Lecture 2: Social Anxiety Disorder

What is SAD in a nutshell?

An overwhelming fear of social situations & persistent anxiety of being humiliated, criticized, and negatively evaluated

What is the common onset and prevalence rate of SAD?

Common onset: Adolescence

Prevalence rate: 5-12%

What are the behavioural symptoms of SAD?

• Fear of situations in which you may be judged negatively

• Avoidance of social situations

• Post- analysis of performance and identification of flaws in social interactions

• Expectation of the worst possible consequences

(catastrophizing) from a negative experience during

a social situation

What are physical symptoms of social anxiety disorder?

• Blushing

• Fast heartbeat

• Trembling

• Sweating

• Upset stomach or nausea

• Trouble catching your breath

• Dizziness or lightheadedness

• Feeling that your mind has

gone blank

• Muscle tension

What is the difference between someone with SAD and someone who is an introvert?

With SAD, it gets in your way, if you’re an introvert, that is your way

What situations do people with SAD struggle with?

THE BASICS … WHAT SITUATIONS ARE “SCARY” / AVOIDED?

 Interacting with unfamiliar people or

strangers

 Attending parties or social gatherings

 Going to work or school

 Starting conversations

 Making eye contact

 Dating

 Entering a room in which people are

already seated

 Returning items to a store

 Eating & even drinking in front of others

 Using a public restroom

When SAD is left untreated, what are the effects?

Low self-esteem

 Negative self-talk

 Poor social skills

 Isolation and difficult social relationships

 Low academic and employment achievement

 Risk of substance abuse

 Risk of depression

 Suicide or suicide attempts

What is the relationship between depression and SAD?

They are often comorbid, and SAD is the most common anxiety disorder for people with depression to have. SAD is a risk factor for depression. (treat SAD first) The risk of developing MD is increased 3.5 times in patients with SAD and 2 times

higher in patients with SAD compared to healthy controls

Why is the link between SAD and depression so pronounced?

Because SAD can lead to impairments in everyday life, it is easy to feel depressed if those things are not going well

What early experience factors contribute to SAD?

Certain parenting styles (overconcern with what others think, controlling, reluctant to show affection, overly cautious)

Experiences of being teased or bullied

(30-40% greater likelihood of developing SAD - genetic factors)

What is Clark and Well’s model of SAD?

What is the difference between Clark and Well’s and Rapee and Heimberg’s model?

R&H emphasises the importance of external threat cues

C&W see anxiety as a “closed model”

What is Rapee and Heimbergs model of SAD?

Why does attentional training help people with SAD?

Our attention is limited, so if they pay attention to the world around them consciously they will have less time to think about how they’re being evaluated

What is the emotional processing theory of exposure?

The idea that people have a “fear structure” when they encounter a dangerous stimulus. This is a good thing. However, fear structure becomes a problem when

(1) The information in the structure does not

accurately represent the world,

(2) Physical and escape/avoidance responses are

triggered by harmless stimuli,

(3) The fear responses interfere with daily

functioning,

(4) Harmless stimuli and responses are viewed as

being dangerous

In exposure, we reduce this fear association towards social stimuli by showing that the fear response will go down when repeatedly exposed

What is the problem with emotion processing theory?

Within and between-session habituation don’t predict treatment outcome sufficiently

Inhibitory learning theory

The idea that the feared association is still there, it’s just overridden by the CS- no US association when that happens repeatedly

Expectancy violation

Proving in exposure therapy that unexpected outcomes with regard to the feared stimulus occur

Design an experiment to conduct expectancy violation

What are you most afraid of? What could happen?

Under which circumstances do you think it most likely that this will

actually happen?

Think of an experiment with which you can best test your expectation.

Determine the duration and frequency that are necessary to violate your expectation.

Check the feasibility of the experiment

“Self presentation efficacy expectancy” (Leary & Atherton, 1986)

• The probability of behaving in a certain intended manner in order to convey an intended impression.

• The more positive the beliefs or expectancies are, the less social anxiety one will experience and vice versa