Social Anxiety Background NotesSocial Anxiety in Adolescents Abstract”chronic, disabling and treatable disorder with common onset in adolescence” (Mehtalia 221)No Indian studiescommon adolescent disorderIntroductionoccurs in western countries in similar rates (more than eastern countries)More prevalent in girlsComorbid conditions in adolescents Material and MethodSocial Phobia Inventory (SPIN)  “self rating screening instrument” (Mehtalia 222)”subscale rating physiological arousal symptoms” (Mehtalia 222)Rating is from 0 (nothing) to 4 (extremely)Liebowitz Social Anxiety Scale (1987) “assesses both social interaction and performance related anxiety as well as fear and avoidance” (Mehtalia 222) Clinical Manifestations of SAD/ Associated Factors”Endorsed by at least 50% of the adolescents” (Mehtalia 223)Avoid giving speeches (most frequent anxiety)Scared of being criticizedAfraid of being watched by othersBeing embarrassedDifficulties with studiesWeight concernsLess intimate family relationshipsLess friends and treated differently by parents Depression and Social Anxiety/Comorbidity of Depression with Social Phobiaassociated with major depressive disorderMost have one or more psychiatric disorder Gender and associated factorsManifestations are equal between gendersBoys more afraid of authorityMore girls had trouble coping with studies and suffered hair loss Prevalence of SAD12.8% in adolescents in study”Eastern cultures emphasize emphasis on self as being part of a group rather than western emphasis on self as being autonomous” (Mehtalia 225) Demographic CharacteristicsNo gender differences in prevalenceWomen have twice more often SAD in community setting or oppressive societiesSAD frequency increased with age”raises risk of having major depression five times as compared to control group” (Mehtalia 226)Social Anxiety Disorder : More than Just a Little Shyness Abstract”marked and persistent fear of social or performance situations” (Jefferson 4)affects 13% of the populationcoexists with other disorders depressiondysthymia Introductionalso known as social phobia”a marked and persistent fear of social or performance situations in which embarrassment may occur” (Jefferson 4)Causes:AnxietyPanic attackSweatingShakingBlushingPalpitationsRespiratory or gastrointestinal distressAnxious prior and during expected social interactions DiagnosisCan be specific or generalizedSpecific is related  “to 1 or 2 performance situations, such as speaking, musical performance, or writing” (Jefferson 4)Generalized “is triggered by nearly all social situations” (Jefferson 4)Liebowitz Social Anxiety scale – 24 item questionnaireSevere generalized SAD is avoidant personality disorder”a pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation” (Jefferson 5) Comorbiditycoexists with more disordersHigh prevalence of comorbidityMajor depressionDysthymiaPanic disorderAnxiety disorderPhobiasAlcohol and substance abuseSAD is often overlookedComplicates treatmentPrevalence, Onset, and Impact13.3% lifetime prevalence in 48 states7.9% year long prevalence in 48 statesBegins in childhood or adolescencePersistent and debilitatingImpairs lifestyle and performance EtiologyCauses include:GeneticsDevelopmentNeurobiological factorsBehavioral inhibition is a dispositionEmbarrassing or humiliating eventConditioning TreatmentGradual exposure to social settingsPsychotherapySocial skills trainingExposure in vivoCognitive therapyCognitive behavioral therapyFinding experienced therapists is difficultSocial Skills TrainingTeaches patients verbal and nonverbal social skillsRehearsal and roleplayingExposure TherapyContinued exposure to create habituation of social settingsNeeds to be lengthy and repeatedCognitive TherapyCorrects irrational thoughts or beliefs causing SADCognitive Behavioral Therapy”Best studied psychotherapeutic approach to social anxiety disorder” (Jefferson 7)Exposure therapy and cognitive therapy Cognitive Behavioral Group Therapy is “as effective as pharmacology” (Jefferson 7)PharmacologyParoxetine- only medication indicated by FDABeta-BlockersReduce autonomic arousal and somatic symptomsNot proven useful on a scheduled basisAnxiolytic PharmacotherapyBenzodiazepinesRapid onsetGood tolerabilityFlexible dosingSide effectsBuspironeEffective at high dosesAntidepressant PharmacotherapyMonoamine oxidase inhibitors (MAOIs)Phenelzine is an effective treatmentDietary restrictions, risk for blood pressure problemsTricyclicsNot effectiveAntidepressantsSelective serotonin reuptake inhibitorsTreatment of choiceDoses consistent with those of depressionBenefits over several weeksAnticonvulsant PharmacotherapyOnly two have been tested for effectsGabapentin- treatment for epilepsyPregabalin- investigational drugUnder investigation Treatment ConsiderationSpecific SADBeta blocker preferred for specific SADBenzodiazepines are effective but impair cognition and coordinationGeneralized SADCognitive behavioral approach is preferablePharmacotherapy should be scheduledDealing with Comorbidity Referred to a psychiatristMultifactorial approach neededProblem is not condition but failure to recognize comorbiditiesHistorical Aspects of Anxiety AnxietyDescriptions common in classical literaturePhobos for fear and Deimos for flightEvolutionPathological behaviors are evolved due to neolithic ancestorsNot preferable in modern timesCanonquick adaptive functions of fear and angerMake responses of fight and flightPavlovnoted the importance of traumadiscriminations between conditional stimuli led to agitation Learning Theoryconditionable part of fear”a learned avoidance maintained by decreases in anxiety” (Klein 297)avoid stressful situations even if they never experienced panic thereKraepelinboth circumscribed and generalized social phobia through patient observationdescriptions claimed fatalisticFreud”accumulating libido, undischarged because of an unsatisfactory sexual life, as with abstinence or coitus interruptus, sufficed to cause an “actual” neurosis” (Klein 298)changes in sexual practices as a cure Conclusionorganisms came across natural and social dangers Natural selection developed specific physiological facilitators Advances in the Research of Social Anxiety and Its Disorderdiagnostic category in the DSM beginning 1980Thought to be a specific phobiaFailed to recognize that individuals fear multiple social situationsRevised DSM defines it as individuals who fear most to all social situationsdiagnosed if person also met criteria for antisocial personality disorderpatients fail to obtain full benefit from CBTNewer CBT modifies “safety behaviors and self-focused attention” (Hofmann 2)greater treatment efficacyCauses maternal rejection in first-time mothersassociated with less positive affect and more angerignored in the social anxiety literature