Social Anxiety Disorder Also known as social phobia Described as an Intense irrational fear of evaluation humiliation and social interactions Most common of anxiety disorders Can really limit a persons ability to interact with other members of society ID: 782456
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Slide1
Presented by Cynthia Cousineau
Social Anxiety Disorder
Slide2Also known as “social phobia”Described as an:
Intense, irrational fear of evaluation, humiliation and social interactionsMost common of anxiety disordersCan really limit a person’s ability to interact with other members of society
What is it?
Slide3A young woman who despises waiting in lines because she feels everyone is watching her.A man who finds it challenging to walk down a crowded street or any public place because he feels very self-conscious.
A college student who decides to skip the first day of school because he knows the teacher may ask the students to introduce themselves to the class.
Examples
Slide4Constantly experience extreme shyness and feelings of self-consciousnessAvoid situations that can trigger fear:
Going to public places Riding busesEating or drinking in the presence of others
Making a mistake in front of someone
Attending parties or other social gatherings
Triggers of Anxiety
Slide5-Making phone calls-Using public restrooms
-Meeting new people -Being watched while doing something -Public speaking
-Performing on stage
-Being teased or criticized
Slide6-Talking with “important” people or authority figures
-Being called on in class -Going on a date -Taking exams-Eating or drinking in public
-Speaking up in a meeting
-Being the center of attention
Slide7The prevailing fear in social phobia is public speaking, which 15% to 30% of people experience.This disorder is more common for women;
Reason: women have more social pressures. For example, the pressures to be attractive, thin, popular, manage a household, equal, and balance work and children.
Tends to begin around the mid to late adolescence.
Facts
(
Nevid
, 2009)
Slide8-Intense worry for days, weeks, or even months before an upcoming social situation
-Extreme fear of being watched or judged by others, especially people you don’t know-Excessive self-consciousness and anxiety in everyday social situations
Psychological Symptoms
Slide9Fear that you’ll act in ways that that will embarrass or humiliate yourself
Fear that others will notice that you’re nervousAvoidance of social situations to a degree that limits your activities or disrupts your life
Slide10A rare occurrence in children exhibiting early signs of social anxiety: - Selective
mutism, in which the child is unable to speak in social situations but can freely speak when in their home environment.
(
Kuusikko
, 2009).
Slide11Those who suffer from of this disorder may also experience other disorders which can trigger or follow social anxiety disorder such as:
Panic disorder
Major depression
Alcohol abuse or dependence
Agoraphobia
(
Chartier
, 2003)
Slide12Pounding heart or tight chest Shaky voice
Rapid breathing Sweating or hot flashes
Upset stomach, nausea
Physical
symptoms
Slide13Dry mouth
Trembling or shaking Muscle tension
Blushing
Dizziness, feeling faint
Twitching
Slide14There are many factors that contribute to the development of social anxiety disorder which can either be genetic or environmental:
-Heredity-Life Events
- Neurobiological factors
Causes
Slide15Heredity makes some people more vulnerable to the disorder then others.
Family studies and twin studies have investigated the genetic factors associated with social phobia, and showed that there is a relationship between parental and social phobia among offspring.
It also shows that the majority of the relatives of people suffering from this disorder tended to be women.
Twin studies
also prove that genetics are a contributing factor to the disorder. When comparing the relationship between shyness and social fears, identical twins were more similar than non-identical twins.
In addition, there was also a greater similarity between children and their biological parents than their adoptive parents.
Heredity
(
Tillfors
, 2004).
Slide16Life events contribute to the development of this disorder, in particular negative life e
vents such as:Marital conflicts in the family Running away
Physical or sexual abuse
Failing at school
Dropping out of high school
Life events
Slide17-Studies have shown that people suffering from the disorder experienced more negative life events than those who do not suffer from the disorder.
-Social phobic women experienced more sexual abuse and conflicts with close relatives or friends while men experienced more physical abuse.
-People who were shy as children have a greater chance of developing the disorder when they reach adolescence, because they lack more social skills then those who were not.
(
Marteinsdottir
, 2007).
Slide18Neurobiological factors also play a role; serotonin and dopamine are two neurotransmitters that help with the regulation of social anxiety.
Animal studies show that high amounts of serotonin are accompanied with increased aversive and avoidant behaviour.
The
amygdala, a part of the brain located in the prefrontal cortex and the
hippocampus is responsible for the control of fear responses. Social phobia= damage these parts of the brain.
Neurobiological factors
Neurobiological factors also play a role; serotonin and dopamine are two neurotransmitters that help with the regulation of social anxiety. Animal studies show that high amounts of serotonin are accompanied with increased aversive and avoidant behaviour. The amygdala, a part of the brain located in the prefrontal cortex and the hippocampus is responsible for the control of fear responses. Damage to the amygdala could cause an imbalance of anxiety and fear resulting in social phobia. Mowrer
’
s two-stage theory suggest that phobias originate from a learned behaviour such as pairing fear with social situations, known as classical conditioning, and operant conditioning, which learns that avoiding the stimulus can reduce the fear (Tillfors, 2004).
Slide19Mowrer’s two-stage theory suggest that phobias originate from a learned behaviour such as pairing fear with social situations, known as classical conditioning, and operant conditioning, which learns that avoiding the stimulus can reduce the fear.
Neurobiological factors
(
Tillfors
, 2004)
(January 23, 1907 - June 20, 1982)
Slide20Pharmacotherapy and Cognitive behavioural therapy proved to be the most effective treatments of social anxiety disorder.
