This document provides an overview of the treatment of social phobia. It discusses the presentation, psychopathology, and differences between social phobia and agoraphobia. Behavioral treatments including graded exposure and cognitive restructuring are considered effective. A cognitive model is proposed where attentional shifting towards safety behaviors and rumination play a key role in maintaining symptoms. Guidelines for pharmacological treatment are also summarized.
This document provides information on Dissociative Identity Disorder (DID), formerly known as Multiple Personality Disorder. It discusses skepticism around DID and explains that dissociation exists on a spectrum from mild daydreaming to more severe identity fragmentation. The document outlines characteristics of DID like disturbances in identity, existence of distinct alters, and types of relationships between alters. Causes like childhood trauma and abuse are explored, as are popular portrayals of DID in films and books. Assessment tools, integration in therapy, and two case studies of individuals with DID are summarized.
Social phobia in Australia, treatment, Symptoms and TriggersSuzana Phillips
Discover social phobia, what it is, the treatment and emotional and behavioural symptoms. Furthermore a look into the lives of people living with the disorder and how to cope.
Phobias are irrational fears that affect 5-10% of the population and can disrupt daily functioning. They are classified as agoraphobia, specific phobia, or social phobia. Specific phobias are the most common and include fears of animals, heights, and blood. Treatment involves cognitive behavioral therapy to help patients understand their fears and gradually face feared situations, as well as medication like SSRIs or MAOIs which can reduce anxiety and fear. Left untreated, phobias can lead to complications and impact quality of life, so recognition and treatment are important.
Cognitive-behavioral therapy is the best approach for treating social anxiety disorder based on its past higher success rates compared to other approaches. CBT combines cognitive therapy to examine how negative thoughts contribute to anxiety with behavior therapy to examine how patients behave and react to anxiety-triggering situations. Studies have shown CBT to be superior to biological treatments like medication in the long run, with more successful outcomes than psychoanalysis, trait theory, and other approaches. While no approach is perfect, CBT provides patients with effective tools to overcome social anxiety by addressing both cognitions and behaviors.
Personality disorder are a group of mental health conditions that are characterized by inflexible and atypical patterns of thinking, feeling, and behaving.
The document discusses stigma associated with mental illness. It notes that stigma involves negative stereotypes and attitudes that label people with mental illness as less worthy. These attitudes are perpetuated by misrepresentations in media and a lack of understanding. The document outlines various factors that contribute to stigma, including fear, economic issues, lack of treatment facilities, and cultural beliefs. It also discusses the negative impacts of self-stigma, discrimination, and social exclusion that people with mental illness often face. Interventions like social contact and education are mentioned as ways to potentially help address stigma.
Psychology is the study of human behaviour. It seeks to look at the motivational drives within an individual
and offer an explanation to the behaviour that is demonstrated
Ancient cultures believed mental illness was caused by evil spirits and treated it by trepanning, or drilling holes in the skull. Hippocrates proposed it was caused by imbalances in bodily fluids. In the Middle Ages, the mentally ill were often considered witches. Psychopathology is the study of abnormal behavior, including patterns causing distress, harm to others, or impaired functioning. Abnormality is defined statistically, as deviant from social norms, by subjective discomfort, or as maladaptive. Biological, behavioral, cognitive, and psychoanalytic theories offer explanations of abnormal behavior and mental disorders.
This document provides information on Dissociative Identity Disorder (DID), formerly known as Multiple Personality Disorder. It discusses skepticism around DID and explains that dissociation exists on a spectrum from mild daydreaming to more severe identity fragmentation. The document outlines characteristics of DID like disturbances in identity, existence of distinct alters, and types of relationships between alters. Causes like childhood trauma and abuse are explored, as are popular portrayals of DID in films and books. Assessment tools, integration in therapy, and two case studies of individuals with DID are summarized.
Social phobia in Australia, treatment, Symptoms and TriggersSuzana Phillips
Discover social phobia, what it is, the treatment and emotional and behavioural symptoms. Furthermore a look into the lives of people living with the disorder and how to cope.
Phobias are irrational fears that affect 5-10% of the population and can disrupt daily functioning. They are classified as agoraphobia, specific phobia, or social phobia. Specific phobias are the most common and include fears of animals, heights, and blood. Treatment involves cognitive behavioral therapy to help patients understand their fears and gradually face feared situations, as well as medication like SSRIs or MAOIs which can reduce anxiety and fear. Left untreated, phobias can lead to complications and impact quality of life, so recognition and treatment are important.
Cognitive-behavioral therapy is the best approach for treating social anxiety disorder based on its past higher success rates compared to other approaches. CBT combines cognitive therapy to examine how negative thoughts contribute to anxiety with behavior therapy to examine how patients behave and react to anxiety-triggering situations. Studies have shown CBT to be superior to biological treatments like medication in the long run, with more successful outcomes than psychoanalysis, trait theory, and other approaches. While no approach is perfect, CBT provides patients with effective tools to overcome social anxiety by addressing both cognitions and behaviors.
Personality disorder are a group of mental health conditions that are characterized by inflexible and atypical patterns of thinking, feeling, and behaving.
The document discusses stigma associated with mental illness. It notes that stigma involves negative stereotypes and attitudes that label people with mental illness as less worthy. These attitudes are perpetuated by misrepresentations in media and a lack of understanding. The document outlines various factors that contribute to stigma, including fear, economic issues, lack of treatment facilities, and cultural beliefs. It also discusses the negative impacts of self-stigma, discrimination, and social exclusion that people with mental illness often face. Interventions like social contact and education are mentioned as ways to potentially help address stigma.
Psychology is the study of human behaviour. It seeks to look at the motivational drives within an individual
and offer an explanation to the behaviour that is demonstrated
Ancient cultures believed mental illness was caused by evil spirits and treated it by trepanning, or drilling holes in the skull. Hippocrates proposed it was caused by imbalances in bodily fluids. In the Middle Ages, the mentally ill were often considered witches. Psychopathology is the study of abnormal behavior, including patterns causing distress, harm to others, or impaired functioning. Abnormality is defined statistically, as deviant from social norms, by subjective discomfort, or as maladaptive. Biological, behavioral, cognitive, and psychoanalytic theories offer explanations of abnormal behavior and mental disorders.
The document defines neurological disorders and discusses their biological and environmental causes. It states that neurological disorders result from excessive stimulation of certain dopamine synapses in the brain, as evidenced by brain scans and studies using drugs. Some of the most common disorders discussed are schizophrenia, depression, dissociative identity disorder, phobias, mood disorders, and anxiety. Specific details are provided about the symptoms and causes of schizophrenia and depression.
