Social Anxiety (eBook)

Clinical, Developmental, and Social Perspectives

Patricia M. DiBartolo, Stefan G. Hofmann (Herausgeber)

eBook Download: EPUB

2010 | 2. Auflage
632 Seiten
Elsevier Science (Verlag)
978-0-12-378552-7 (ISBN)

Clinicians, social and developmental psychologists and behavioral geneticists have all conducted research over the past ten years which is essential to furthering our understanding of and treatment of social anxiety disorders. If researchers and clinicians are to successfully combat this disorder, the literature must fully integrate studies on social anxiety, shyness, and embarrassment with the research on social anxiety disorder subtypes, biological theories and cognitive-behavioral or pharmacological treatment outcome studies. This ,book weaves together research findings gathered by renowned minds across these various disciplines, and chapters deal with both theory and research. Thorough exploration is given as to how to define what constitutes social anxiety, and assessment of the condition and its relationship to other psychological disorders. ,The biological basis and treatment approaches are also all explored in full. Coverage includes key issues not disucssed fully by other existing books, including related disorders of adult and childhood, relationship to social competence and assertiveness, relationship to perfectionism, social skills deficit hypothesis, comparison between pharmacological and psychosocial treatments, and potential mediators of change in the treatment of social anxiety disorder.

* The most comprehensive source of up-to-date data, with review articles covering a thorough deliniation of social anxiety, theoretical perspectives, and treatment approaches
* Consolidates broadly distributed literature into single source, saving researchers and clinicians time in obtaining and translating information and improving the level of further research and care they can provide
* ,Each chapter is written by an expert in the topic area
* Provides more fully vetted expert knowledge than any existing work
* Integrates findings from various disciplines - clinical, social and developmental psychology, psychiatry, neuroscience, - rather than focusing on only one conceptual perspective
* Provides the reader with more complete understanding of a complex phenomena, giving researchers and clinicians alike a better set of tool for furthering what we know
* Offers coverage of essential topics on which competing books fail to focus, such as: related disorders of adult and childhood, the relationship to social competence, assertiveness and perfectionism, social skills deficit hypothesis, comparison between pharmacological and psychosocial treatments, and potential mediators of change in the treatment of social anxiety disorder population

Social Anxiety Clinical, Developmental, and Social Perspectives, Second Edition, provides an interdisciplinary approach to understanding social anxiety disorder (SAD) by bringing together research across several disciplines, including social psychology, developmental psychology, behavior genetics, and clinical psychology. The book explains the different aspects of social anxiety and social phobia in adults and children, including the evolution of terminology and constructs, assessment procedures, relationship to personality disorders, and psychopathology. It considers most prominent theoretical perspectives on social anxiety and SAD discussed by social psychologists, developmental psychologists, behavior geneticists, clinical psychologists, and psychiatrists. These theoretical perspectives emphasize different factors that can contribute to the etiology and/or maintenance of social anxiety/SAD. Treatment approaches are also discussed, such as cognitive behavioral therapy, exposure intervention, social skills training. The contents of this volume represent some of the best views and thoughts in the field. It is hoped that the breadth of perspectives offered will help foster continued interdisciplinary dialogue and efforts toward cross-fertilization to advance the understanding, conceptualization, and treatment of chronic and debilitating social anxiety. - The most comprehensive source of up-to-date data, with review articles covering a thorough deliniation of social anxiety, theoretical perspectives, and treatment approaches- Consolidates broadly distributed literature into single source, saving researchers and clinicians time in obtaining and translating information and improving the level of further research and care they can provide- Each chapter is written by an expert in the topic area- Provides more fully vetted expert knowledge than any existing work- Integrates findings from various disciplines - clinical, social and developmental psychology, psychiatry, neuroscience, - rather than focusing on only one conceptual perspective- Provides the reader with more complete understanding of a complex phenomena, giving researchers and clinicians alike a better set of tool for furthering what we know- Offers coverage of essential topics on which competing books fail to focus, such as: related disorders of adult and childhood; the relationship to social competence, assertiveness and perfectionism; social skills deficit hypothesis; comparison between pharmacological and psychosocial treatments; and potential mediators of change in the treatment of social anxiety disorder population

