3.2- Adolescent Social Anxiety Disorder

Case 3 - Case Formulation Using the Integrative Model: (pp. 35-37)

Answer: B. An inherited tendency toward anxiety or behavioral inhibition

Explanation: Biological vulnerability in SAD refers to an inherited tendency toward anxiety or behavioral inhibition (e.g., shy or inhibited temperament from infancy). Traumatic events (C) are precipitating factors, not predisposing ones.

According to the integrative model, which of the following best describes the biological vulnerability that predisposes individuals to Social Anxiety Disorder (SAD)?

A. A learned habit of avoiding social situations from observing parents
B. An inherited tendency toward anxiety or behavioral inhibition
C. A traumatic childhood event such as ridicule or bullying
D. Negative self-evaluation in social situations

Answer: B. True alarm

Explanation: A true alarm occurs when there is an actual negative social event (e.g., ridicule, humiliation). A false alarm would be panic in the absence of real threat.

In the integrative model of SAD, a person who has a panic-like reaction during a public speaking event after being humiliated by a teacher is experiencing what type of alarm?

A. False alarm
B. True alarm
C. Avoidance response
D. Selective attention bias

Answer: C. Avoidance of feared social situations

Explanation: Avoidance prevents the individual from disconfirming negative predictions and reinforces fear, thus maintaining (perpetuating) the disorder. Predisposing factors include genetic/temperament; precipitating factors include humiliating events.

Which of the following is considered a perpetuating factor in the 4Ps formulation of SAD?

A. Genetic predisposition to anxiety
B. Social humiliation in adolescence
C. Avoidance of feared social situations
D. Absence of family history of anxiety disorders

Answer: B. Selective attention to failures and fear of negative evaluation

Explanation: Individuals with SAD show selective attention to perceived failures, fear of negative evaluation, and perfectionistic standards for social performance.

Which cognitive distortion is most commonly associated with SAD, according to Clark & Wells (1995) and Hofmann & Barlow (2002)?

A. Overestimation of positive feedback from others
B. Selective attention to failures and fear of negative evaluation
C. Denial of anxiety symptoms in public
D. Preference for solitary activities as a coping strategy

Answer: B. Being shy and socially inhibited since birth

Explanation: Bonnie’s temperamental shyness from birth is a biological predisposition. Avoidance (A) is perpetuating, fear of negative evaluation (C) is a cognitive maintaining feature, and humiliation (D) would be a precipitating factor.

In the case of Bonnie, which of the following is best classified as a predisposing factor for her SAD?

A. Avoiding social situations by relying on her younger sister
B. Being shy and socially inhibited since birth
C. Worrying that others will think badly of her after speaking
D. A humiliating event in adolescence

Answer: A. Having socially supportive friends who encourage participation

Explanation: Protective factors reduce the likelihood or severity of the disorder. Supportive relationships can buffer against anxiety, whereas B, C, and D increase risk.

Which of the following best represents a protective factor in the 4Ps model of SAD?

A. Having socially supportive friends who encourage participation
B. Selective attention to negative social cues
C. Parents who are overly concerned with others’ evaluations
D. Avoidance of feared social interactions

Answer: C. SAD runs in families, with relatives having higher prevalence (e.g., 16% vs 5%)

Explanation: Family studies (Fyer et al., 1993) show SAD runs in families, supporting a genetic and learned component.

Which statement about the familial risk of SAD is correct?

A. Children of parents with SAD have the same risk as the general population
B. Relatives of SAD patients show no higher risk than controls
C. SAD runs in families, with relatives having higher prevalence (e.g., 16% vs 5%)
D. Family history only influences panic disorder, not SAD

Answer: B. SAD is diagnosed if panic attacks are confined to social situations

Explanation: Panic disorder is more generalized; if panic occurs only in social contexts, the correct diagnosis is SAD.

In distinguishing SAD from panic disorder, which of the following is correct?

A. Panic disorder is diagnosed when panic occurs only in social situations
B. SAD is diagnosed if panic attacks are confined to social situations
C. Both disorders are identical in diagnostic criteria
D. SAD never involves panic attacks

Answer: A. Early shyness and social inhibition

Explanation: Predisposing factors include biological and temperamental vulnerabilities such as shyness.

Which of the following is a predisposing factor for SAD in the 4Ps model?

A. Early shyness and social inhibition
B. A humiliating incident in adolescence
C. Avoidance of feared social situations
D. Supportive friendships during high school

Answer: C. A humiliating event such as being ridiculed in class

Explanation: Precipitating factors trigger the onset—e.g., social trauma.

Which is a precipitating factor for SAD?

A. Avoidance of speaking in public
B. High self-imposed standards in social performance
C. A humiliating event such as being ridiculed in class
D. An inherited tendency toward inhibition

Answer: B. Parents show fear and avoidance in social situations, which the child imitates

Explanation: Parents who are socially fearful and evaluative may model this behavior, teaching children to avoid social situations.

Which of the following illustrates parental modeling as a risk factor for SAD?

A. A child inherits a shy temperament
B. Parents show fear and avoidance in social situations, which the child imitates
C. A teacher humiliates the child in front of peers
D. The child sets very high standards for themselves

Answer: B. A cognitive distortion linked to self-criticism

Explanation: Bonnie’s case illustrates negative self-evaluation, a cognitive maintaining feature of SAD.

Bonnie frequently berated her physical appearance despite being attractive. This is best understood as:

A. A protective factor
B. A cognitive distortion linked to self-criticism
C. A precipitating factor
D. A false alarm

Answer: A. Avoidance that perpetuates SAD

Explanation: Avoidance and delegating tasks reinforce SAD by preventing exposure and learning.

Bonnie often had her younger sister complete social tasks for her. This behavior is best classified as:

A. Avoidance that perpetuates SAD
B. Protective factor against SAD
C. Predisposing biological factor
D. True alarm response