text: Learning theory hypothesises that avoidance maintains the fear in social phobia, as individuals with SAD are motivated to avoid ‘punishment’ by others (Veale, 2003). Graded self-exposure has been the treatment of choice for social phobia for many years (APS, 2010). A detailed hierarchy is made of all the feared situations that provoke anxiety and that the person avoids and each is rated from 0 to 100%, according to the degree of anticipated anxiety (Veale, 2003). Veale (2003), reports that a significant number of patients refuse exposure treatment or drop out early and out of those who complete treatment, about 50% will recover from SAD. Issues in the success of treatment tend to be related to having a depressed mood, avoidant personality, intolerance of emotion and avoidance behaviour (Veale, 2003). Alternative approaches have included group cognitive–behavioural therapy (Heimberg et al, 1990) or the addition of coping skills, cognitive restructuring or shame-attacking from rational emotive behaviour therapy (Veale, 2003).
  Andrea reported that her goals for treatment are to be able to relax more and feel better about herself, manage her compulsions (i.e. adherence to excessive rules), and improve her relationships with her husband and child. Based on Andrea’s diagnosis of OCD and symptoms of SAD and MDD, the following treatment goals are proposed:
  Improving Andrea’s day-to-day functioning (i.e. improve Andrea’s ability to manage work, study, parenting and her intimate and social relationships).