Social Anxiety Disorder, also known as social phobia, is an intense fear or distress in social situations that can range from everyday interactions to performances. It affects 5% of adults in the US and Canada and 2.7% in Australia, with onset typically around age 11.5. Genetics play a role as shyness can lead to the disorder, and experiences like bullying can also contribute to its development. Lower levels of neurotransmitters like dopamine and serotonin as well as hypersensitivity in the amygdala and anterior cingulate cortex are neural factors. Treatment includes cognitive behavioral therapy and medication like SSRIs.
This a project for a high school AP Psychology course. This is a fictionalized account of having a psychological ailment. For questions about this blog project or its content please email the teacher, Laura Astorian: laura.astorian@cobbk12.org
This document discusses social phobia (social anxiety disorder), including its symptoms, causes, treatment, and impact on individuals. It notes that social phobia involves an intense fear of embarrassment or humiliation in social situations. Common symptoms include blushing, sweating, trembling, difficulty making and keeping friends, and feeling nauseous around others. Treatment typically involves psychotherapy, medication, or a combination of both. Cognitive behavioral therapy and anti-anxiety medications are commonly used. The condition can develop in youth and last a lifetime if not treated.
The document discusses the portrayal of bipolar disorder in films. It analyzes characters with bipolar disorder in 7 films from 1994-2015, coding their depictions of anger, agitation, self-medicating behaviors, delusions, paranoia, depression, and illusions of grandeur. The document hypothesizes that films do not accurately portray individuals with bipolar disorder based on outdated and stigmatizing portrayals in past media. It seeks to determine if more recent films provide realistic depictions through a content analysis of characters in the selected films.
Psychological disorder: what makes a behavior “abnormal”?
Abnormal psychology studies mental disorders to understand and treat them. People with psychological disorders experience significant distress due to dysfunctional patterns of thought, emotion, and behavior that are considered deviant in their culture. Psychological disorders are out of a patient's control and may be treated with drugs or therapy, like other medical disorders. They have both biological and environmental influences, reflecting the bio-psycho-social model of illness.
Dissociative identity disorder (DID), formerly known as multiple personality disorder, is a mental condition where a person has two or more distinct personality states or identities. It is caused by severe childhood abuse or trauma that leads the person to dissociate as a coping mechanism. Treatment involves psychotherapy and helping the different identities, or alters, integrate their memories and experiences. Famous people like football player Herschel Walker have discussed living with DID.
Generalized and phobic anxiety disordernabina paneru
This slide contains information regarding Generalized and phobic anxiety disorder. This can be helpful for proficiency level and bachelor level nursing students. Your feedback is highly appreciated.
Dissociative identity disorder (DID), formerly known as multiple personality disorder, is characterized by distinct personality states called alters that repeatedly take control of one's behavior. It is caused by extremely traumatic childhood abuse and develops as a coping mechanism. People with DID can have as few as two or as many as hundreds of distinct alters. Treatment involves psychotherapy to help alters communicate and integrate their identities. However, the validity of DID remains controversial due to concerns over misdiagnosis and the influence of therapists. Famous cases like The Three Faces of Eve and Sybil brought attention to the disorder.
Dissociative Identity Disorder (DID), previously known as Multiple Personality Disorder, involves two or more distinct personality states that control an individual's behavior. It is caused by severe childhood trauma and results in memory lapses, identity confusion, and switching between alters. Treatment focuses on integrating alters through psychotherapy and sometimes medication, with the goal of achieving normal functioning. People with DID can lead normal lives, though management of alters and their associated emotions can be challenging.
This chapter discusses abnormal behavior and psychological disorders. It is estimated that 30-40% of adults experience problems with anxiety and/or depression. Both biological and psychological factors are involved in many psychological disorders. Common disorders discussed include anxiety disorders like phobias, PTSD, and OCD, as well as mood disorders like depression and bipolar disorder. Personality disorders are also covered, which are believed to develop during childhood. The chapter addresses issues around defining abnormality and applying psychology, including civil liberties and the ethics of caring for those with psychological disorders.
This document provides an outline on agoraphobia, including its introduction, aetiology, clinical features, diagnostic criteria, prognosis, and management. It defines agoraphobia as a fear of open or crowded spaces where escape may be difficult. Most sufferers are women with onset in early adulthood, and they may experience depressive or obsessive symptoms. While agoraphobia is often chronic and fluctuating if untreated, cognitive behavioral therapy involving exposure treatment is as effective as medications in the short term and more effective long term.
Phobic anxiety disorder is characterized by an irrational and persistent fear of a specific object, situation, or activity. There are several types of phobias, including simple phobias where one fears a specific stimulus, social phobia involving fear of social situations, and agoraphobia which is a fear of being in places where escape may be difficult. Phobias are treated through pharmacotherapy using benzodiazepines or antidepressants as well as behavior therapy and psychotherapy to help patients overcome their irrational fears. Nursing care involves assessing symptoms and triggers, providing education, and addressing safety and social needs.
The document discusses dissociative disorders, which involve disruptions in consciousness, memory, identity or perception, and describes several major types including dissociative amnesia, fugue, identity disorder and depersonalization disorder. It outlines the diagnostic criteria for these disorders according to the DSM and notes that dissociative disorders are often caused by trauma, especially childhood abuse or an unpredictable home environment, and can be treated with therapies like art or cognitive therapy as well as medication.
This document discusses dissociative disorders including dissociative amnesia, fugue states, depersonalization disorder, and dissociative identity disorder (DID). It describes the symptoms and causes of each disorder and outlines treatment approaches including establishing trust, providing support, medication management, and therapy techniques. Nursing care for patients with dissociative disorders focuses on safety, education, developing consistency and trust, and helping patients cope with daily living and underlying conflicts or trauma.
Anxiety disorders include disorders that share features of excessi.docxYASHU40
Anxiety disorders involve excessive fear and anxiety about future threats. Separation anxiety disorder specifically involves developmentally inappropriate fear or anxiety about separation from attachment figures. Key features include distress when anticipating or experiencing separation, worrying about harm befalling attachment figures, and reluctance or refusal to be away from attachment figures. Separation anxiety disorder is common in children and typically involves fears of being away from home or parents, though it can also affect adults with fears of separation from spouses or children. It is diagnosed when fears or anxiety last at least 4 weeks in children or typically 6 months in adults and cause impairment.
This is the Final for Dr. Bachman's Psychopathology Course for Webster University. This has been uploaded to assist with studying for the Counselor's Examination.
The document defines neurological disorders and discusses their biological and environmental causes. It states that neurological disorders result from excessive stimulation of certain dopamine synapses in the brain, as evidenced by brain scans and studies using drugs. Some of the most common disorders discussed are schizophrenia, depression, dissociative identity disorder, phobias, mood disorders, and anxiety. Specific details are provided about the symptoms and causes of schizophrenia and depression.
