SOCIAL ANXIETY NOTES Social Anxiety Disorder (Social Phobia) Social Anxiety which the sufferer recognizes as excessive and unreasonable. Not only feel shy in situations, but also experience physical symptoms. Symptoms such as: Subtypes General Social Anxiety Disorder Most common Fear of dating, going to a party, joining in a conversation, engaging in small talk, and so on Performance-based Speaking up at a work meeting, performing on a stage, etc. Observational fears Fear of doing things in front of others. Fear of making a mistake or doing something embarrassing. Prevalence Prevalent disorder, ranking only behind depression and alcoholism. Affects about 4% of the population in any one year. Comorbidities Linked to difficulties in educational achievement, lower lifetime earnings, increased risk of medical problems, and clinical depression Causes Mix of genetics and environment. May have grown up in families where parents modeled social anxiety. History of painful childhood experiences. Parts and Components Social Anxiety has three parts/components, what we call the tripart model of Social Anxiety: Physical Component Physical symptoms such as: Blushing Sweating Trembling Nausea Rapid Heart beat Shortness of breath Light headedness Feeling Loss of Control Sinking sensation in the gut Feel that symptoms are being displayed Cognitive Component Thoughts that someone with social anxiety has when they are or anticipate being in a social situation. This is what has lay the foundation for effective treatment. They are more tuned into their feelings than their thoughts. They may be acutely aware of the feeling of dread and sinking feeling on their stomach, but not the thoughts of "people may think I'm boring", or "what if I blush", etc. 💡While individuals with SAD often picture themselves displaying extreme and very apparent anxiety symptoms, research has shown that this is almost always a grossly distorted image. People with GAD often overestimate the visibility of their anxiety symptoms compared to ratings by objective viewers. Commons Distortions Fortune Telling / Catastrophizing This is where the person in their thinking goes into the future and makes that particularly negative prediction. E.g. "I will mess up this interview", "I will never get a job", etc. Emotional Reasoning You think something must be true because you feel it so strongly. "I'm feeling anxious, so this conversation must be going poorly." Disqualify the Positive Illustrated in thoughts like "it went okay on that date only because they were easy to talk to, or were just being nice when laughing at my jokes" etc. Behaviors Avoidance Avoids situations that provoke anxiety, which does give them immediate relief, but they are also reinforcing in their behavior and in their minds that the situation is dangerous and needs to be avoided. Safety Behavior People find themselves in the situation, but do something to reduce the anxiety in that situation. For example, wearing a lot of make up to cover blushing, or only allowing themselves to talk to a few people. Social Skills People with SAD may believe that they have poor social skills, but this view is often false. They often don't have any deficits in social skills, and this belief reflects an overly critical approach to self. Treatment Most SAD sufferers are ready to commit to treatment. And their motivation comes from them realizing that SAD prevents them from having the experiences that they want. They will be informed that they will be asked to endure some discomfort through being exposed to new situations, but that this will be done gradually, and not until people have been given coping skills to deal with new situations. CBT CBT is an effective and tolerable treatment for social phobia. With the greatest evidence for efficacy of exposure + cognitive restructuring. CBT is associated with maintenance and extension of treatment gains. Some studies report that 80% of the people who go through the treatment report significant improvement, both in the reduction of painful anxiety symptoms and the increase of freedom to take on challenging but fulfilling opportunities in their life. Treatment begins with careful assessment of all the components of the social anxiety, and pinpointing the situations that trigger the anxiety. This will later turn into a (hierarchical) list of situations they will take on later, based on how difficult they are (starting with easiest). We also identify thoughts that play a role into their anxiety, like "I will make a fool of myself", "everyone will see how nervous I look", etc. Normalizing these thoughts can be important. Saying things like "thoughts are not facts", they can be distorted, and we can develop thoughts that are more helpful. Cognitive Restructuring Identify truth about cognitions: they don't have to be true to affect emotions. Identify anxiety producing thoughts and subject them to questions. Like "what evidence do I really have to support a certain thought?" Learn about common biases in thoughts Treat thoughts as "guesses" or "hypotheses" about the world Apply more accurate and adaptive thoughts according to experience/logic False equivalency: is where you equate a particular behavior or moment with something of much greater significance or permanence. e.g. "looking nervous equals looking foolish", "being rejected means being alone forever", etc. What comes out of this sincere challenging, is new and more accurate thoughts and beliefs. Exposure Interventions Provide a rationale for confronting feared situations Establish a hierarchy of feared situations Provide accurate expectations Set objective goals for social performance Reduce use of safety behaviors Notice what others are doing (to interrupt selffocused attention) Attend to the disconfirmation of fears ("what was learned from the exposure?") Relapse Prevention Meta Data Source: (Dr Vince Greenwood)