Front Cover 1
Social Anxiety 4
Copyright Page 5
Contents 6
Contributors 16
Introduction: Toward an Understanding of Social Anxiety Disorder 20
Delineation of Social Anxiety 21
Theoretical Perspectives 23
Treatment Approaches 25
Conclusion 26
References 27
Part I: Delineation of Social Anxiety 28
Chapter 1. Evolution of Terminology and Constructs in Social Anxiety and Its Disorders 30
Introduction 30
Overlapping and Contrasting Emotional States 32
Definitions 34
Diagnostic Nosology Classifications 35
Relation of Performance Deficits and Social Anxiety 37
Subtypes of SAD 38
Cultural and Developmental Considerations 41
Coverage Across Disciplines and Subdisciplines 42
Summary and Conclusions 43
Acknowledgments 44
References 44
Chapter 2. Assessment of Social Anxiety and Social Phobia 50
The Clinical Interview 51
Interviewer-Rated Scales 55
Self-Report Measures 56
General Measures of Social Anxiety and Social Phobia 57
Measures of Theoretically Derived Components of Social Anxiety 62
Self-Report Measures for Children and Adolescents 66
Role-Playing Procedures 69
Thought-Listing and Thought-Endorsement Procedures 72
Psychophysiological Assessment 75
Summary 78
References 79
Chapter 3. Shyness, Social Anxiety, and Social Anxiety Disorder 92
Introduction 92
Definitions 94
Prevalence 97
Cultural Influences 97
Comorbidity in a Shyness Treatment Sample 98
Development of Chronic Shyness 99
Individual Differences in Shy and Socially Phobic Individuals 103
Characteristics of Shy and Socially Phobic Individuals 104
Treatment 108
Social Fitness Model 112
References 114
Chapter 4. Are Embarrassment and Social Anxiety Disorder Merely Distant Cousins, or Are They Closer Kin? 120
The Nature of Embarrassment 121
Embarrassment and Social Anxiety Disorder 133
Conclusions 139
References 140
Chapter 5. Social Anxiety Disorder and Its Relationship to Perfectionism 146
Perfectionism and Measures of Social Anxiety in Nonclinical Samples 148
Perfectionism in Patients with Social Anxiety Disorder 152
Perfectionism in Social/Evaluative Contexts 156
Perfectionism and Social/Evaluative Avoidance 161
The Effect of Treatment for Social Phobia on Perfectionism 165
Summary and Conclusions 166
References 167
Chapter 6. Social Phobia as a Deficit in Social Skills 174
Introduction 174
The Notion of Social Skills 175
Assessment of the Social Skills of Social Phobic Individuals 179
Skills Deficits and Social Phobia – Direct and Indirect Evidence 187
Social Phobia as a Problem in Social Functioning 199
The Treatment of Social Phobia as an Antidote to Its Etiology, or, Social Skills Training for Social Skills Deficits 201
Conclusion 203
References 203
Chapter 7. Relation to Clinical Syndromes in Adulthood 210
Comorbidity in Studies Using DSM-III and DSM-III-R Criteria 210
Comorbidity in Studies Using DSM-IV Criteria 215
Comorbidity Between Social Anxiety Disorder and Other Conditions 224
Cross-Cultural Expressions of Comorbidity 227
Comment and Future Directions 228
References 229
Chapter 8. Avoidant Personality Disorder and Its Relationship to Social Phobia 234
Introduction 234
Diagnostic Issues Using The DSM 234
Review of Early Findings 236
Findings from More Recent Literature 243
Discussion 245
Conclusions 246
References 246
Chapter 9. Social Anxiety in Children and Adolescents: Biological, Developmental and Social Considerations 250
History and Morphology of Social Anxiety Disorder (Social Phobia) 251
Biological Factors 252
Developmental Factors 263
Social Factors 266
The Maintenance of Childhood Social Anxiety: A Cognitive Behavioral Model 269
Evidence-Based Treatment of Social Anxiety 270
Conclusion/Future Directions 275
References 276
Part II: Theoretical Perspectives 298
Chapter 10. Neuroendocrinology and Neuroimaging Studies of Social Anxiety Disorder 300
Introduction 300
Neuroendocrinology of Social Anxiety Disorder 301
Neuroanatomy of Social Anxiety Disorder 305
Integrating Neuroendocrine and Neuroanatomical Studies 325
General Conclusions 326
Future Directions 327
References 328
Chapter 11. Genetic Basis of Social Anxiety Disorder 340
Introduction 340