Social Anxiety Disorder, also known as social phobia, is an intense fear or distress in social situations that can range from everyday interactions to performances. It affects 5% of adults in the US and Canada and 2.7% in Australia, with onset typically around age 11.5. Genetics play a role as shyness can lead to the disorder, and experiences like bullying can also contribute to its development. Lower levels of neurotransmitters like dopamine and serotonin as well as hypersensitivity in the amygdala and anterior cingulate cortex are neural factors. Treatment includes cognitive behavioral therapy and medication like SSRIs.
This a project for a high school AP Psychology course. This is a fictionalized account of having a psychological ailment. For questions about this blog project or its content please email the teacher, Laura Astorian: laura.astorian@cobbk12.org
This document discusses social phobia (social anxiety disorder), including its symptoms, causes, treatment, and impact on individuals. It notes that social phobia involves an intense fear of embarrassment or humiliation in social situations. Common symptoms include blushing, sweating, trembling, difficulty making and keeping friends, and feeling nauseous around others. Treatment typically involves psychotherapy, medication, or a combination of both. Cognitive behavioral therapy and anti-anxiety medications are commonly used. The condition can develop in youth and last a lifetime if not treated.
The document discusses the portrayal of bipolar disorder in films. It analyzes characters with bipolar disorder in 7 films from 1994-2015, coding their depictions of anger, agitation, self-medicating behaviors, delusions, paranoia, depression, and illusions of grandeur. The document hypothesizes that films do not accurately portray individuals with bipolar disorder based on outdated and stigmatizing portrayals in past media. It seeks to determine if more recent films provide realistic depictions through a content analysis of characters in the selected films.
Psychological disorder: what makes a behavior “abnormal”?
Abnormal psychology studies mental disorders to understand and treat them. People with psychological disorders experience significant distress due to dysfunctional patterns of thought, emotion, and behavior that are considered deviant in their culture. Psychological disorders are out of a patient's control and may be treated with drugs or therapy, like other medical disorders. They have both biological and environmental influences, reflecting the bio-psycho-social model of illness.
Dissociative identity disorder (DID), formerly known as multiple personality disorder, is a mental condition where a person has two or more distinct personality states or identities. It is caused by severe childhood abuse or trauma that leads the person to dissociate as a coping mechanism. Treatment involves psychotherapy and helping the different identities, or alters, integrate their memories and experiences. Famous people like football player Herschel Walker have discussed living with DID.
Generalized and phobic anxiety disordernabina paneru
This slide contains information regarding Generalized and phobic anxiety disorder. This can be helpful for proficiency level and bachelor level nursing students. Your feedback is highly appreciated.
Dissociative identity disorder (DID), formerly known as multiple personality disorder, is characterized by distinct personality states called alters that repeatedly take control of one's behavior. It is caused by extremely traumatic childhood abuse and develops as a coping mechanism. People with DID can have as few as two or as many as hundreds of distinct alters. Treatment involves psychotherapy to help alters communicate and integrate their identities. However, the validity of DID remains controversial due to concerns over misdiagnosis and the influence of therapists. Famous cases like The Three Faces of Eve and Sybil brought attention to the disorder.
Dissociative Identity Disorder (DID), previously known as Multiple Personality Disorder, involves two or more distinct personality states that control an individual's behavior. It is caused by severe childhood trauma and results in memory lapses, identity confusion, and switching between alters. Treatment focuses on integrating alters through psychotherapy and sometimes medication, with the goal of achieving normal functioning. People with DID can lead normal lives, though management of alters and their associated emotions can be challenging.
This chapter discusses abnormal behavior and psychological disorders. It is estimated that 30-40% of adults experience problems with anxiety and/or depression. Both biological and psychological factors are involved in many psychological disorders. Common disorders discussed include anxiety disorders like phobias, PTSD, and OCD, as well as mood disorders like depression and bipolar disorder. Personality disorders are also covered, which are believed to develop during childhood. The chapter addresses issues around defining abnormality and applying psychology, including civil liberties and the ethics of caring for those with psychological disorders.
This document provides an outline on agoraphobia, including its introduction, aetiology, clinical features, diagnostic criteria, prognosis, and management. It defines agoraphobia as a fear of open or crowded spaces where escape may be difficult. Most sufferers are women with onset in early adulthood, and they may experience depressive or obsessive symptoms. While agoraphobia is often chronic and fluctuating if untreated, cognitive behavioral therapy involving exposure treatment is as effective as medications in the short term and more effective long term.
Phobic anxiety disorder is characterized by an irrational and persistent fear of a specific object, situation, or activity. There are several types of phobias, including simple phobias where one fears a specific stimulus, social phobia involving fear of social situations, and agoraphobia which is a fear of being in places where escape may be difficult. Phobias are treated through pharmacotherapy using benzodiazepines or antidepressants as well as behavior therapy and psychotherapy to help patients overcome their irrational fears. Nursing care involves assessing symptoms and triggers, providing education, and addressing safety and social needs.
The document discusses dissociative disorders, which involve disruptions in consciousness, memory, identity or perception, and describes several major types including dissociative amnesia, fugue, identity disorder and depersonalization disorder. It outlines the diagnostic criteria for these disorders according to the DSM and notes that dissociative disorders are often caused by trauma, especially childhood abuse or an unpredictable home environment, and can be treated with therapies like art or cognitive therapy as well as medication.
This document discusses dissociative disorders including dissociative amnesia, fugue states, depersonalization disorder, and dissociative identity disorder (DID). It describes the symptoms and causes of each disorder and outlines treatment approaches including establishing trust, providing support, medication management, and therapy techniques. Nursing care for patients with dissociative disorders focuses on safety, education, developing consistency and trust, and helping patients cope with daily living and underlying conflicts or trauma.
Anxiety disorders include disorders that share features of excessi.docxYASHU40
Anxiety disorders involve excessive fear and anxiety about future threats. Separation anxiety disorder specifically involves developmentally inappropriate fear or anxiety about separation from attachment figures. Key features include distress when anticipating or experiencing separation, worrying about harm befalling attachment figures, and reluctance or refusal to be away from attachment figures. Separation anxiety disorder is common in children and typically involves fears of being away from home or parents, though it can also affect adults with fears of separation from spouses or children. It is diagnosed when fears or anxiety last at least 4 weeks in children or typically 6 months in adults and cause impairment.
This is the Final for Dr. Bachman's Psychopathology Course for Webster University. This has been uploaded to assist with studying for the Counselor's Examination.
Social anxiety is preventing the author from achieving their goals and dreams. They are shy and quiet by nature, feeling uncomfortable expressing opinions publicly. Public speaking terrifies them and can trigger panic attacks. College can be intimidating for socially anxious people, as simple interactions like saying "hi" can be awkward. However, the author has started to overcome their social anxiety by making friends in two of their classes and saying greetings to classmates.
