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Social Anxiety Disorder

Social Anxiety Disorder. Bonita Blas, Ashley Canillo, Sarah Taitano. Social Anxiety. (Stein, 2009). Subtypes & S pecifiers. Performance only: if the fear is restricted to speaking or performing in public.

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Social Anxiety Disorder

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  1. Social Anxiety Disorder Bonita Blas, Ashley Canillo, Sarah Taitano

  2. Social Anxiety

  3. (Stein, 2009)

  4. Subtypes & Specifiers • Performance only: if the fear is restricted to speaking or performing in public. • Performance fear may manifest in work, school, or academic settings in which regular public presentations are required. • Individuals with performance anxiety do not fear or avoid nonperformance social situations

  5. Prevalence Age: • Prevalence decreases with age • In older adults 12 month prevalence estimate around 2%-5% • Children and adolescents is comparable to adults Gender: • Higher rates found in woman than in men. • In adolescents, Social Anxiety Disorder is more prevalent in males than females. Places: • US estimates 7% • Europe estimates 2.3% Ethnicity: • SAD have higher rates found in American Indians and lower in persons of Asian, Latino, African American, Afro-Caribbean compared to non-Hispanic whites.

  6. Clinical course • In the United States, 13 years old is the median age of onset. • 75% of people with Social Anxiety Disorder have an onset between 8 and 15 years old. • Onset may be linked to humiliating experience • Older adults have lower level of social anxiety for board situations • Younger adults have higher rates for specific situations (DSM V, pp 205)

  7. Risk and prognostic factors • Temperamental – Underlying Traits, Behavioral Inhibition, and fear of negative evaluation • Environmental – Environmental risk factors, (e.g. childhood maltreatment and adversity) • Genetic and physiological - genetic factors & heredity (DSM V, pp 205)

  8. Differential diagnosis and common comorbid conditions • Normative shyness • Agoraphobia • Panic disorder • Generalized anxiety disorder • Separation anxiety disorder • Specific phobias • Selective mutism • Major depressive disorder • Body dysmorphicdisorder • Delusional disorder • Autism spectrum disorder • Personality disorders • Other medical conditions • Oppositional defiant disorder (DSM V, pp206-207)

  9. Evidence Based Practices • Pharmacological Treatment • Selective Serotonin Reuptake Inhibitors (SSRIs) • Most popular, relatively few major side effects • Prozac, Paxil, Zoloft • Serotonin and Norepinephrine Reuptake Inhibitors(SNRI • Act on 2 brain chemicals not just serotonin • Cymbalta, Effexor-XR • Benzodiazepines • Lowers anxiety levels quickly, but can be addictive • Xanax, Valium, Klonopin

  10. Evidence-Based Practices • Psychological Treatment • Cognitive Behavioral Therapy • Most effective and widely accepted as first treatment choice • Common features of CBT for SAD: • Collaborative • Focus on developing new skills • Brief and time-limited (12-16 sessions) • Focused on present • Structured • May also include other therapeutic approaches such as: • Psychoeducation • Cognitive Restructuring • In Vivo Exposure • Interoceptive Exposure • Social Skills Training

  11. Cognitive Behavioral Therapy

  12. Case Studies: CBT • Case Study 1: Study completed in Sweden. Compared Internet-Based Cognitive Behavioral Therapy (IBCBT) to Cognitive Behavioral Group Therapy (CBGT). 126 people were eligible to complete the study and randomized (IBCBT-64, CBGT-62). Results found that IBCBT just as effective as CBGT post treatment. (Hedman, et. al, 2011) • Case Study 2: Study completed in Sweden. This study aimed to distinguish if determine if shame, guilt and depressive symptoms are associated with SAD. It also set out to see if CBT helped to reduce these symptoms. Participants within the SAD group all received CBT and took a pre-test/post-test to determine levels of shame prior to and at the end of the study. Results found that CBT significantly lowered level of shame. (Hedman, Strom, Stunkel, & Mortberg, 2013)

