social anxiety disorder

UCP

what is SAD

• marked fear or anxiety about a social situation, out of proportion to the actual threat

• situations avoided, or endured with intense fear

• causes clinically significant impairment in social, occupational, etc areas

• persistent for over 6 months

• fear of future possible threats and their uncontrollability

symptoms

emotional → fear of doing or saying something that will result in embarrassment, humiliation, or rejection by others

physical → fear of blushing, sweating, shaking, or looking nervous

cognitive → fear of seeming boring, stupid, or strange

prevalence and onset

• lifetime prevalence of ~12% in adults

• women are more likely to have it (or report having it)

• present in 0.8% of British 5-19 year olds in 2107, up from 0.32% in 1999

• theoretically happens in adolescence, however some signs may be present earlier

• lower prevalence in collectivist societies

outcomes

risks of:

• substance misuse

• depression

• limiting prospects on professional life

• effect on relationships

• comorbidity

criteria for children

• anxiety must occur in peer settings not just during interactions with adults

• may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations

• fear is irrational and out of proportion

possible causes of SAD

genetic → meta-analysis of twin studies produced a mean heritability of 0.65

early environment → some evidence that early parenting stereotypes can increase the risk, mainly overprotection and modelling of social avoidance

early shaming experiences → parents and other authority figures may increase the effect of a negative appraisal

evolutionary model of SAD

• group living is advantageous for survival

• groups need stability to function, requiring a system for problem solving

• don’t want to be excluded from the group

affiliation system

• based on trust and cooperation between individuals

• increases social bonds and relationships

• in humans associated to ‘need to belong’ proposed by Maslow

• exclusion and rejection from a valued group is a harsh punishment, and one of the most feared aspects of rejection

social rank system

• present in most systems that live in groups

• fights and aggression between members of the same group is costly to individuals and groups

• allows distribution of resources without the need for aggression and competition

• primates and humans have the ability to monitor social status

• guide appropriate behaviour and regulate interactions

• guides individuals about acceptable actions in different ranks of the group structure

SAD from POV of evolution

• response is designed to prevent social rejection or exclusion

• by monitoring and correcting the behaviour we can function within the norms of the group

• SAD is an oversensitive system that does not stop when it should, when the threat is no longer present

Heimberg model - cog behavioural

• focuses on factors that increase and maintain SAD in individuals

• assumption that other people are always evaluating you

• assumption the audience has very high standards

• evaluation judged as very negative and very important

cognitive model - Clark and Wells

• people with SAD think they have social skill deficits, but it may actually be an issue with cognitive appraisal

• these beliefs cause them to act and think in ways that maintain the anxiety

• situation appraised as dangerous, so person engages in safety mechanisms to attenuate negative feelings

• these factors feedback the situation as even worse, reinforcing the negative appraisal

treatment

according to NICE guidelines

• individual CBT based on cognitive models

• medication potions available

• psychoeducation

• systematic training in externally focused self-attention

• modification of pre/post event processing