Social anxiety disorder, also known as social phobia, is defined as a persistent fear of social or performance situations where the individual fears embarrassment, scrutiny, or judgment by others. It involves intense anxiety and avoidance of social interactions, presentations, and other interpersonal situations that could involve evaluation. Left untreated, social anxiety can significantly interfere with one's daily life and functioning.
Abnormal Psychology Vs Psychopathology EssayAngie Lee
The document discusses abnormal psychology and psychopathology. It notes that abnormal psychology focuses on individuals who deviate from statistical or social norms in terms of their behavior, thoughts, or emotions. While abnormal psychology and psychopathology are often used interchangeably, abnormal psychology is sometimes viewed more negatively as it implies that individuals are "not normal". However, deviating from statistical norms does not necessarily mean someone has a psychological disorder or illness. The document provides examples to illustrate this point.
This summary provides an overview of the key points from the document:
1. The document discusses the author's personal experience and perceptions of depression as a mental illness. Through studying psychology, the author gained a better understanding of depression and realized their previous views were limited.
2. Growing up, the author was surrounded by people who did not view depression as a real mental illness and thought it did not warrant treatment. There is also stigma around mental illness in South African society.
3. The document defines depression according to the DSM-5, outlining cognitive, emotional, behavioral, and other symptoms. It emphasizes that depression significantly impacts one's ability to function.
Anxiety is a normal evolutionary response to threats but can become maladaptive and constitute a psychiatric disorder. Risk factors include female sex, lower social support and IQ, pre-existing psychiatric illnesses, family history, substance abuse, and prior trauma. Phobias refer to excessive fears of specific objects or situations that are avoided. Obsessive compulsive disorder involves intrusive thoughts and images that cause distress and are accompanied by compulsive behaviors aimed at reducing anxiety.
This document provides an overview of mental health and mental disorders. It discusses that mental illness is a medical disease that prevents happiness and health. There are two main types of mental disorders: organic caused by physical brain issues, and functional caused by psychological factors without brain damage. Some specific disorders discussed are anxiety disorders like phobias, OCD, PTSD; affective disorders involving mood swings like depression; and personality disorders. The document also covers signs that someone may need mental health help and common providers like psychiatrists, psychologists, and social workers.
Psychological DisordersEssentials of Psychology Ps.docxwoodruffeloisa
Psychological Disorders
Essentials of Psychology : Psychological
Disorders
Lesson 5 Overview
The objective of this lesson
is to give you an overview
of psychological disorders
and approaches to their
treatment. It isn’t meant to
make you a clinical
psychologist. Two
points should be stressed
from the very beginning. First, the labels that have been applied to
mental disorders have changed over the years. For example, at one
time, excessive masturbation was considered pathological in males,
and it was sufficient to have a woman confined to an asylum.
Homosexuality was finally eliminated from the official manual
of mental disorders in only the past couple of decades.
Second, mental disorders and approaches to their treatment are, to
some extent, social products. As societies change over time, so do
ideas about mental disorders. For that matter, as society changes,
Page 1Copyright Penn Foster, Inc. 2019
Course Version: 2
different kinds of mental disorders are likely to become more common.
For example, eating disorders, which certainly have psychological
components, were all but unknown in the sixteenth century. Getting
enough to eat was a sufficient problem for most people. Conclusion:
One should apply labels to people with extreme caution. Just as
personalities vary, every disorder has commonalities and differences.
5.1 Differentiate a healthy personality from a disordered
personality in the context of mental health and stress
management
Psychological Disorders
READING ASSIGNMENT
Read this assignment. Then read Chapter 10 in your textbook.
Normal versus Abnormal
Let’s say that you’re among an isolated tribe of people in the
Venezuelan rain forest. In your society, it’s normal for males to prize
shrunken heads as trophies with great power. Headhunting is normal
for these people. Let’s say you’re a sociologist studying American
divorce statistics. You find that for every two marriages, one will end in
divorce. Does that make divorce normal or abnormal? For a
psychologist, statistical normality simply refers to the distribution of
some variable in a population. For example, 100 is the mean score on
an IQ test, and normal or average ranges from about 80 to 120. On
the other hand, when someone says that Justin’s compulsion to wash
his hands 40 or 50 times a day “isn’t normal,” you may agree with that
observation. Yet, you should keep in mind that in social worlds, when
Page 2Copyright Penn Foster, Inc. 2019
Course Version: 2
people refer to normal behavior they’re often simply making a
judgment about behavior that they prefer.
Psychologists must use some approach other than “normal” versus
“abnormal” to identify abnormal behavior. For psychologists, behavior
is considered abnormal if people experience distress and if that
distress prevents them from functioning in their daily life. Given that
general definition, it’s also best to think of normal and abnormal as two
ends of a continuum. Thu ...
Introduction and history of mental illnesscandyvdv
Early explanations of mental illness involved possession by demons or evil spirits. People with mental illnesses were often tortured to drive out demons. By the 18th century, madness began to be seen as an illness rather than demonic possession, leading thousands to be released from torture to asylums with medical treatment. Today, the medical model and influence of psychology both contribute to understanding and treating mental disorders, which are classified according to standardized diagnostic criteria.
This document provides an overview of schizophrenia, including its diagnostic criteria, symptoms, subtypes, causes, affected brain areas, treatment options, and epidemiology. It discusses how schizophrenia is diagnosed according to the ICD-10 and DSM-IV, outlining the key diagnostic criteria. It also summarizes the suspected genetic, environmental, and lifestyle risk factors associated with schizophrenia development.
Breaking Free of Overcoming Social AnxietyCounsel India
Countless people worldwide suffer from social anxiety, a complicated and frequently crippling mental health illness that goes beyond occasional shyness or apprehension. This e-book explores the complex nature of social anxiety, providing insight into its description, causes, symptoms, and significant effects on people's lives.
For more such interesting and informative e-books, visit our website -
https://www.counselindia.com/ebook
1. Treatment of social phobia
David Veale
Adv. Psychiatr. Treat. 2003 9: 258-264
Access the most recent version at doi:10.1192/apt.9.4.258
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2. Veale Advances in Psychiatric Treatment (2003), vol. 9, 258–264
Treatment of social phobia
David Veale
Abstract Social phobia (or social anxiety disorder) manifests as a marked and persistent fear of negative
evaluation in social or performance situations.The epidemiology, diagnosis and psychopathology are
reviewed, including clinical presentation, cultural aspects and the differences between agoraphobia
and social phobia. Behavioural treatments, including graded self-exposure and cognitive restructuring,
are considered. A cognitive model of the maintenance of social phobia is discussed. It is hypothesised
that attentional shifting towards imagery, safety behaviours and ‘post-mortem’ analyses play a key
role in symptom maintenance. The implications of this for treatment are described, and guidelines for
pharmacological treatment are summarised.