  13. Case Studies: CBT • Case Study 3: Study completed in The Netherlands. This study compared an internet-based cognitive bias modification to a school-based cognitive behavioral group training and a control group to determine if either reduced symptoms of social and test anxiety in highly socially and/or test anxious adolescents aged 13-15. Students were randomly placed into the 3 groups and completed a pre/post test as well as 6 and 12 month follow up. Results found that early CBT intervention helps to reduce test anxiety and decrease in social anxiety. (Sportel, Hullu, de Jong, & Nauta, 2013) • Case Study 4: Study completed in Germany. This study was designed to determine the long-term effectiveness of Resource-Oriented Cognitive Behavioral Therapy (ROCBT) and Cognitive Therapy(CT). Both treatments were assessed at 2 years and again at 10 years. Results found significant improvement on social anxiety measures between post treatment and 10 year follow up. (Willutzki, Teismann, & Schulte, 2012)

  14. CULTURE: Adolescents • “Of all mental disorders, anxiety disorders affect the greatest number of children and adolescents (Mazur-Elmer, 2004)”… “they are among the most common psychiatric disorders in youth…and occur in 5-18% of all children and adolescents (Labellearte, Ginsburg, Walkup & Riddle, 1999).” • “Social anxiety disorder in adolescents is a serious condition with onset early in life, which often persists over the course of the lifespan (Mazur-Elmer, 2004).”

  15. ONSET AND PREVALENCE • According to SAMHSA, “among adolescents between the ages of 13 and 18, lifetime anxiety disorders (e.g., generalized anxiety disorder, specific phobia) are the most prevalent (31 percent) and have the earliest median age of first onset, usually around age 6 (2013).” •  The DSM states, "the median age at onset of social anxiety disorder in the United States is 13 years, and 75% of individuals have an age at onset between 8 and 15 years (APA, 2013).” • “the onset of SAD occurs at a relatively early age, with the average onset being 15.5 years (Mazur-Elmer, 2004).”

  16. “Anxiety in females is much more prevalent than in males. • Research has reported that as early as age six, girls are twice as likely as boys to experience anxiety symptoms • Some researchers have theorized that females may have a genetic or biological predisposition in developing internalizing disorders • Others proposed that gender differences in anxiety disorders are linked to differences in parent-child interaction styles (Mazur-Elmer, 2004).” • Lifetime Prevalence and Gender • Males: 7% • Females: 11.2% • Gender differences more prominent among adolescents • (SAMHSA, 2013)

  17. THE IRONY: A Gap? • “the topic of social anxiety in adolescents as despite being one of the most prevalent disorders of childhood and adolescence, social anxiety disorder paradoxically stands out as one of the least recognized, researched, and treated pediatric disorders (Mazur-Elmer, 2004).” • “Data on treatment for mental health and substance use disorders are more limited for children and adolescents than for adults… • Parents or primary care providers may have difficulty identifying behavioral health disorders or helping children and adolescents access the right types of treatment. On average, as reported in the NCS-R, the time from the onset of a mental disorder, which many experience first during childhood or adolescence, to first getting treatment is nearly 10 years… • This delay may lead to less effective treatments and poor outcomes (SAMHSA, 2013).”

  18. “Research suggests that many children and adolescents with mental health needs historically have not received mental health services… • A study using data from three nationally representative household surveys conducted from 1996 to 1998 found that of the 15 percent to 21 percent of children and adolescents aged 6 to 17 who were described as having a need for mental health care in the past year, only 20 percent received mental health services in the past year… • Adolescents with anxiety disorders (18 percent), substance use disorders (15 percent), and eating disorders (13 percent) are the least likely (among disorders measured in the NCS-A) to get treatment for their specific disorder. … • Treatment rates are highest for those with ADHD (48 percent) and lowest for those with anxiety disorders (32 percent) (As cited in SAMHSA, 2013).”

  19. “a six month study was conducted of 26 children aged 7 to 12 years who received a diagnosis of SAD, but did not receive treatment. The majority (62 %) retained their diagnosis over the six month follow-up period. Only 17% of the children showed dissipation of their social anxiety over the six-month follow-up… The Need to Close the Gap Social anxiety disorder is a condition warranting attention by both clinicians and researchers... Evidence suggests that social anxiety disorder in not a transient problem from which young people necessarily recover without some form of intervention; which is why attention to childhood social anxiety is important (Mazur-Elmer, 2004).”

