Social Phobia

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According to Abnormal psychology (14th ed. ) the definition of Social Phobia is “the fear of situations in which a person might be exposed to the scrutiny of others and fear of acting in a humiliating or embarrassing way”. Social Phobia is one of the most common individual DSM-IV Disorders (Butcher). Although social phobia does not usually manifest itself until the teenage years or early adulthood, it can be brought on by many different factors in early childhood, like being bullied or based on genetic or learned behaviors from parents.

They are also some different variation of social phobia; there is generalized social phobia, social phobia with agoraphobia, social phobia with or without panic attacks and also Japanese disorders similar to it called Taijin kyofusho. All these variations of social phobia come with different effects on people and caused by different factors.

Social Phobia causes people to worry that other people are looking at you and noticing what you are doing, dislike being introduced to other people, find it hard to go into shops or restaurants, worry about eating or drinking in public, feel embarrassed about undressing in public, so you can’t face going to the beach, can’t be assertive with other people, even when you know you need to. Although these traits can simply just characterizes shyness in people.

There are different degrees and other factors that make it more than shyness, social phobia can occur in different degrees and when combined with other disorders like depression, it can be a very serious disorder. About 5 percent of the population suffers from some degree of social phobia. Social Phobia is developed early on in life due to negative past experience with people or the environmental reasons. Family history also is a major factor for example if parents were also social phobic or has other personality disorders.

If Social isn’t treated properly it can lead to more serious problems like self-medication and drug addictions (Shyness). Generalized social phobia is when a person has significant fears of basically all social situations. Having parents that were emotionally cold, socially isolated, avoidant and devalued sociability and did not encourage being social, whom have also been social phobic, can cause this. Generalized social phobia also goes along with avoidant personality disorder, which can be a learned behavior passed on from parents as well.

Also being exposed to being exposed to uncontrollable and unpredictable stressful like abuse or parental divorce can lead to social phobia (Butcher). Because of these events in their lives, individuals with generalized social phobia have difficulty in social situations that they cannot control (Amir). Also ones that involve performance like public speaking and interactional like going to a party. This is different from people with non-generalized social phobia whom may just have a fear of being in public (Stein).

Social phobia can be more difficult to treat and live with especially if pair with agoraphobia, the fear of public places or being away from one’s home. People with agoraphobia, may also be frightened by their bodily sensations. Many agoraphobics tend avoid exercising; watching scary movies, drinking caffeine and sexual activities as well has social situations and leaving their homes (Butcher). Agoraphobia is also listed under DSM–IV–TR like social phobia (Rosellini).

Although social phobia manifests itself in the teenage years or early adulthood, agoraphobia doesn’t tend to manifest itself until later in life, usually sometime after the age of 28 in both males and females (Ost). Based on the degree of any of the various subtypes of social phobia panic attacks may be a symptom, especially in those social phobic with agoraphobia. Social phobia often coexists with other disorders, particularly other anxiety disorders which can also contribute to panic attacks (Turner).

When studying psychology disorders the main focus is always put on the United States and is based on norms of western cultures. But different cultures around the world have different norms that cause there to be differences with disorders and how they affect people. For example one of the Japanese social disorders Taijin kyofusho is when people fear embarrassing or offending others unlike the social phobia types previously discussed where people have a fear of embarrassing themselves.

Taijin kyofusho is manifested by a fear of embarrassing or offending others by blushing, improper facial expressions, a blemish, or a physical deformity, staring inappropriately, or causing an offensive odors or flatulence (Dinnel). When it comes to the assessment of social phobia, multiply avenues can be taken. Social phobia exists on a continuum of low to extreme social anxiety disorders (Rapee, 742). The spectrum begins with the low level of shyness and continues with social phobia at the middle level and then finally avoidant personality disorder as an extreme (Rapee, 742).

It is important that when assessing a client, the clinician is able to indentify these differences as to proceed with proper treatment. Three assessments that prove effective begin with the clinical interview and can be followed up with a behavioral assessment or a cognitive assessment. A clinical interview, consists of developing an understanding of the patients symptoms and building a trusting foundation with the therapist (Heimberg, 186). A behavioral assessment focuses on a three-response-system: self-report, physiology, and overt behavior (Heimberg, 202).

Cognitive assessment evaluates the thoughts and beliefs the client places on themselves within a situation causing social anxiety (Heimberg, 232). In the beginning when clinicians begin the steps of the clinical interview for the assessment process of a social phobic, it is important for the therapist to be aware of the distress that the new client will be under (Heimberg, 186). Understanding the anxiety that the patient will be under could lead to skipping the interview, or numbing the anxiety with drugs or alcohol.