Social phobia (or social anxiety disorder) consists alcohol or substance misuse or body dysmorphic
of a marked and persistent fear of social or disorder. In body dysmorphic disorder, patients are
performance situations. Affected individuals fear often too ashamed to reveal their preoccupation with
that they will be evaluated negatively or that they their appearance, and present with symptoms of
will act in a humiliating or embarrassing way. social anxiety and depression, fearing that the
Exposure to social or performance situations mental health professional will view them as vain
invariably leads to panic or marked anxiety, and or narcissistic. A similar situation exists in patients
such situations therefore tend to be avoided or with olfactory reference syndrome, who believe
endured with extreme distress. that they have body odour that others will find
Social phobia is the third most common mental unpleasant, which they may camouflage with
disorder in adults worldwide, with a lifetime perfume. Therefore, all patients with symptoms of
prevalence of at least 5% (depending on the social anxiety should be routinely asked whether
threshold for distress and impairment). There is they are very concerned about some aspect of their
an equal gender ratio in treatment settings, but appearance or about body odour. It should be
in catchment area surveys, there is a female pre- emphasised that patients with social phobia do not
ponderance of 3:2. Individuals are more likely to lack social skills. Most affected individuals will have
be unmarried and have a lower socio-economic normal social skills in a consultation with you, or
status. Although common, social phobia is often not with a friend or partner. In social situations, they
diagnosed or effectively treated. There have, are trying too hard and can appear to lack social
however, been a number of developments in our skills, because they might interact less, keep their
understanding and treatment of social phobia over head down or not reveal personal information.
the past decade, and these are the focus of this Patients (for example, those with Asperger syn-
article. drome) who do lack communication skills have a
different problem.
The presentation of social phobia can depend on
Presentation cultural contexts. In Western cultures, patients might
present to surgeons for cures for complaints of
The onset of social phobia usually takes place excessive blushing or sweating. In Japan, social
during adolescence, although a minority of causes phobia is manifested as an extreme fear of bringing
involve a late onset after a significant life event (such offence to others, and is referred to as taijin kyofusho.
as an episode of failure). The typical course is Sufferers of this disorder may fear that making
chronic and life-long. Predisposing factors include eye contact, blushing, imagined defects in their
a shy or anxious temperament from childhood. There appearance or their body odour would be offensive
is significant comorbidity, especially of depression, to others.
David Veale is an honorary senior lecturer at the Royal Free and University College Medical School and a consultant psychiatrist
at the Priory Hospital (The Bourne, Southgate, London N14 6RA, UK). He has a special interest in cognitive–behavioural
therapy and its application to anxiety disorders and body dysmorphic disorder.
258 Advances in Psychiatric Treatment (2003), vol. 9. http://apt.rcpsych.org/
3. Treatment of social phobia
Psychopathology sensations as evidence of an immediate catastrophe
to their health. Panic attacks in agoraphobia tend to
The core psychopathology in social phobia is a fear be both situational and spontaneous. Affected
of negative evaluation in social and performance individuals are concerned with a wider range of
situations. It overlaps with the concept of shame, autonomic sensations such as palpitations and
although the two sets of literature have largely feeling dizzy or short of breath. Those with social
ignored one other (Gilbert & Andrews, 1998). Social phobia, however, are more likely to be concerned
anxiety is best described as the fear of feeling with autonomic sensations of blushing, shaking or
ashamed (e.g. of the emotions aroused and their stammering (which the person believes may be
interference in one’s presentation) or the fear of being noticeable to others). Panic attacks in social phobia
shamed (e.g. by the negative evaluation of oneself occur almost exclusively in social situations. Some-
and potential loss of rank), or both. times, a patient with agoraphobia also has comorbid
Social phobia usually leads to avoidance of symptoms of social anxiety. For example, he might
situations such as public speaking or talking to a believe that he will collapse or go mad as a result of
group, parties, meetings, eating or drinking in a panic attack, but in a social situation, he might
public, working or writing while being observed, also fear causing a scene and others evaluating him
telephone calls, intimacy or dating. Groups are negatively. Typical beliefs in an individual with
nearly always more anxiety-provoking than is an social phobia focus on the perceived negative
individual. Peers of the same age are usually more evaluation by others of revealing a flaw or un-
anxiety-provoking than older individuals. For acceptable behaviour (for example, the person
heterosexual individuals, people of the opposite believes that her hands will shake or she will sound
gender are usually more anxiety-provoking than stupid or boring). This is also referred to in the
those of the same gender. Sometimes individuals in literature as ‘external shame’.
authority, especially at work, are more anxiety- Such individuals tend to have high standards or
provoking than individuals at the same level. rules about how they must perform in social
There tend to be two sub-types of social phobia – situations. Their assumption is that failing to
generalised and non-generalised. Generalised social achieve these standards might lead others to see
phobia is more disabling and involves a more diverse them as inferior, flawed or inadequate and they them-
range of feared stimuli. Those affected by it include selves also agree with this assessment (referred to
some patients with avoidant personality disorder as ‘internal shame’). They predict that this failure
and it has a worse prognosis. Non-generalised will lead to rejection or a further failure to achieve
social phobia is associated with avoidance of a an important goal. Individuals with no internal
limited range of performance situations or inter- shame may know that others are rejecting them and
actions (such as public speaking), and this overlaps view them as inferior, but not believe it about
with performance anxiety in sexual dysfunction. themselves.
Non-generalised social phobia is easier to treat, with The emotions in social phobia are predominantly
a better prognosis. those of anxiety and shame, and sometimes self-
A person afraid of speaking in public would not disgust or anger (which will depend on beliefs and
receive a diagnosis of social phobia if public safety behaviours). As in other anxiety disorders,
speaking was not routinely encountered and the the main coping (or defensive) behaviour is to escape
person was not particularly distressed about it. It is from the situation. There is a strong urge not to be
usually the degree of distress or impairment that seen. Eye gaze is commonly averted and there is
warrants a diagnosis of social phobia, and the behavioural inhibition (discussed in more detail
possible indicators need to be considered in the below under ‘safety behaviours’). These behav-
appropriate context. For example, transient or mild iours might be linked to the submissive defensive
social anxiety is especially common in adolescence. behaviours used to reduce aggression in another
The degree of severity in social phobia is very person in response to the threat of rejection.
variable, ranging from individuals who are virtually When the focus is on another person as being bad
housebound and have never had a relationship, to and doing something to expose the individual as
others who are highly functioning except in certain inferior, then the main emotion is of humiliation
areas such as making a presentation, which they (rather than social anxiety). There is a sense of
find very distressing and which handicaps them in injustice and unfairness, often leading to anger and
their occupation. a strong desire for revenge against the one who is
Social phobia might be confused with agora- exposing the self as weak or inferior.
