Social Anxiety Disorder

by Martin M. Antony, Karen Rowa

Overview

Social anxiety is characterized by excessive anxiety or discomfort in situations where a person might feel judged or evaluated by others, including performance situations (e.g., being the center of attention, public speaking, working under observation, playing sports or music in front of an audience) and situations involving interpersonal contact with others (e.g., making small talk, meeting new people, dating). According to large-scale epidemiological studies, social phobia is one of the most prevalent psychological disorders. Although prevalence estimates vary, recent studies suggest that approximately 7% of Americans suffer from this disorder. In addition to the high percentage of people with symptoms meeting criteria for this disorder, many other individuals experience social anxiety or shyness to a lesser, but still impairing degree. Social phobia is also a common comorbid condition, often diagnosed along with other anxiety disorders. Taken together, this information suggests that practitioners are likely to encounter patients displaying some degree of social anxiety, no matter what specialty service or setting they occupy. Although social anxiety is a widely encountered problem, there are few resources available to provide straightforward, accessible assessment and treatment information for practitioners. This book aims to fill that gap. Over the past 20 years, effective tools have been developed to identify and treat individuals with social anxiety. The current book provides up-to-date information on the diagnosis, identification, conceptualization, and treatment of social anxiety and social phobia. This book is aimed at practitioners who practice in a broad range of settings, from specialty clinics to general practice, as well as students. Existing books tend to focus on the psychopathology of social anxiety, address multiple disorders in one volume, or provide extensive and detailed protocols for treating this disorder. In

Product Details

ISBN-13:	9780889373112
Publisher:	Hogrefe Publishing
Publication date:	01/01/2008
Series:	Advances in Psychotherapy -- Evidence-Based Practice Series , #12
Pages:	102
Product dimensions:	6.90(w) x 9.90(h) x 0.20(d)

Table of Contents

Preface v

Dedication vii

1 Description l

1.1 Terminology 1

1.2 Definition 1

1.3 Epidemiology 3

1.4 Course and Prognosis 4

1.5 Differential Diagnosis 5

1.5.1 Panic Disorder with Agoraphobia 5

1.5.2 Generalized Anxiety Disorder 6

1.5.3 Specific Phobia 7

1.5.4 Depression 7

1.5.5 Avoidant Personality Disorder 8

1.5.6 Schizoid Personality Disorder 8

1.6 Comorbidity 9

1.7 Diagnostic Procedures and Documentation 9

1.7.1 Interviewer Administered Measures 10

1.7.2 Self-Report Severity Measures 11

1.7.3 Behavioral Approach Tests (BATs) 11

1.7.4 Assessing Suitability for Treatment 12

2 Psychological Approaches to Understanding Social Anxiety Disorder 14

2.1 The Cognitive Model of Clark and Wells 14

2.2 The Cognitive Behavioral Model of Rapee and Heimberg 17

2.3 Negative Learning Experiences and Social Anxiety 19

2.4 Temperamental Bases of SAD 20

2.5 Implications for Treatment 21

3 Diagnosis and Treatment Indications 22

3.1 Key Features to be Assessed 22

3.1.1 Situational Triggers 22

3.1.2 Physical Features 23

3.1.3 Cognitive Features 23

3.1.4 Avoidance Strategies 24

3.1.5 Safety Behaviors 24

3.1.6 Anxiety Sensitivity 25

3.1.7 Social Skills 25

3.1.8 Environmental Factors 26

3.1.9 Comorbidity 26

3.1.10 Functional Impairment 27

3.2 Overview of Effective Treatment Strategies 27

3.3 Factors That Influence Treatment Decisions 29

3.3.1 Age, Sex, and Ethnicity 29

3.3.2 Education 30

3.3.3 Family and Relationship Factors 30

3.3.4 Client Preference 30

3.3.5 Treatment History 30

3.3.6 Ability to Articulate Cognitions 31

3.3.7 Anxiety Sensitivity and Fear of Sensations 31

3.3.8 Severity of Avoidance and Safety Behaviors31

3.3.9 Social Skills 31

3.3.10 Comorbidity 32

3.3.11 Group Versus Individual Treatment 32

4 Treatment 33

4 Methods of CBT 33

4.1.1 Self-Monitoring 33

4.1.2 Psychoeducation 36

4.1.3 Cognitive Strategies 38

4.1.4 Exposure-Based Strategies 44

4.1.5 Social Skills Training 51

4.1.6 Relaxation and Arousal Management Strategies 53

4.2 Mechanisms of Action 54

4.2.1 Cognitive Models 54

4.2.2 Behavioral Models 55

4.2.3 Emotional Processing Models 56

4.3 Efficacy 56

4.3.1 Efficacy of CBT 56

4.3.2 Predictors of Outcome 60

4.3.3 Preventing Relapse and Return of Symptoms 61

4.4 Combination Treatments 62

4.4.1 Medication Treatments 62

4.4.2 Comparing and Combining Medications and CBT 63

4.5 Overcoming Barriers to Treatment 66

4.5.1 Treatment Ambivalence 66

4.5.2 Homework Noncompliance 68

4.5.3 Adapting Treatment for Comorbidity 69

4.6 Adapting Treatment for Different Age Groups 70

4.6.1 Children and Adolescents 70

4.6.2 Older Adults 71

4.7 Adapting Treatment for Different Cultures 72

5 Case Vignettes 74

Case 1 Susan's Public Speaking Fears 74

Case 2 Jeremy's Generalized Social Fears 77

6 Further Reading 81

7 References 82

8 Appendix: Tools and Resources 91

Editorial Reviews

Reviewer: Nicholas Greco IV, MS, BCETS, CATSM, FAAETS (C3 Education and Research, Inc.)
Description: This installment in the Advances in Psychotherapy series focuses on social anxiety disorder (SAD). In keeping with past topics in this series, this book highlights the latest in interventions, both psychopharmacological and nonpharmacological. The information is also presented in an easy-to-read format.
Purpose: The purpose is to provide readers with empirically supported psychological therapy for SAD, specifically cognitive behavioral therapy (CBT). Secondarily, this latest installment in the series strives to provide the necessary knowledge and treatment interventions of most use to clinicians. The book well exceeds the authors' objectives.
Audience: This book will be of most value to mental health clinicians such as psychologists, psychiatrists, social workers, family physicians, and other mental health professionals, but it also would serve quite well as a supplement at the graduate level. The authors bring with them substantial expertise and are credible members of the field.
Features: Readers are given a strong overview on SAD with a thorough discussion of the differential diagnostic considerations. The book is broken down into six parts which include a description of SAD, psychological approaches to understanding SAD, diagnostic and treatment indications, treatment, case vignettes, and further reading. The highlights are the two case vignettes which bring together everything discussed in previous chapters and provide wonderful closure to such a terrific additional to the field. Readers will appreciate that the book is only 80 pages, but still has all of the essential information.
Assessment: This latest addition to the Advances in Psychotherapy series is a perfect companion for every clinician and harried researcher who needs reliable and accurate information.

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