Treatments
Slide21Of the many selective serotonin reuptake inhibitors, Fluoxetine
was the 1st to be used in the treatment of social anxiety disorder.
One study studied the effects of
fluoxetine
on 16 patients diagnosed with the disorder, for a 12-week period. The treatment started with a dose of 20 mg/day and increased every four weeks according to response and side effects.
3 of the patient had to drop out because of side effects, 10 showed signs of improvement and the remaining 3 did not.
Pharmacotherapy
(Van
Ameringen
, 1999).
Slide22The most common
type of medication used in the treatment of social anxiety disorder is the monoamine oxidase
inhibitor (MAOI)
phenelzine
.However, because of the dietary limitations it imposes on the patient and the possible risk of life-threatening events associated with the use of this drug, the usage of it in the treatment for patients with social phobia has decreased.
Benzodiazeprine
is another SSRI used but only recommended for patients with a history of depression with or without alcohol or substance abuse, because it includes side effects such as sedation, impaired concentration and forgetfulness.
(Van
Ameringen
, 1999)
(Veale, 2003)
Slide23Other SSRIs used in the treatment of social phobia include:
sertraline, citalopram, paroxetine
fluvoxamine and
sertraline.
(Van
Ameringen
, 1999)
Slide24The learning theory focuses on how avoidance retains the fears associated with social phobia. Since patients with the disorder are motivated to avoid humiliating situations and judgement by others.
Cognitive behavioural therapy
(Veale, 2003)
Slide25Other techniques used in the treatment of the disorder are:
cognitive restructuringguided imageryproblem solving
social skills training
stress management
gradual exposurerelaxation training
Slide26In this study 67 children from the ages of 8 to 12 were randomly assigned to one of 2 groupsA
behavioural intervention program focusing on decreasing anxiety and improving social skills or a control group which focused on anxiety management.
The 2 groups met for a period of 12 weeks.
The children in the experimental group attained higher levels of social skills and showed significantly less social anxiety.
Approximately two-thirds of the children in the experimental group no longer showed signs of social phobia while 5% of those in the control group no loner qualified as having the disorder.
One study on the effectiveness of cognitive-behavioural group therapy
(Walsh, 2002).
Slide27In cognitive therapy, a model was established for the maintenance of social phobia.
The aim: to figure out why the fears of someone with social anxiety disorder are maintained despite the non-occurrence of the feared situation and the exposure to social situations. It suggest that in a social situation patients enter with certain
rules
such as “
I have to always appear intelligent”,” or unconditional beliefs such as “
I’m boring
”.
When the patient feels they are at risk of a negative evaluation they use visual images, bodily sensations and auditory perspectives to understand how others may be evaluating them.
Another factor which maintain the symptoms of social phobia are
safety behaviours: actions that are taken in feared situations to help prevent the feared event.
Cognitive behavioural therapy
Slide28Cognitive therapy starts with a detailed assessment of the problem.
Sessions are often recorded for feedback in future sessions. The therapist 1st identifies a recent social situation that created a significant amount of anxiety to the patient. The therapist then use the “downward arrow” technique, which identifies the main beliefs and assumptions of the patient, by asking the patient questions such as:
“
Lets assume you did sound stupid what would that mean about you
?” and; “Let’s assume everyone in the room was laughing to themselves because you sounded stupid, would that mean to you?
Cognitive therapy
(Veale, 2003)
Slide29Later the therapist tries to identify the
symptoms of anxiety by asking: “When you believed the feared event might happen, did you observe anything happening to your body?” If the therapist wants to identify the safety behaviours that were used he would ask:
“When you though a feared situation would happen, what did you do to try to stop it?”
This model tries to understand and make changes in the patient’s way of thinking with the help of the following strategies:
- shifting
attentional
focus, video feedback, and modifying negative self-images and assumptions.
Cognitive therapy
Slide30Chartier, M.J., Walker, J.R., & Stein, M.S. (2003). Considering
comorbidity in social phobia. Social Psychiatry Epidemiology, 38, 728-734.
Kuusikko
, S., Pollock –
Wurman, R., Ebeling, H., Hurting, T.,
Joskitt
, L.,
Mattila
, M.L,
Jussila, K. & Moilanen, I. (2009). Psychometric evaluation of social phobia and anxiety scale for children (SPAI-C) and social anxiety scale for children-revised (SASC-R).
European Child & Adolescent Psychiatry
,
18
, 116-124.
Marteinsdottir
, I.,
Svensson
, A., Svedberg, M.,
Anderberg,U.M
, & Von
Knorring
, L. (2007). The role of life events in social phobia.
Nordic Journal of Psychiatry. 61(3)
, 207-212.
Nevid
, J.S., Greene, B., Johnson, PA., and Taylor, S. (2009).
Essentials of abnormal psychology in a changing world
(2
nd
Canadian Edition). Toronto: Pearson. 183-184.
Tillfors
, M. (2004).Why do some individuals develop social phobia? A review with emphasis on the neurobiological influences.
Nordic Journal of Psychiatry,
58(4), 267-276.
Van
Ameringen
, M., Mancini, C.,
Oakman
, J., &
Farvolden
, P. (1999). Selective Serotonin Reuptake Inhibitors in the Treatment of Social Phobia: The emergency gold standard.
CNS drugs
, 11(4): 307-315.
Veale, David. (2003) Treatment of social phobia.
Advances in psychiatric treatment
, vol. 9, 258-264.
Walsh, J. (2002). Shyness and social phobia: a social work perspective on a problem in living.
Health & Social Work
, 27(2), 137-144.
References