phobia. Individuals with agoraphobia tend to Alcohol and other substances are commonly used
be female and to be anxious about their physical in social phobia, but such usage might result in a
or mental health. They misinterpret physical self-fulfilling prophecy as patients may indeed make
Advances in Psychiatric Treatment (2003), vol. 9. http://apt.rcpsych.org/ 259
4. Veale
fools of themselves after excessive alcohol consump- affected individual’s own evaluation of his or her
tion. Although alcohol and substance dependence behaviour that is crucial in determining the degree
need to be treated first, many such patients will of social anxiety. Such alternative approaches are
have difficulty attending self-help groups such as not usually recommended, as adherence is likely to
Alcoholics Anonymous. Nevertheless, mental health be poor unless the therapist is prepared to model
practitioners who treat alcohol and substance the behaviour. Self-exposure and variants of
misuse frequently fail to address the comorbid social cognitive restructuring are effective and valid
anxiety once the patient has stopped misusing and treatments, but the treatment gains might only be
relapse is therefore common. modest. For example, Heimberg et al (1990) report
that only 65% make ‘clinically significant change’.
Assessment measures
Cognitive therapy
Suitable assessment measures include the Brief
Social Phobia Scale (Davidson et al, 1991) and the Clark & Wells (1995) and Clark (2001) have
Social Anxiety Scale (Liebowitz, 2002), which are developed a cognitive model for the maintenance of
both observer-rated. Subjective rating scales include social phobia (Fig. 1). Most of the material for the
the Social Phobia and Anxiety Scale (Turner & rest of this article is derived from their approach.
Beidel, 1989), the Social Phobia Inventory (Connor The aim of the model is to answer the question of
et al, 2000) and the Fear Questionnaire (Marks why the fears of someone with social phobia are
& Mathews, 2002). maintained despite frequent exposure to social or
public situations and the non-occurrence of the
feared catastrophes. Recent research from controlled
Graded self-exposure trials supports the efficacy of the approach (Clark
et al, 2003). The model suggests that when patients
Learning theory hypothesises that avoidance enter a social situation, certain rules (e.g. ‘I must
maintains the fear in social phobia, as patients are always appear witty and intelligent’), assumptions
motivated to avoid ‘punishment’ by others. The (e.g. ‘If a woman really gets to know me then she
anticipated ‘punishment’ – the prediction of will think I am worthless’) or unconditional beliefs
rejection, deflation and isolation – is never dis- (e.g. ‘I’m weird and boring’) are activated. When
confirmed. Graded self-exposure has been the
treatment of choice for social phobia for many years.
A detailed hierarchy is made of all the situations Social
situation
that the person avoids, with a rating of 0 to 100%
according to the degree of anticipated anxiety. Self-
exposure involves repeatedly facing previously
avoided situations in a graded manner until
Activates assumption
habituation has occurred.
There are problems with exposure alone – for
example, tasks might be brief (and not long enough
for the anxiety to subside) or not susceptible to Perceived social danger
regular repetition. Furthermore, a significant number
of patients refuse self-exposure or drop out early. Of
those who complete treatment, about 50% will
overcome their problem. Treatment failures tend to Processing
be associated with a depressed mood, avoidant of self as a
social
personality, intolerance of emotion and marked object
avoidance behaviour. Alternative approaches have
included group cognitive–behavioural therapy
(Heimberg et al, 1990) or the addition of coping skills,
cognitive restructuring or shame-attacking from Safety Somatic and
rational emotive behaviour therapy. An example of behaviours cognitive
symptoms
shame-attacking is for the patient to shout out the
names of stations on a railway line. Other passengers
might think that the individual is stupid, but he or
she can learn that performing a stupid act does not
Fig. 1 A model of social phobia.
make one stupid ‘through and through’. It is the
260 Advances in Psychiatric Treatment (2003), vol. 9. http://apt.rcpsych.org/
5. Treatment of social phobia
individuals believe that they are in danger of aim is to understand the development and main-
negative evaluation, an attentional shift occurs tenance of the disorder and how the patient’s current
towards detailed self-observation, and monitoring beliefs, emotions and behaviour interact. Sessions
of sensations and images. Socially anxious indivi- are recorded on audio- or videocassette so that the
duals thus use internal information to infer how patient may listen to a session again and provide
others are evaluating them (in Fig. 1 this is feedback at the next session. The therapist also has
‘processing of self as a social object’). The internal an opportunity of reviewing the sessions in
information is associated with feeling anxious, and supervision.
vivid or distorted images are imagined from an An idiosyncratic version of the model (Fig. 1) is
observer perspective (Hackmann et al, 2000). These drawn up with the patient, based upon a review of
images are mostly visual, but they might also include recent episodes of social anxiety. First, the therapist
bodily sensations and auditory or olfactory identifies a specific and recent social situation that
perspectives. This is not, of course, what an observer was sufficiently anxiety-provoking. He or she then
actually ‘sees’. Recurrent images can be elicited by attempts to identify the negative automatic thoughts
asking patients to recall a social situation associated by asking questions such as: ‘What went through
with extreme anxiety. The images are usually linked your mind as you noticed yourself becoming
to early memories. The therapist asks the patient anxious’, ‘What was the worst you thought could
when he or she remembers first having the experience happen?’ and ‘What did you suppose that others
encapsulated in the recurrent image and to recall would notice or think?’
the sensory features and meaning that these had. The therapist may use a ‘downward arrow’
For example, someone who had an image of being technique to try to identify the patients’ assumptions
fat remembered being teased during adolescence, and core beliefs. This involves asking the patient to
which resulted at the time in feelings of humiliation assume the worst and then to assume that the
and rejection. thought is true. The therapist then asks what the
A second factor that maintains symptoms of social most anxiety-provoking thing about the thought is
phobia are safety behaviours. These are actions taken or what it means to the individual. For example:
in feared situations which are designed to prevent
Therapist: How did you feel you came across?
feared catastrophes (Salkovskis, 1991). Safety Patient: I felt I appeared very red and sounded
behaviours in social phobia include: using alcohol; stupid.
avoiding eye contact; gripping a glass too tightly; Therapist: Let’s assume that you did appear very red
excessive rehearsing of a presentation; reluctance and sounded stupid, what would that mean
to reveal personal information; and asking many about you?
questions. Safety behaviours are often problematic: Patient: I felt that I looked like an idiot and others
they prevent disconfirmation of the feared catas- would be secretly laughing at me.
trophe; they can heighten self-focused attention and Therapist: Let’s assume it’s true that everyone in the
monitoring to determine if the behaviour is room is laughing to themselves, what
would that mean to you?