Linkage Studies in Social Anxiety Disorder 340
Association Studies in SAD 341
Association Studies in Traits of Potential Relevance to SAD 342
Conclusions 346
References 346
Chapter 12. Temperamental Contributions to the Development of Psychological Profiles 350
How Many Temperaments? 350
Genes and Neurochemistry 352
Other Origins of Temperament 354
Sources of Evidence 355
Variation in Reactions to the Unfamiliar 357
High- and Low-Reactive Infants 358
Assessment in the Second Year 359
Assessment at Four-and-a-Half Years 360
Assessment at Seven-and-a-Half Years 361
Assessment at 11 Years 362
Assessment at 15 Years 364
References 369
Chapter 13. Basic Behavioral Mechanisms and Processes in Social Anxieties and Social Anxiety Disorders 374
Introduction 374
Current Status of Behavioral Theory of Social Anxieties and Social Anxiety Disorder 377
Contemporary Behavioral Principles as a Basis for the Further Development of Theories of Social Anxieties and Social Anxiety Disorder 379
Summary and Conclusions 393
Acknowledgments 394
References 394
Chapter 14. Cognitive Biases in Social Anxiety Disorder 400
Introduction 400
Attention 401
Interpretation 405
Memory 409
Conclusions 414
References 415
Chapter 15. A Cognitive Behavioral Model of Social Anxiety Disorder: Update and Extension 422
The Original Model 423
Imagery in Social Anxiety Disorder 428
Post-Event Processing 434
The Combined Cognitive Biases Hypothesis 436
Fear of Positive Evaluation 439
Emotion Dysregulation in Social Anxiety Disorder 440
Implications for the Rapee–Heimberg Model of Social Anxiety Disorder 441
References 444
Chapter 16. Social Anxiety, Social Anxiety Disorder, and the Self 450
The Self 450
Overview 451
A Social-Cognitive Perspective 451
Theoretical and Research Perspectives on Social Anxiety 453
Theoretical and Research Perspectives on Social Anxiety Disorder 459
Future Directions 466
References 467
Chapter 17. Social Anxiety, Positive Experiences, and Positive Events 474
A Self-Regulation Perspective on Social Anxiety 475
Social Anxiety and Positive Experiences 476
Positive Cognitions Relevant to the Social Anxiety Spectrum 479
Biological Markers of Diminished Rewards in Social Anxiety 486
Meaningful Heterogeneity in Social Anxiety 487
Summary 489
References 492
Chapter 18. Social Anxiety as an Early Warning System: A Refinement and Extension of the Self-Presentation Theory of Social Anxiety 498
The Original Self-Presentation Theory 499
Extending the Self-Presentation Approach: Sociometer Theory 501
Social Anxiety and Interpersonal Behavior 506
Implications for Treatment 507
Conclusions 510
References 510
Part III: Treatment Approaches 514
Chapter 19. Psychopharmacology for Social Anxiety Disorder 516
Medication Treatments 517
Pharmacotherapy in Children and Adolescents 534
Recommendations 537
References 539
Chapter 20. Treatment of Social Anxiety Disorder: A Treatments-by-Dimensions Review 546
Treatment Impact on Physiological Symptoms 547
Treatment Impact on Cognitive Symptoms 550
Treatment Impact on Overt Behavioral Performance 567
Overall Conclusions 572
Summary 575
References 576
Chapter 21. Comparison between Psychosocial and Pharmacological Treatments 582
Psychosocial Treatments 582
Pharmacological Treatments 584
Comparison of Psychosocial and Pharmacological Treatments: Meta-Analyses 584
Comparison of Psychosocial and Pharmacological Treatments: Individual Trials 585
Advantages of Psychosocial Treatments 589
Advantages of Pharmacological Treatment 589
Novel Therapeutics: Combining "Cognitive Enhancers" with Psychosocial Treatment 590
Clinical Implications and Discussion 593
References 596
Chapter 22. Mechanisms of Action in the Treatment of Social Anxiety Disorder 604
A Model of Social Anxiety Disorder 605
Mechanisms of Treatment: Pharmacotherapy 607
Mechanisms of Treatment: CBT 611
Combined Pharmacotherapy and CBT 617
Social Skills Training 618
Acceptance and Commitment Therapy 618
Other Psychosocial Treatments 619
Summary 620
References 621
Index 626
A 626
B 627
C 627
D 628
E 629
F 629
G 629
H 630
I 630
K 630
L 630
M 630
N 631
O 631
P 631
Q 632
R 632
S 633
T 635
V 635
Y 635

