ch. 5 social anxiety disorder pt 2

SAD

marked fear of anxiety focused on one or more social or performance situations

fear of negative evaluation (FNE)

speaking in public, eating in a restaurant, interacting with people

fear of positive evaluation

fear of being judged (gives standards for themselves), don’t know how to response socially

typical areas of concern for social anxiety

• social competence

• physical appearance

• signs of anxiety

SAD safety behaviours

• excessive substance use (especially alcohol)

• being on phone

• online friendships

• talking to 1 person

• not staying in a conversation with 1 person

• asking lots of questions

difference between shyness and SAD

most shy people do not have symptoms that meet diagnostic criteria for SAD

male SAD concerns

more towards dating, more likely to abuse substances to self medicate

taijun kyofusho

belief that one displays specific physical flaws/socially inappropriate behaviours that are not common in western culture

• fear of offending others from their own flaws

genetic components of SAD

• proclivity towards anxiety

• disposition to easily blush, sweat, shake

• parents of SAD people tend to be more socially fearful

  • modelling, genetics

behavioural inhibition

tendency to experience distress and to withdraw from unfamiliar situations, people or environment

biological predispositions for SAD

predisposed to fear angry, critical, or rejecting people/faces

treatments for SAD

• antidepressants (SSRIs)

• CBGT

• IPT

CBGT

cognitive behavioural group therapy

• for social phobia, includes role-play of feared social situations

• social mishap exposures

• performance exposures

GAD

uncontrollable, unproductive worrying about everyday events

• feelings of catastrophe, inability to stop worry-anxiety cycle

symptoms of GAD

muscle tension, mental agitation, susceptibility to fatigue, irritability, difficulty sleeping

• arousal of autonomic system

GAD diagnosis

• excessive uncontrollable worry occurring more days than not for at least 6 months

how is GAD different than SAD

worry is the cognitive component of GAD

what makes worry excessive

worrying when there is nothing wrong, or in a manner that is disproportionate to actual risk

twin studies in GAD

heritable

• risk is greater for monozygotic than dizygotic

anxiety sensitivity

tendency to become distressed in response to arousal-related sensations

physiological differences between GAD and other disorders

GAD has less physiological responsivity than other panic-based disorders

• chronic muscle tension appears to differentiate GAD

cognitive characteristics of GAD

1. intolerance of uncertainty

2. positive beliefs about worry

3. poor problem orientation

4. lack of confidence in problem solving ability

intolerance to uncertainty

less tolerant of situations involving uncertainty

positive beliefs about worry

hold stronger beliefs that worrying is effective in avoiding negative outcomes and promoting positive outcomes

poor problem orientation

tend to view problems as threats to be avoided rather than as challenges to be met, unable to distinguish which problem to conquer first, everything is burning down

lack of confidence in problem solving ability

• become easily frustrated when dealing with problems

• pessimistic about problem solving outcomes

cognitive avoidance

worry may serve an avoidance function

how is worry an avoidant coping strategy

reduces distress/emotion for short-term

• negative reinforcement

avoidance that does not look like avoidance

• reassurance seeking

• excessive information seeking

• quick decision making

• slow decision making

• procrastination

• over preparing

GAD treatment

• benzos

• SSRIs

• CBT

• MBTs

CBT for GAD

patients confront threatening images and thoughts head-on; learn to use cognitive therapy to counteract and control worry

mindfulness-based therapies (MBTs)

acceptance of distressing thoughts and feelings in addition to CBT