‘working’; they increase the feared symptoms (e.g.,
Patient: I think no one will really want to know me
keeping arms close to the body to stop others seeing
in the future and I’ll be alone.
one sweat will increase sweating); they have an
effect on others (e.g. the individual may appear cold Next, the therapist identifies the autonomic
and unfriendly, so that a feared catastrophe becomes sensations or symptoms of anxiety by asking
a self-fulfilling prophecy); and they can draw questions such as: ‘When you thought the feared
attention to feared symptoms (e.g. speaking quietly event might happen, what did you notice happening
and slowly will lead others to focus on the indi- in your body?’ (e.g. blushing, shaking, sweating).
vidual even more). Safety behaviours are next elicited by asking
It is hypothesised that a third factor that main- ‘When you thought the feared event might happen,
tains symptoms of social phobia is anticipatory and did you do anything to try to prevent it from
post-event processing. Such processing focuses on happening?’, ‘Is there anything you do to try to
the feelings and constructed images of the self in the ensure you come across well?’ or ‘Do you do
event and leads to selective retrieval of past failures. anything to stop drawing attention to yourself?’
Increased self-consciousness and imagery are
elicited by asking questions such as: ‘What happens
Stages of therapy to your attention when you are most afraid? Do
you become more self-conscious? Do you have
Therapy begins with a detailed assessment and difficulty following what others are saying? Do you
formulation of the problem, which is developed have a picture in your mind of how you feel you
collaboratively between therapist and patient. The are coming across?’ Further details of the imagery
Advances in Psychiatric Treatment (2003), vol. 9. http://apt.rcpsych.org/ 261
6. Veale
are elicited and of whether it takes an observer first, getting insight in attentional processes and the
perspective. effects of heightened self-focused attention; second,
The model may then be used to determine its focusing attention outward in non-threatening
potential application to past and present experi- situations; and third, focusing attention outward in
ences and how each of the components is linked to threatening situations.
a feedback loop. It is particularly important to review
how increased self-focused attention and using
safety behaviours are counterproductive, and Video feedback
increase the frequency of the thoughts and anxiety.
The aim of video feedback is to demonstrate that the
Once a patient is engaged in the model, then various
patients’ impressions of how they think they appear
strategies may be used to consolidate understanding
are inaccurate and based on their internal images
and to make changes in the system.
and feelings. For example, a patient may make a
prediction about how red he appears when he
Shifting attentional focus blushes. An experiment may be set up, whereby he
selects the predicted ‘redness’ on a colour chart and
The aim of shifting attentional focus is to enable compares this with the actual ‘redness’ of his
patients to concentrate on how others respond to blushing on a video with the colour chart in the
them, rather than on constructed images or impres- background. This approach is also suitable for any
sions of how they think they appear. A role-play is reaction that can be objectively observed on a video
done, in which the focus of attention is manipulated and compared against an agreed reference point.
in order to demonstrate the adverse effect of self-
focused attention and safety behaviours. The patient
is asked to compare the degree and content of self- Modifying negative self-images
consciousness, subjective anxiety and whether the
Self-images might be associated with negative
self is still in an observer perspective.
memories from childhood or adolescence. For
Readers may like to try this for themselves, to begin
example, the image and memories might be of being
to understand the strategies used by someone who
teased and isolated from one’s peers. Therapy may
is socially anxious. Test out two different scenarios
be directed at historical reviews of such images
with a colleague. For the first scenario, demand a
(Arntz & Weertman, 1999), and referring to them as
high standard from yourself that you must appear
being ‘ghosts from the past’ that have not yet been
extremely witty and intelligent in the conversation
updated. Therapy is therefore aimed at modifying
with your colleague and throughout your conver-
the images or changing them in line with current
sation, focus your attention on how you are feeling
reality.
and observe the impression that you think you are
making (looking at yourself from an observer’s
perspective). You should monitor whether you are Modifying assumptions and core beliefs
coming across as extremely witty and intelligent.
For the second scenario, reduce your expectations Modifying of assumptions and core beliefs in social
about being witty and intelligent and focus your phobia is no different from that in standard cognitive
attention wholly on the way that your colleague therapy. However, a key strategy is to make
responds. After the role-play, it is time to receive predictions and test out assumptions in behavioural
feedback on your performance from your colleague experiments. This may involve ‘exposure’ to social
and reflect on how hard it is to monitor yourself in situations, but it does not involve repeated exposure
self-focused attention. Homework might focus on and a model of habituation. The emphasis is on
an exercise in dropping of safety behaviours and shifting the focus of attention, dropping safety
shifting attentional focus in a social situation. This behaviours, processing the situation (not the self)
might then be followed with more traditional tasks and evaluating what was predicted against what
of graded exposure, but without safety behaviours. actually happened. For example, an individual with
Other researchers have developed more elaborate social phobia who fears that she may behave in an
strategies, such as Task Concentration Training unacceptable manner would be encouraged to
for shifting attentional focus (Bogels et al, 1997). This behave ‘unacceptably’, perhaps by making pauses
is a technique that aims specifically at redirecting in her speech, having damp armpits, expressing an
the affected individual’s attention away from opinion or spilling her drink, and to observe
anxiety and internal sensations such as blushing, another’s response. Alternatively, a survey could
trembling, sweating or imagery, and towards the be conducted to find how unacceptable these
social task at hand and relevant environmental behaviours are to others and what the consequences
aspects. The training consists of three phases: might be.
262 Advances in Psychiatric Treatment (2003), vol. 9. http://apt.rcpsych.org/
7. Treatment of social phobia
Modifying post-interaction ruminations dose can include sedation, forgetfulness, impaired
concentration and disinhibition, especially when
Those affected by social phobia often engage in ‘post- used intermittently. Benzodiazepines are especially
mortems’. Here, the therapist helps the patient to contraindicated for patients with comorbidity of
identify the content of the event (not the feelings) depression and/or a history of alcohol or substance
and review what actually happened by shifting to misuse.
external processing and constructing an alternative
data log of information that is normally disregarded
or distorted. Which treatment for whom?
Therapy would normally take between 8 and 20
out-patient sessions, depending on the severity and Only one trial has compared later versions of CBT
chronicity of the phobia. Patients with very severe with an SSRI (Clark et al, 2003), and it found CBT to
phobia, who are housebound or dependent on be superior to fluoxetine. No trials have yet com-
alcohol, might do better on an intensive programme pared later versions of CBT with a combination of
of CBT as either day-patients or in-patients in the CBT and another SSRI, especially in the long term
right setting. and after discontinuation of the active treatment.