Introduction: Toward an Understanding of Social Anxiety Disorder

Stefan G. Hofmann and Patricia M. DiBartolo

Humans are social creatures. We have a strong need to be liked, valued, and approved of by others. As a result, we have generated sophisticated social structures and hierarchies that greatly determine an individual’s value. Ostracism from these social groups negatively impacts a variety of health-related variables, and social exclusion is experienced as a punishment. For example, violations of social norms can lead to imprisonment, which limits an individual’s social contacts. Moreover, violating prison rules can lead to a further restriction of social relationships and even solitary confinement. Due to the importance of our social structures, humans naturally fear negative evaluation by their peers.

The clinical expression of this evolutionarily adaptive concern is social anxiety disorder (SAD). In Western cultures, the lifetime prevalence rates of SAD range between 7 and 12% of the population (Furmark, 2002; Kessler, Berglund, Demler, Jin, & Walters, 2005). This disorder affects men and women relatively equally, with the average gender ratio (female:male) ranging between 1:1 (Moutier & Stein, 1999) and 3:2 (Kessler et al., 2005) in community studies. During childhood, SAD is often associated with shyness and behavioral inhibition (BI). If the problem is left untreated, it typically follows a chronic, unremitting course and can lead to substantial impairments in vocational and social functioning (Stein & Kean, 2001).

When reading the existing literature of social anxiety, one is struck by the lack of integration of the research findings that have been gathered by the various scientific disciplines, including social psychology, clinical psychology, psychiatry, developmental psychology, and behavior genetics. For example, clinical psychologists and psychiatrists tend to know relatively little about the relationship between social anxiety, shyness, and embarrassment or about contributions from behavior genetics. Conversely, social and developmental psychologists know relatively little about SAD subtypes, biological theories of SAD, and cognitive behavioral or pharmacological treatment outcome studies. In order to address these gaps in knowledge, we (Hofmann & DiBartolo, 2001) recruited some of the most distinguished theorists and researchers from the various fields to initiate an interdisciplinary dialogue in one edited volume almost 10 years ago. The field has progressed considerably since that first book was published. This current volume updates the status of the scientific findings across a variety of diverse disciplines with contributors providing data and theory from their own conceptual perspectives relevant to their area of expertise.

Delineation of Social Anxiety

Chapter 1 by McNeil reviews the evolution of the terms social anxiety, SAD, and related constructs. Constructs such as shyness, introversion, BI, social anxiety, and SAD all share very similar meanings and are often used interchangeably, which can complicate things enormously. Choosing the right terminology is not a trivial thing. It reflects, and possibly determines, our understanding and conceptualization of the issue under investigation. McNeil proposes a number of specific ways in which these terms may inter-relate. He concludes that different forms of “social anxieties” exist along a continuum, and that related constructs, such as shyness, span from “normal” and “high normal” to pathological levels of social anxiety.

A similar dimensional approach towards psychopathology is the implicit model of many psychological assessment procedures for social anxiety and social SAD. Consistent with this notion, Herbert and colleagues (Chapter 2) start from the basic premise that social anxiety and SAD do not differ qualitatively but rather quantitatively. Therefore, the various assessment methods (which should include a multimodal approach) can be used for assessing social anxiety as well as SAD. However, as we note below, other theorists believe that such a dimensional perspective toward SAD and shyness is problematic (e.g., see Chapter 12).

The aforementioned terminology problem becomes even more complex when we consider the construct of shyness, which is covered by Henderson and Zimbardo (Chapter 3). As their chapter shows, it seems almost impossible to discuss the psychopathology of shyness without referring to social anxiety or related constructs. Their chapter notes the overlap between shyness and SAD while recognizing that individuals who label themselves as shy often express heterogeneous behavioral and symptom profiles. A little clearer seems to be the distinction between social anxiety/SAD and embarrassment, which is discussed by Miller (Chapter 4). Unlike SAD, the experience of embarrassment is something ordinary, normal, and adaptive because it provides an effective way to overcome minor and inevitable mishaps that occur in interactions with other people. Miller points to one important commonality between social anxiety/SAD and embarrassment: both constructs include the fear of negative evaluation by others. Neither SAD nor embarrassment would exist if people did not care what others thought of them.