Social Phobia- Diagnosis, Assessment, and Treatment, outlines advice for how a clinician should set up an assessment interview for a socially phobic client. It suggests that more space and muted lighting would be ideal to put the client coming in for interview at ease. Keeping loose time constraints on the meeting is also advised to ensure that no amount of information about the patient remains unknown (Heimberg, 190). Doing this also allows for the interviewer and client to make a strong, trusting connection.

This is important so that the client feels safe and willing to give the necessary information for assessment (Heimberg, 186). Yielding to the insecurities of the client is important to ensure they do not feel as if they are being judged. Asking questions beginning with “Who,” “What,” “Where,” and “When” are all acceptable words to use when inquiring the patient. It is important to stay away from the word “Why” for the reason that a person with social phobia may become uncomfortable and believe the answer they give will be judged critically (Heimberg, 187).

The importance of gathering data with self-reports, diagnostic interviews and rating scales, all help the clinician determine the best assessment for the client. A behavioral assessment, as previously mentioned, focuses around three main aspects: self-report, physiology, and overt behavior. In 1979, Marks and Matthews Fear Questionnaire was the first self-report assessment made available and deemed a valid tool for evaluating the severity of social phobia (Cottraux, Bouvard, & Messy, 1987; Cox, Swinson, & Shaw, 991). The benefit of using self-report and diagnostic assessments is explained by a team at Temple University: “The clinician has the freedom to accommodate to the patient’s way of understanding his or her symptoms, to challenge inconsistencies in patient report, and to employ a fund of information in rating the severity of symptoms and their relevance to diagnostic criteria (Hart, 3)” However, they also recognize the negative aspects of using diagnostic analysis.

It is mentioned that diagnostic assessments are usually held at long durations and can require a well-trained professional to be present. LSAS (Liebowitz, 1987) rating scale measures four areas: performance fear, performance avoidance, social fear, and social avoidance (Heimberg, 193). Results of the LSAS have yielded results to positive patient correlation to social phobia (Hart, 14). SAD is another test given to clients to determine social phobia. SAD has its advantages and disadvantages relating to its validity to social phobia (Hart, 13-14).

Many of its questions point directly to a diagnosis of social phobia. However, other questions are misleading and could represent another disorder (Hart, 13-14). Role-play tests are also used when assessing a persons anxiety levels. They involve an assessment of conversation and daily-life interaction skills with the patient and unfamiliar counterparts (Heimberg, 217). The benefit of this test, allows for the therapist to evaluate the clients reaction on a spectrum based on experiences the patient with social phobia faces on a day to day routine (Heimberg, 217). In Behavioral Assessment Tests (BATs), patients with social phobia are asked to confront fear-eliciting social situations in a controlled environment, typically within the context of a role- play task (Hart, 21). ” Through research, it has been stressed the importance of a physiological assessment and its determination for a social phobic diagnosis. Heimberg recognizes that unfortunately there are few studies to back up that any specific biological reactions are linked specifically with social phobia (Tancer, 1994).

Common responses to the anxiety felt by a client with social phobia include the of experience blushing, increased and rapid heart rapid, respiratory and pulse rate changes (Heumber, 221). While assessing for social phobia these physiological attributes are reoccurring among many patients. One author, within his text, adds a chart depicting the four main aspects of cognitive assessment and their functions within Ingram and Wisnicki (1991) approach to cognitive taxonomy (Heimberg, 232-233).

Cognitive products use techniques to pinpoint thought processes of the client (Heimberg, 232-234). “The goal of production methods used in the assessment of social phobia is to produce a representative sample of the patient’s thoughts in anticipation of, during, and/or after exposure to feared social stimuli. Probably the most commonly used production method is thought listing, which requires patients write down all of the thoughts that they can recall having during a particular period of time (Elting and Hope, 1995) (Hart, 19)”

Cognitive operations dictate the critical features of the components of its psychopathology as using “selective attention to cues of a social threat” (Heimberg, 234). This specific operation focuses on how the client with social phobia retrieves and processes the information of a situation causing fear. Cognitive prepositions denote the “high expectancies of a social threat, and low expectancies for the performance of socially relevant behaviors” (Heimberg, 234). These expectancies, engrained in the client, can stem back to significant past experiences, values, beliefs, or abstract thinking (Heimberg, 233).

Identifying these engrained thought processes then help the client and clinician to pinpoint reasons to why the patient may be placing these feelings of fear and anxiety into future life situations. Cognitive structures refer back to the physiological makeup of the client. How ones thought processes, fears and anxieties are measured is based on the architecture of the socially phobic person (Heimberg, 233). Heimberg also mentions the possibility of the effect of ones central nervous system and its makeup can determine and affect their social phobia.

