Terapia de conducta para la fobia escolar: estudio de un caso

School phobia is defined as maladapted patterns of anxiety behaviours related to school situations. It is considered one of the most disabling anxiety disorders during childhood and adolescence. In this article a case study of a 15 years-old adolescent, diagnosed with school phobia is presented. The identified antecedent stimuli were aversive social situations, as being the target of jokes and threats by her peers during school situations such as recess, and anticipatory behaviours like gearing up for school, getting out of home, and/or taking the bus. Deficits in social skills and self-esteem were also found as mediating factors. Problembehaviours were high anxiety, passive and active avoiding behaviours, and negative thoughts. The treatment focused on enhancing coping skills involved in school situations, and improving the repertory of social behaviours. The techniques used were therapeutic contract, social skill training, in-vivo exposure, self-instructions and contingency management. When the treatment ended, the patient was attending her classes and her social competence level had improved. Treatment gains were maintained at follow-up session.ResumenLa fobia escolar se define como un patrón desadaptativo de respuestas de ansiedad ante situaciones escolares, y está considerado como uno de los trastornos infanto-juveniles más incapacitantes. En este trabajo se presenta el caso clínico de una adolescente de 15 años diagnosticada de fobia escolar. Fueron identificados como estímulos antecedentes situaciones sociales aversivas, como ser objeto de burlas y amenazas, situaciones escolares como el recreo, y situaciones anticipatorias como vestirse, salir de casa y coger el autobús. Además, se detectó un déficit en habilidades sociales y autoestima, que actuaban como variables mediadoras. Las conductas problema eran una elevada ansiedad, conductas de evitación activa y pasiva, y pensamientos negativos. El tratamiento se centró en potenciar las habilidades para afrontar la ansiedad en situaciones escolares, y mejorar el repertorio de conductas sociales. Las técnicas empleadas fueron el contrato terapéutico, entrenamiento en habilidades sociales, exposición en vivo, autoinstrucciones y manejo de contingencias. La incorporación a clase se hizo efectiva al término del tratamiento y se mantenía en los seguimientos, habiéndose mejorado también el nivel de competencia social.AbstractSchool phobia is defined as maladapted patterns of anxiety behaviours related to school situations. It is considered one of the most disabling anxiety disorders during childhood and adolescence. In this article a case study of a 15 years-old adolescent, diagnosed with school phobia is presented. The identified antecedent stimuli were aversive social situations, as being the target of jokes and threats by her peers during school situations such as recess, and anticipatory behaviours like gearing up for school, getting out of home, and/or taking the bus. Deficits in social skills and self-esteem were also found as mediating factors. Problembehaviours were high anxiety, passive and active avoiding behaviours, and negative thoughts. The treatment focused on enhancing coping skills involved in school situations, and improving the repertory of social behaviours. The techniques used were therapeutic contract, social skill training, in-vivo exposure, self-instructions and contingency management. When the treatment ended, the patient was attending her classes and her social competence level had improved. Treatment gains were maintained at follow-up session.