Does this mean that socially anxious individuals are overly perfectionistic when it comes to social interactions? This hypothesis is investigated in the chapter by Frost, Glossner, and Maxner (Chapter 5). They conclude that certain characteristics of perfectionism, and in particular the maladaptive evaluative concern dimensions, are in fact associated with social anxiety and related constructs. A review of the literature suggests that, compared to nonanxious controls, individuals with clinical levels of social anxiety are more perfectionistic. The central features of perfectionism related to SAD are an excessive concern over mistakes, doubts about the quality of one’s actions, and the perception that other people have excessively high expectations. Although similar differences in perfectionism dimensions can also be found when comparing nonclinical participants with other anxiety-disordered groups, certain of these dimensions are elevated in samples with SAD relative to other anxiety patients.

The next chapter, by Stravynski, Kyparissis, and Amado (Chapter 6), deals in detail with the relationship between social anxiety/SAD and social skills, and more specifically with the (once) popular assumption that SAD is caused by a deficit in social skills. Based on a critical review of the literature, Stravynski et al. conclude that there is very little empirical evidence to suggest that SAD is caused by, or even consistently linked with, deficits in social skills. They argue that the main problem lies in the conceptualization and operational definition of the construct of social skills. The authors encourage researchers to take a fresh look at the “social” aspect of SAD by investigating the pattern of social behaviors characterizing SAD in real-life situations.

Two of the remaining chapters of the first part of the volume deal with contemporary diagnostic controversies, namely with the relationship between SAD and other DSM (Diagnostic and statistical manual of mental disorders) Axis I disorders in adulthood (Chapter 7 by Wenzel), and Axis II disorders (Chapter 8 by Reich). Comorbidity, which refers to the co-occurrence of two or more mental disorders in one person, is an inevitable “side effect” of our existing categorical diagnostic classification system (the DSM). Based on the existing literature, Wenzel concludes that comorbidity is common, even typical, for individuals with SAD. Rates of comorbidity between SAD and other anxiety and mood disorder are high and there is growing evidence of heightened risk for substance use disorders as well. Wenzel also notes emerging evidence indicating increased risk of comorbidity for SAD and a variety of other conditions (e.g., eating disorders, bipolar disorder). She urges the field to begin to identify the pathogenesis of these comorbidities, rather than merely document their co-occurrence.

Among the Axis II disorders, the most highly comorbid (and most controversial) diagnostic category is avoidant personality disorder (APD). The empirical evidence, as reviewed by Reich, suggests that SAD and APD probably relate to the same disorder with different subtypes. SAD and APD cannot be distinguished on the basis of symptomatology or treatment response. Although individuals with both SAD and APD seem to report a greater degree of distress in social situations, they respond equally well to treatment to those without this additional Axis II diagnosis. Reich points out that this raises the question of whether APD is in fact a viable Axis II diagnosis because our diagnostic system defines a personality disorder as an enduring, inflexible, and pervasive problem. Reich offers a creative solution to this problem by creating a subcategory in Axis II for chronic Axis I disorders “with significant personality features.”

The final chapter of Part I, by Detweiler, Comer, and Albano (Chapter 9), examines the risks, phenomenology, etiology, and empirically supported treatments for socially anxious children and adolescents. Their review reveals the considerable social, occupational, and emotional tolls associated with SAD in developing youth. Furthermore, Detweiler et al. present the latest research on the biological, social, and developmental risks associated...

Erscheint lt. Verlag	22.9.2010
Sprache	englisch
Themenwelt	Geisteswissenschaften ► Psychologie ► Klinische Psychologie
	Geisteswissenschaften ► Psychologie ► Persönlichkeitsstörungen
	Geisteswissenschaften ► Psychologie ► Sozialpsychologie
	Medizin / Pharmazie ► Gesundheitsfachberufe
	Medizin / Pharmazie ► Medizinische Fachgebiete ► Psychiatrie / Psychotherapie
	Technik
ISBN-10	0-12-378552-9 / 0123785529
ISBN-13	978-0-12-378552-7 / 9780123785527

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Buch | Hardcover (2010)

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