At this time there are no current tools of cognitive neuroscience to measure or further investigate this specific aspect of cognitive taxonomy (Heimberg, 234). Ingram-Kendall deepens their analysis with a second tier to their cognitive taxonomy. This dimension is called the “componoent model of psychopathology” and identifies three aspects of psychopathology that can more accurately assess the client (Heimber, 233). The first area is called critical features and this focuses directly to “the aspects that are central to the disorder” (Heimber, 233).

The second, common features, “are aspects of phsycopathology that are identifiable with a variety of different disorders” (Heimberg, 233). Error variance is the final component and it highlights “features that vary unsystematically, such as individual differences” (Heimberg, 233). As recently as the 1980s, there were only about a half-dozen published reports of attempts to treat social phobia (Heimburg, 261). This diagnosis was not even included in the DSM until the third published edition in 1980. This shows that Social Phobia has gone under diagnosed and under treated for some time now.

Now that treatment is becoming more accessible to those who have been diagnosed, there are more cases of documented treatment processes and the success rates of those cases. According to one author, the major areas of treatment for Social Phobia are various social skills training programs, relaxation and exposure based techniques, as well as cognitive-behavioral approaches (Heimburg, 261). There have also been studies into the use of pharmacological treatments on their own and then the use of these treatments in combination with cognitive-behavioral approaches (Heimburg, 261).

The goal of social skills training is to aid patients in improving the behavior skills for normal social interaction that they lack. These behavior skills include verbal skills like appropriate speech patterns and content, and non-verbal skills such as eye contact, posture, and facial and hand gestures (Heimburg, 262). Inadequacies in these skills are thought to be a major contributing factor to social phobia. By improving these skills, it is thought that patients’ anxiety will be reduced (Heimburg, 262).

These patients are usually assigned to this type of treatment for about fifteen weeks. Studies have shown that these patients showed some improvement and lessened anxiety in social situations, but not significantly compared to those in the control group (Heimburg, 262). During the follow-up period the group that received the treatment maintained their improved social skills, but they did not improve any further.

This shows that the treatment had significant impacts on certain aspects of their patients’ social lives, but id not fully cure their phobia. Relaxation techniques are designed to provide a coping mechanism for those with social phobia. These techniques are supposed to help those with social phobia to deal with the physiological symptoms of their disorder (Heimburg, 279). Some clinicians believe that these techniques are most useful when combined with various exposure exercises because they teach patients how to use these learned relaxation skills in a simulated situation that they are likely to actually encounter in their everyday life.

Within this type of treatment, patients are taught to recognize the early signs of their anxiety and then cope with these symptoms rather than allowing them to overwhelm them (Heimburg, 279). This course of treatment involves a great deal of self-monitoring at the start of treatment because patients are the best judges of what triggers their anxiety and what their symptoms feel like. Once the triggers and symptoms are recognized, patients are taught the best way to deal with these without allowing their anxiety to set in and take control (Heimburg, 279).

These relaxation methods are often combined successfully with exposure methods because of the well-known positive impacts exposure has on fear reduction. Exposure techniques usually involve collaboration between patients and their clinicians in which specific situations that cause anxiety are identified. Once these situations are identified then they are put in order from the lowest level of anxiety caused to the highest. Then the patient will confront each of these situations in order to experience them and prevent anxiety (Heimburg, 280). The amount of therapist involvement in this type of treatment varies from case to case.

Sometimes therapists are highly involved in the simulation of anxiety causing situations, and other times the responsibility is largely the patient’s (Heimburg, 280). This type of therapy has proven to be incredibly helpful in reducing anticipatory anxiety and anxiety in strenuous situations. Patients in this type of therapy also showed less avoidance of situations that previously induced a great deal of anxiety (Heimburg, 281). Cognitive-Behavioral interventions are highly useful in the treatment of social phobia because of the great impact that cognitive factors have on the development of phobias.

This type of therapy delves into the patient’s fears of what others think of them. Patients also tend to talk about their perceptions about what others think of them (Heimburg, 283). In this type of treatment, patients are asked to imagine certain anxiety causing situations and then vocalize what about them causing the anxiety. Then the thought processes of the patient are addressed and the inaccurate thought processes are challenged and ideally changed to a more productive way of thinking (Heimburg, 283).

There is a high success rate with this type of therapy because of the way that changed thought processes tend to change behaviors. According to another author there are two broad strategies for treating those with Social Phobia. There are treatment methods to reduce anxiety and there are methods to improve social functioning (Stravynski, 291). Within each of these methods there are different techniques that make each approach a complex, yet complete way to treat the patient’s disorder.

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