As always, treatment will depend upon patient
choice and availability of therapy, but in common
Pharmacotherapy with other anxiety disorders, CBT is the initial choice
Medication is indicated if it is the patient’s first of treatment for social phobia, as it is usually more
choice, CBT has failed, there is a long waiting-list acceptable and has a reduced risk of relapse. As
for CBT or there is significant comorbidity of always, the main problem is user choice and access
depression. The treatment of choice in social phobia to CBT in a timely manner.
is a selective serotonin reuptake inhibitor (SSRI)
(Ballenger et al, 1998). Of the SSRIs, only paroxetine References
is licensed and marketed in the UK for social phobia, Arntz, A. & Weertman, A. (1999) Treatment of childhood
although there is no reason why other SSRIs may memories: theory and practice. Behaviour Research Therapy,
not be as effective. Most affected individuals can 37, 715–740.
Ballenger, J. C., Davidson, R. T., Lecrubier, Y., et al (1998)
tolerate a normal starting dose of an SSRI, as they Consensus statement on social anxiety disorder from the
do not usually experience an ‘activation syndrome’ International Consensus Group on Depression and
(as in panic disorder). The starting dose is used for Anxiety. Journal of Clinical Psychiatry, 59, 54–60.
Bogels, S. M., Mulkens, S. & De Jong, P. J. (1997) Task
2–4 weeks and then increased as necessary. The concentration training and fear of blushing. Clinical
onset of action is usually within 6 weeks and an Psychology and Psychotherapy, 4, 251–258.
adequate trial period is 8 weeks. The full response Clark, D. M. (2001) A cognitive perspective on social phobia.
In International Handbook of Social Anxiety: Concepts, Research
may occur after up to 12 weeks. and Interventions Relating to the Self and Shyness (eds W. R.
About 50% of patients relapse on discontinuation Crozier & L. E. Alden). pp. 405–430. Chichester: John
of an SSRI and treatment is therefore continued for a Wiley & Sons.
––– & Wells, A. (1995) A cognitive model of social phobia. In
minimum of 12 months. Once in remission, the dose Social Phobia – Diagnosis, Assessment, and Treatment (eds R.
may be reduced slowly (e.g. a 25% reduction every G. Heimberg, M. R. Liebowitz, D. Hope, et al), pp. 69–93.
2 months). If a patient fails to respond to an SSRI, New York: Guilford.
–––, Ehlers, A., Hackmann, A., et al (2003) Cognitive therapy
then some evidence exists for the efficacy of a mono- vs. fluoxetine plus self exposure in the treatment of
amine oxidase inhibitor (MAOI) (e.g. phenelzine, generalized social phobia (social anxiety disorder): A
45– 90 mg daily) or a reversible monoamine oxidase randomised placebo controlled trial. Journal of Consulting
and Clinical Psychology, in press.
inhibitor (RIMA) (e.g. moclobemide, 300–900 mg Connor, K. M., Davidson, J. R. T., Churchill, L. E., et al (2000)
daily). Allow 2 weeks between discontinuing an Psychometric properties of the Social Phobia Inventory
SSRI (5 weeks if fluoxetine) and commencing an (SPIN). British Journal of Psychiatry, 176, 379–386.
Davidson, J. R. T., Potts, N. L. S., Richichi, E. A., et al (1991)
MAOI or RIMA. Although there are no evidence- The Brief Social Phobia Scale. Journal of Clinical Psychiatry,
based guidelines on the treatment of patients who 52, 48–51.
have failed to respond fully to an SSRI or an MAOI, Gilbert, P & Andrews, B. (1998) Shame: Interpersonal Behaviour,
Psychopathology, and Culture. New York: Oxford University
expert opinions suggest the adjunctive use of beta- Press.
blockers (e.g. propranolol, starting dose 20 mg daily, Hackmann, A., Clark, D. M. & McManus, F. (2000) Recurrent
gradually increased to 60 mg, or atenolol 50–100 mg images and early memories in social phobia. Behaviour
Research and Therapy, 38, 601–610.
daily) to augment the response. Similarly, clonidine Heimberg, R. G, Dodge, C. S., Hope, D. A., et al (1990)
may augment the response for symptoms of blushing Cognitive behavioral group treatment for social phobia:
when used as an adjunct to an SSRI. The use of Comparison with a credible placebo control. Cognitive
Therapy and Research, 14, 1–23.
benzodiazepines (especially short-acting ones) is Liebowitz, M. R. (2002) Social phobia. Modern Problems in
not recommended, because side-effects at a higher Pharmacopsychiatry, 22, 141–173.
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Marks, I. M. & Mathews, A. M. (2002) Brief standard self- c the aim of video feedback is to demonstrate that the
rating for phobic participants. Behaviour Research and patient’s impressions of how they think they appear
Therapy, 17, 263–267.
Salkovskis, P. M. (1991) The importance of behaviour in the are inaccurate and based on internal images and
maintenance of anxiety and panic. Behavioural Psycho- feelings
therapy, 19, 6–19. d behavioural experiments are used to make predic-
Turner, S. M. & Beidel, D. C. (1989) Social phobia: clinical tions which are then tested
syndrome, diagnosis, and comorbidity. Clinical Psychology
e social skills training is provided.
Review, 9 (Special issue: Social phobia), 3–18.
4 In the presentation of social phobia:
Further reading a onset is gradual during adolescence
b the typical course is chronic and life-long
Crozier, W. R. & Alden, L. E. (2001) International Handbook of
Social Anxiety: Concepts, Research and Interventions Relating c predisposing factors include a shy or anxious
to the Self and Shyness. Chichester: John Wiley & Sons. temperament from childhood
Heimberg, R. G (1995) Social Phobia: Diagnosis, Assessment d a minority are of late onset after a significant life
and Treatment. New York: Guilford. event
e panic often occurs when alone.
Multiple choice questions 5 In pharmacotherapy for social phobia:
1 Individuals with social phobia: a an SSRI should usually be commenced at a lower
a experience an image from a field perspective (i.e. as dose than that used for depression
looking out from their own eyes) b the full response occurs in about 6 weeks
b lack social skills c an alternative to an SSRI is an MAOI
c avoid social situations to prevent negative evaluation d short-acting benzodiazepines are recommended
d focus on the perceived negative evaluation of a e beta-blockers may be helpful as initial treatment of
revealing flaw or unacceptable behaviour choice.
e may assume they will be rejected or fail to achieve
important goal.
2 Social phobia:
a is the third most common mental disorder in adults
b has a lifetime prevalence rate of about 10%
c occurs more frequently in males than females in
psychiatric clinics
d has significant comorbidity with depression, and
substance misuse
MCQ answers
e is more likely to occur among unmarried individuals 1 2 3 4 5
with a lower socio-economic status a F a T a F a T a F
3 In cognitive therapy of social phobia: b F b F b F b T b F
a fluoxetine was found to be more effective than CBT c T c F c T c T c T
b the aim of shifting attentional focus is to enable d T d T d T d T d F
patients to concentrate on how they think they appear e T e T e F e F e F
to others
264 Advances in Psychiatric Treatment (2003), vol. 9. http://apt.rcpsych.org/