  20. “adolescents are faced with numerous developmental demands, from dealing with hormonal changes to emotional regulation, while in an attempt to successfully adapt… Unfortunately, anxiety is often dismissed as a developmentally normal component of a teenager’s life (Price & Ingram, 2001). This perception may explain the lack of existing research about emotional difficulties in adolescence (Mazur-Elmer, 2004)”

  21. CLOSING FINDINGS • “Research has demonstrated that adolescence is a critical period for understanding the etiology and course of emotional disorders (project), hence there is strong emphasis on early intervention being key to preventing the development of SAD • With onset in late-childhood, social anxiety disorder can interfere with friendships, academics, and critical developmental tasks (Velting & Albano, 2001). • Left untreated, the consequences of social anxiety disorder are far-reaching in to adulthood, resulting in serious compromises to an individual’s ability to live independently and to his or her full potential (Reinecke et al., 2006). • The challenge of preventing the consequences of SAD lies in early diagnosis • Failure to intervene early with effective treatments may render the youth vulnerable to impairments in a wide range of functioning, resulting in harmful effects on his or her long-term emotional development (as cited in Mazur-Elmer, 2004).” • Weakness in studies and treatments: created for adult populations and to address all anxiety disorders in one cluster, rather than specific ones, hence, for the most part, majority of statistics represent ALL anxiety disorders (Herbert, Gaudiano, Rheingold, Moitra, Myers, Dalrymple & Brandsma, 2009).

  22. VIDEO • http://www.youtube.com/watch?v=kitHQUWrA7s

  23. References American Psychiatric Association, & American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Washington, D.C: American Psychiatric Association. Cognitive behavior therapy for generalized social anxiety disorder in adolescents: A randomized controlled trial James D. Herbert, Brandon A. Gaudiano, Alyssa A. Rheingold, Ethan Moitra, Valerie H. Myers, Kristy L. Dalrymple, Lynn L. Brandsma Journal: Journal of Anxiety Disorders 2009 DOI: 10.1016/j.janxdis.2008.06.004 Hedman, E., Ström, P., Stünkel, A., & Mörtberg, E. (2013). Shame and Guilt in Social Anxiety Disorder: Effects of Cognitive Behavior Therapy and Association with Social Anxiety and Depressive Symptoms. Plos ONE, 8(4), 1-8. doi:10.1371/journal.pone.0061713 Hedman, E., Andersson, G., Ljótsson, B., Andersson, E., Rück, C., Mörtberg, E., & Lindefors, N. (2011). Internet-Based Cognitive Behavior Therapy vs. Cognitive Behavioral Group Therapy for Social Anxiety Disorder: A Randomized Controlled Non-inferiority Trial. Plos Clinical Trials, 8(3), 1-10. doi:10.1371/journal.pone.0018001 Labellarte, M. J., Ginsburg, G. S., Walkup, J. T., & Riddle, M. A. (1999). The treatment of anxiety disorders in children and adolescents. Biological Psychiatry. doi:10.1016/S0006-3223(99)00248-6 Mazur-Elmer, A. (2004). TREATING SOCIAL ANXIETY IN ADOLESCENTS: TEN GROUP THERAPY LESSON PLANS. Retrieved from https://www.uleth.ca/dspace/handle/10133/2578 Nationalallieance of mental illness cognitive behavioral therapy. (n.d.). Retrieved from http://www.nami.org/Content/NavigationMenu/Inform_Yourself/About_Mental_Illness/About_Treatments_and_Supports/Cognitive_Behavioral_Therapy1.htm Social anxiety disorder and social phobia support. (n.d.). Retrieved from http://www.socialanxietysupport.com/disorder/

  24. References Social anxiety institute. (n.d.). Retrieved from https://socialanxietyinstitute.org/ Sportel, B., de Hullu, E., de Jong, P. J., & Nauta, M. H. (2013). Cognitive Bias Modification versus CBT in Reducing Adolescent Social Anxiety: A Randomized Controlled Trial. Plos ONE, 8(5), 1-11. doi:10.1371/journal.pone.0064355 Substance Abuse and Mental Health Services Administration. (2013). Behavioral Health, United States, 2012. HHS Publication No. (SMA) 13-4797. Rockville, MD: Substance Abuse and Mental Health Services Administration. Willutzki, U., Teismann, T., & Schulte, D. (2012). Psychotherapy for Social Anxiety Disorder: Long-Term Effectiveness of Resource-Oriented Cognitive-Behavioral Therapy and Cognitive Therapy in Social Anxiety Disorder. Journal Of Clinical Psychology, 68(6), 581-591. doi:10.1002/jclp.21842 Stein, D. J. (2009) Social anxiety disorder in the west and in the east. Annals of clinical psychiatry, 21(2), 109-117. Retrieved from https___www.aacp.com_pdf%2F2102%2F2102ACP_Review3 (1)

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