among in-school adolescents in Rivers State. Hence the null hypothesis is rejected.

Discussion of Result

Discussion of findings from the study is done based on issues. Research findings one as revealed in table 1 showed that in-school adolescents who were exposed to ACT psychotherapeutic intervention approach experienced a reduction in the SAD level as indicated in their pretest and post test mean difference of 64.27 in LSAS. Further investigation by subjecting the mean difference to paired t-test statistics revealed a significant t-value. There is the practical applicability that when adolescents face social anxiety, therapist can use ACT as an intervention in managing the clients to reduce anxiety level. The finding is not surprising to the researcher because social acceptance skills have over the year proven to be effective in managing social behavioural problems. This finding collaborates with that of Abolmaali (2014) whose research revealed the effectiveness of ACT in reduction of symptoms of social anxiety among young people in Tehran.

            From research findings two as revealed on 4.2, the mean scores of the in-school adolescents exposed to IPT approach was higher at their pre-test than their post test. This gave a mean difference of 32.27. When subjected to a paired t-test, a significant t-value was obtained. Interpersonal therapy emphasizes on stressful social interactive events that goes on in the lives individuals and the need to relate with others. IPT is a form of psychotherapy that focuses on you and your relationship with other people. It’s based on the concept that relationships are at the centre of psychological problems. The findings revealed that interpersonal deficits of students with SAD can be managed using IPT. An idea that therapist should note and use in psychotherapeutic interventions. This is not strange to the researcher because of the awareness that social interactions are key in interpersonal relationships. Addressing interpersonal therapy will place them is a better opposition to face life challenges efficiently and live socially meaningful lives. 


            It is obvious that various psychotherapeutic approaches have over the years proven to be effective in helping adolescents manage their social anxiety problems based on reviewed literature. Acceptance and commitment therapy and inter-personal therapy have proven to be effective in reducing social anxiety among adolescents in Rivers State. It is also obvious that the effect of these psychotherapeutic approaches can be relatively permanent and prolonged whenever the subjects have mastered the treatment processes.

Implication of the Study

            The study revealed that Social Anxiety Disorder is prevalent among adolescents in secondary schools in Rivers State despite the urban nature of the area with so many institutions of learning. For the students, the knowledge of the likely causes of social anxiety disorder will help them avoid the predisposing factors. It will also help them engage in healthy behaviour that promotes high-self esteem. There is an implication that they will look for voluntary counselling services for those that are having this problem. The study also indicated that the therapies were effective in modifying social anxiety and so can be used to substitute drug therapy with its various negative side effects.

            Since most of these psychotherapeutic interventions have been found to be effective in managing social anxiety, there is an implication that therapist and counselling psychologist will use them effectively in managing behavior problems of students. There is also an implication that most schools may seek the services of qualified counselors in helping their students modify this problematic behaviour. The implication of the study is also that psychologist will do better in handling most of these social disorders and thus a wake-up call for all hands to be on deck to curb this menace.

Recommendations Based on Findings

  1. Psychologist, counsellors and therapist should apply eclecticism-eclectic therapy (use of multiple approaches in dealing with clients problem) in order to help them achieve the needed result.
  2. Therapist should ensure that they apply ACT and IPT where necessary in helping client to adjust socially in school.



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