Task 3 Flashcards
(26 cards)
SOCIAL ANXIETY DISORDER
People are anxious in social situations and fear being rejected or humiliated in public, to point that their lives become focused on avoiding social encounters.
More likely than specific phobia to create severe disruption in person’s life, because it is harder to avoid social situations.
Women are more likely to develop this (esp. fear of performance), but men seek treatment more often, because their fears often include dating situations
It tends to develop either in early preschool years or adolescence, when people become self-conscious and concerned about others’ opinions.
CRITERION A for SA
Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (conversation, meeting unfamiliar people), being observed (eating or drinking), and performing in front of others (speech).
CRITERION B for SA
Individual fears that she/he will act in way or show anxiety symptoms that will be negatively evaluated (humiliating or embarrassing).
CRITERION C for SA
Social situations almost always provoke fear or anxiety.
CRITERION D for SA
Social situations are avoided or endured with intense fear or anxiety.
CRITERION E for SA
Fear or anxiety is out of proportion to actual threat posed by social situation and to sociocultural context.
CRITERION F for SA
Fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.
CRITERION G for SA
– Fear, anxiety or avoidance causes clinically significant distress or impairment in social, occupational or other important areas of functioning.
CRITERION H for SA
Fear, anxiety or avoidance is not attributable to physiological effects of substance (drug of abuse, medication) or another medical condition.
CRITERION I for SA
Fear, anxiety or avoidance is not better explained by symptoms of another disorder, such as panic, body dysmorphic or autism spectrum disorder.
CRITERION J for SA
If another medical condition (Parkinson’s, obesity, disfigurement) is present, fear, anxiety, or avoidance is clearly unrelated or excessive.
Social anxiety performance only
IF FEAR IS RESTRICTED TO SPEAKING OR PERFORMING IN PUBLIC, IT SHOULD BE SPECIFIED AS ‘PERFORMANCE ONLY’.
THEORIES OF SOCIAL ANXIETY DISORDER
There are several accounts to explain what makes someone develop social anxiety disorder, but there is not a lot of evidence for any of them.
Genetic factors – Lead to a more general tendency toward anxiety disorders, via their role in brain areas of amygdala, hippocampus and prefrontal cortex.
Cognitive factors – People with social anxiety disorder have excessively high standards for their social performance and focus on negative aspects of social interactions, evaluating their own behavior harshly. They tend to assume that if they feel anxious, it is because the interaction is not going well.
What creates these behavioral habits and cognitive biases?
Studies support notion that family environments where parents are overprotective, controlling, critical, negative and they model socially anxious behavior, can lead to development of social anxiety disorder, especially for children temperamentally prone to shyness
TREATMENTS FOR SOCIAL ANXIETY DISORDER
Although SSRIs and SNRIs (serotonin-norepinephrine) have been shown efficacious in reducing symptoms, but symptoms return when medication stops.
CBT – Useful for treating social anxiety. It involves identifying negative cognitions clients have about themselves and social situations and teaching them how to dispute these cognitions. While people practice feared behaviors, coach might teach them relaxation techniques.
Acceptance and Commitment Therapy (ACT) – Builds on CBT techniques to emphasize mindfulness, acceptance and values.
CBT is as effective as antidepressants in reducing symptoms over course of therapy, and more effective in preventing relapse.
CBT in group format is equally effective – Groups allow natural way to engage in social situations, increasing exposure, while also building social skills.
Mindfulness-based interventions – Teach individuals to be less judgmental about own thoughts and reactions and more focused on present moment.
PANIC DISORDER
A key characteristic of panic attacks is that they appear to come in absence of any environmental trigger.
28% of adults have occasional panic attacks, especially during times of stress, but these do not change how they live their lives.
3-5% of people will develop panic disorder, usually between late adolescence and mid-thirties. It is more common in women and tends to be chronic.
Criterion A for PD
CRITERIA A – Recurrent unexpected panic attacks. Panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, during which time four (or more of following symptoms occur:
(1) Palpitations, pounding heart, accelerated heart rate; (2) Sweating; (3) Trembling or shaking; (4) Sensations of shortness of breath or smothering; (5) Feelings of choking; (6) Chest pain or discomfort; (7) Nausea or abdominal distress; (8) Feeling dizzy, unsteady, light-headed or faint: (9) Chills or heat sensations; (10) Paresthesias (numbness or tingling sensations); (11) Derealization (unreality) or depersonalization (detached from oneself); (12) Fear of losing control or going crazy; (13) Fear of dying.
Culture-specific symptoms may be seen and should not count as one of the four required symptoms.
Criterion B for PD
– At least one of the attacks has been followed by 1 month (or more) of one or both of the following:
- Persistent concern or worry about additional panic attacks or their consequences (losing control, having heart attack, going crazy);
- Significant maladaptive change in behavior related to attacks (behaviors to avoid having panic attacks, such as avoidance of exercise or unfamiliar situations
Criterion C for Pd
Disturbance is not attributable to physiological effects of substance (drug abuse, medication) or another medical condition (hyperthyroidism).
Criterion D for Pd
Disturbance is not better explained by another mental disorder (panic attacks do not occur in response to feared social situations, circumscribed phobic objects or situations, obsessions, reminders of traumatic events or to separation from attachment figures).
BIOLOGICAL FACTORS
Family history & twin studies suggest that heritability is about 43-48%. No specific genes have been identified as causing it
FF response in Pd
Poorly regulated in people with disorder, due to poor regulation of NTs – Norepinephrine, serotonin, GABA and CCK.
Hyperventilation, inhaling small amount of CO2 or ingesting caffeine are triggers Initiate physiological changes of FF response
There is dysregulation of norepinephrine system in locus ceruleus It has well defined pathways to limbic system and poor regulation may cause panic attacks, which in turn will stimulate limbic system and lower threshold for activation of anxiety. Anticipatory anxiety may increase likelihood of dysregulation of locus ceruleus and thus another panic attack
Premenstrual period & postpartum in PD
Women report increased anxiety symptoms. Hormone progesterone affects activity of serotonin and GABA systems. Fluctuations in progesterone levels lead to imbalance of serotonin or GABA systems, influencing susceptibility.
Increase in progesterone can induce mild chronic hyperventilation, which for women prone to attacks, is enough to start attack.
Menstruation in woman there a fluctuation in the progysteral levels that leads to a disfunction in gaba and serotonin levels
COGNITIVE FACTORS
Cognitive theorists argue that people prone to panic attacks tend to: (1) Pay very close attention to their bodily sensations (2) Misinterpret these in negative way (3) Engage in snowballing catastrophic thinking, exaggerating symptoms and their consequences.
Anxiety sensitivity – Unfounded belief that bodily symptoms have harmful consequences.
Interoceptive awareness – Heightened awareness of bodily cues that may signal coming panic attack.
Interoceptive conditioning – Process where bodily cues that occurred during previous panic attacks become CS, signaling new attacks.
Belief about controllability – In a study where one group could adjust amount of CO2 coming through mask and the other could not, 80% of people who believed to have no control experienced panic attack, compared to 20% of those who believed they had control
DIFFERENCE PANIC DISORDERS & SOCIAL PHOBIA
social anxiety has social aspect (can be diagnosed after 6) vs panic attacks are more physical responds ( can be diagnosed after a month)
