E-Book, Englisch, 110 Seiten
Antony / Rowa Social Anxiety Disorder
1. Auflage 2008
ISBN: 978-1-61334-311-1
Verlag: Hogrefe Publishing
Format: EPUB
Kopierschutz: 6 - ePub Watermark
E-Book, Englisch, 110 Seiten
Reihe: Advances in Psychotherapy - Evidence-Based Practice
ISBN: 978-1-61334-311-1
Verlag: Hogrefe Publishing
Format: EPUB
Kopierschutz: 6 - ePub Watermark
Social anxiety is characterized by excessive anxiety or discomfort in situations where a person might feel judged or evaluated by others, including performance situations (e.g., being the center of attention, public speaking, working under observation, playing sports or music in front of an audience) and situations involving interpersonal contact with others (e.g., making small talk, meeting new people, dating). According to large-scale epidemiological studies, social phobia is one of the most prevalent psychological disorders. Although prevalence estimates vary, recent studies suggest that approximately 7% of Americans suffer from this disorder. In addition to the high percentage of people with symptoms meeting criteria for this disorder, many other individuals experience social anxiety or shyness to a lesser, but still impairing degree. Social phobia is also a common comorbid condition, often diagnosed along with other anxiety disorders.
Taken together, this information suggests that practitioners are likely to encounter patients displaying some degree of social anxiety, no matter what specialty service or setting they occupy. Although social anxiety is a widely encountered problem, there are few resources available to provide straightforward, accessible assessment and treatment information for practitioners. This book aims to fill that gap. Over the past 20 years, effective tools have been developed to identify and treat individuals with social anxiety. The current book provides up-to-date information on the diagnosis, identification, conceptualization, and treatment of social anxiety and social phobia.
This book is aimed at practitioners who practice in a broad range of settings, from specialty clinics to general practice, as well as students. Existing books tend to focus on the psychopathology of social anxiety, address multiple disorders in one volume, or provide extensive and detailed protocols for treating this disorder. In contrast, this book is a more concise guide to identification and treatment that is accessible for the busy practitioner. It focuses specifically on social phobia and social anxiety, making it an attractive reference book for professionals who require clear, easy to follow guidelines on treatments for social anxiety.
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Description
1.1 Terminology
People with SAD fear and avoid situations due to anxiety over the possibility of being embarrassed or judged by others Social anxiety disorder (SAD; also called social phobia) is characterized by an intense fear of social or performance situations. In these situations, people with SAD are worried about embarrassment, humiliation, or scrutiny by others. Although many people are nervous or shy in social or performance situations (e.g., some studies suggest that 40% of individuals consider themselves to be chronically shy; Henderson & Zimbardo, 1998), SAD is diagnosed when this anxiety becomes so intense and pervasive that it causes significant distress for a person or it impairs the person’s ability to function (e.g., at work or school, in relationships, etc.). Some situations that people with SAD often fear include: • Conversations • Meeting new people • Calling acquaintances or strangers on the telephone • Parties • Talking to authority figures • Expressing a controversial opinion or disagreement • Being assertive • Speaking in front of a group • Participating in meetings • Entering a crowded room • Being the center of attention • Eating or drinking in front of others • Writing in front of others • Making mistakes in front of others The number of situations feared by people with SAD varies from person to person. Some people report concerns about a few situations, or even just one particular situation (e.g., public speaking) whereas others indicate fear across a broad range of social and performance situations. 1.2 Definition
The major classification scheme that provides a definition of and criteria for diagnosing SAD is the text revision of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR; American Psychiatric Association, 2000). The DSM-IV-TR views SAD categorically, meaning that criteria for the disorder are either met or not met. Of course, even though the diagnostic criteria are categorical, social anxiety exists on a continuum from mild shyness to severe symptoms. In severe cases of social anxiety, criteria for avoidant personality disorder (APD) may also be met. In fact, some authors have argued that there is such substantial overlap between severe SAD and APD that it may not be useful to consider them as distinct conditions. Indeed, there are few cases in which an individual is diagnosed with APD without a corresponding diagnosis of SAD. Studies suggest no differences between the disorders with respect to parental history of social anxiety, with both disorders showing a two to three-fold increase in risk of social anxiety if family history was positive for social anxiety (Tillfors, Furmark, Ekselius, & Fredrikson, 2001). However, a number of studies have found that there are other significant differences between individuals with just SAD versus those with both SAD and APD, suggesting that there is more that separates these groups than simply their level of social anxiety (Hofmann & Barlow, 2002). Further, authors have argued that these syndromes should remain distinct because SAD is a treatable disorder while outcomes for APD are less optimistic (Wittchen & Fehm, 2003). Statistical procedures, such as structural equation modeling, also support the conceptual distinction of these constructs (Strunk, Huppert, Foa, & Davidson, 2003). Clinically, it can be difficult to disentangle these syndromes, leaving a clinician unsure whether a client has both disorders, versus simply one or the other. Later in this chapter, we outline strategies that clinicians can use to differentiate between SAD and APD. In severe cases, people with SAD may be unable to work and may have no close friends In DSM-IV-TR, SAD is defined as a marked and persistent fear of one or more social situations that often leads to avoidance of the feared situations. The individual fears being humiliated, scrutinized, or embarrassed. This fear must occur upon most exposures to social situations (i.e., it cannot be a transient fear), and the person must recognize that the fear is excessive. Some individuals may experience cued panic attacks in social situations (e.g., either when they are in the situation or when they are anticipating an upcoming stressful situation). Symptoms of social anxiety must lead to significant distress for the individual, or impairment in the person’s life. Examples of ways that SAD may cause functional impairment for sufferers include social or marital problems (e.g., few friends, marital tension due to one’s inability to attend social events, inability to date), employment or academic activities (e.g., inability to get a job due to fears of interviews, lack of advancement in one’s current job due to anxiety, missed days of work, or missed classes), and day-to-day functioning (e.g., inability to make important phone calls, avoidance of public places). Impairment in SAD can be severe. Indeed, individuals with SAD report greater functional impairment than individuals with a variety of medical conditions including end-state renal failure (Antony, Roth, Swinson, Huta, & Devins, 1998) and genital herpes (Wittchen & Beloch, 1996). Functional impairment can lead to serious consequences. For example, one of our clients with SAD was not collecting disability payments he was entitled to because of fears of being criticized by others if he applied, as well as strong anxiety about making phone calls to “strangers” to request an application. Due to this inability to override his anxiety and apply for support, he found himself falling into significant debt. According to DSM-IV-TR, the term “generalized” should be used to describe cases of SAD in which an individual reports fear in most social or performance situations. Although no specific rules are provided for how many situations constitute “most” social situations, this subtype appears to be a reliable and valid way of distinguishing between individuals with more pervasive SAD versus those whose fear is limited to a small number of situations (e.g., public speaking). 1.3 Epidemiology
SAD appears to be one of the most common psychological disorders, though prevalence rates in the literature vary across studies. For example, lifetime prevalence estimates for SAD based on large community samples in the United States range from 3 to 13% (Antony & Swinson, 2000; Kessler et al., 2005; Somers, Goldner, Waraich, & Hsu, 2006). One factor that may account for the variability across studies is the diagnostic instrument used to assess SAD. For example, older studies based on DSM-III criteria (e.g., Eaton, Dryman, & Weissman, 1991), tended to assess fear in a relatively small number of social situations, compared to newer studies based on DSM-III-R (Kessler et al., 1994) or DSM-IV (Kessler et al., 2005) criteria. When a greater number of social situations are provided as prompts for individuals, prevalence rates tend to be higher. Prevalence rates also vary depending on ways in which distress and impairment are measured in SAD, the age composition of the sample, and the cultural composition of the sample (Wittchen & Fehm, 2003). SAD tends to begin in adolescence (i.e., mid to late teens), but can also occur earlier in childhood. In fact, significant numbers of adults report that they have had problems with social anxiety for their entire lives or as long as they can remember. A large-scale study of individuals presenting at an anxiety clinic found a mean age of onset of 15.7 years, a number that was younger than the age of onset of the other anxiety disorders (Brown, Campbell, Lehman, Grisham, & Mancill, 2001). Studies suggest that SAD is associated with similar or related problems in childhood, including selective mutism, school refusal, separation anxiety, and shyness (Albano & Detweiler, 2001). Since most studies employ retrospective data from adults, it is unclear whether SAD, per se, would have been diagnosed in childhood for these individuals or whether individuals believe that they had SAD in childhood because they were dealing with a host of related problems that later developed into SAD. Nevertheless, SAD is routinely diagnosed in specialty anxiety clinics for children, validating the fact that this disorder commonly begins in childhood or adolescence. Cases of SAD beginning in later adulthood are rare and may actually be social anxiety secondary to another mental disorder (e.g., social withdrawal in depression, avoidance of eating in public in an eating disorder). SAD is slightly more prevalent in women than men Epidemiological studies suggest that SAD is slightly more common in women than in men (Fehm, Pelissolo, Furmark, & Wittchen, 2005), though these differences appear especially small when compared to gender differences for other anxiety disorders where women are commonly overrepresented (e.g., panic disorder, specific phobias, generalized anxiety disorder). Gender differences in clinical samples are negligible, and some evidence even suggests that men may be more likely to present for treatment (Hofmann & Barlow, 2002). There are some gender differences in the...
