Treating Social Phobias and Social Anxiety
The essential feature of social phobia is a marked and persistent fear of performance situations when patients feel they will be the centre of attention and will do something humiliating or embarrassing. The situations that provoke this fear can be quite specific, for example public speaking, or be of a much more generalised nature involving fear of most social interactions, for example initiating or maintaining conversations, participating in small groups, dating, speaking to anyone in authority. Exposure to the feared situation almost invariably provokes anxiety with similar symptoms to those experienced by patients with panic attacks but some seem to be particularly prominent and difficult i.e. blushing, tremor, sweating and a feeling of 'drying up' when speaking.
Single motherhood has been linked to a large array of social and psychological problems, both in the mothers themselves and in their offspring. In an unusual study, Whitehead (2000) investigated the stigma associated with teenage pregnancy. She noted that pregnant teenagers who choose not to terminate their pregnancy face a range of responses from their family and friends, resulting in their social exclusion and isolation. In short, the problems of single-parenthood commence even before the birth of their babies. This study investigated perceptions of teenage pregnancy in a population of 95 pregnant and nonpregnant teenagers. Family and education were the primary factors in influencing attitudes and perspectives in relation to teenage pregnancy. Most of the families had absentee fathers. The factor of education revealed that the teenage pregnant group tended to view school as an unhappy and lonely experience. Moral issues influenced whether the pregnancy was viewed negatively or...
Based on what you've said today, it seems you're here because you want to feel less self-conscious when you're in social situations. You'd like to feel more positive about yourself. I think you said, 'I want to believe in myself' and you also talked about how you want to figure out what you're feeling inside and how to share your emotions with others you care about.
In the ENRICHD trial,52 2481 post-MI patients with major or minor depression and or low perceived social support were randomly assigned either to usual medical therapy or to an intervention consisting of up to 6 months of cognitive behavior therapy at a median of 17 days after the index MI, with sertraline added for patients with persistent depressive symptoms. The intervention improved depression and social isolation but not event-free survival. The failure to demonstrate any survival benefit was thought, in part, to have been due to the fact that a large proportion of patients with mild, transient, depression were involved. An ensuing subgroup analysis of those patients enrolled in the ENRICHD with the most severe symptomatology, however, also failed to demonstrate any survival benefit.53 In addition, it was shown that intervention patients whose depression did not improve were at substantial risk for late mortality.
Anderson IM, Nutt D J et al 2000 Evidence-based guidelines for treating depressive disorders with antidepressants a revision of the 1993 British Association for Psychopharmacology guidelines. Journal of Psychopharmacology 14 3-20 Ballenger J C et al 1998 Consensus statement on panic disorder from the International Consensus Group on Depression and Anxiety. Journal of Clinical Psychiatry 59 47-54 Ballenger J C et al 1998 Consensus statement on social anxiety disorder from the International Consensus Group on Depression and Anxiety. Journal of Clinical Psychiatry 59 54-60 Ballenger J C et al 2000 Consensus statement on posttraumatic stress disorder from the International Consensus Group on Depression and Anxiety. Journal of Clinical Psychiatry 61 60-66 Ballenger J C et al 2001 Consensus statement on generalized anxiety disorder. Journal of Clinical Psychiatry 62 53-58 Davies S J C et al 1999 Association of panic disorder and panic attacks with hypertension. American Journal of Medicine...
The focus of the anxiety and worry is not confined to features of an Axis I disorder, e.g., the anxiety or worry is not about having a Panic Attack (as in Panic Disorder), being embarrassed in public (as in Social Phobia), being contaminated (as in Obsessive-Compulsive Disorder), being away from home or close relatives (as in Separation Anxiety Disorder), gaining weight (as in Anorexia Nervosa), having multiple physical complaints (as in Somatization Disorder), or having a serious illness (as in Hypochondriasis), and the anxiety and worry do not occur exclusively during Posttraumatic Stress Disorder.
Similarly, the lay public overuses the terms compulsive and panic. In diagnostic circles, compulsive behavior generally alerts the clinician to symptoms associated with either obsessive-compulsive disorder or obsessive-compulsive personality disorder. In contrast, many individuals with eating disorders and substance abuse disorders refer to their behaviors as compulsive. Once again, further questioning is needed before assuming that the client is suffering from a compulsive disorder. Finally, panic disorder is a very specific syndrome in DSM-IV-TR. However, many individuals with social phobias, agoraphobia, or public speaking anxiety talk about being frozen with panic. Therefore, although client use of the word panic should alert the interviewer to the possibility of an anxiety disorder, the appropriate diagnosis may not be panic disorder.
Special needs for the growing number of elderly patients in cardiac rehabilitation have to be considered. Decreased mobility and impaired cognitive functions make program attendance difficult for many patients. Co-morbidities have a considerable impact on exercise testing and training. Depression and social isolation are more prominent than in younger patients. However, elderly patients profit from structured cardiac rehabilitation to the same extent as younger patients. The main goals of cardiac rehabilitation in elderly
A large US study15 with 1084 women and 1397 men with a minor or major depression were treated when indicated with an SSRI or cognitive behavioral therapy. The intervention did not increase event-free survival, but less depression and less social isolation occurred in the intervention group.
About the goals of an intervention is important to avoid both extremes neglect and overactivity. The focus on amount of intake, optimisation of nutrients or weight is curative in nature, since it does not aim to relieve primarily suffering. Treatment of the sensation of loss of appetite, decreasing the distress related to social interactions associated with meals, is palliative in nature. However, the optimal management of constipation leading to (almost) complete reversal of anorexia, or stenting the colon to improve bowel obstruction, aim to relieve suffering but are curative in nature. In both cases a pure palliative approach to relieve anorexia, visceral pain, and nausea in constipation and bowel obstruction would probably be of minor quality in many patients.
The dictum that aggression breeds aggression also can be extended to problems of violence in schools and other social situations. One common form of group behavior involves social exclusion of others based on their characteristics and behavior. For example, a student who shows high accomplishments in academic subjects may be excluded from the in group whose members call him a nerd. Can this kind of group behavior instigate aggression in those who receive it A recent experiment investigated this question in the laboratory (Twinge, Baumeister, Tice, & Stucke, 2001). Human participants were exposed to social exclusion by telling them that other participants had rejected them as part of the group. Social exclusion caused participants to behave more aggressively in various contexts.
Disposition from the OU is predicated on the relief of dyspnea, improvement of congestion without long-suffering orthostasis, and discharge to an adequate outpatient environment. If these goals cannot be met, inpatient hospitalization or placement in an assisted-living facility should be considered. Approximately 25 4,58,59,65 of HF patients will require inpatient hospitalization after a 24-hour OU admission. Patients not meeting discharge criteria by the 24-hour OU LOS limit require inpatient admission. A lower threshold for admission is appropriate in the very elderly, those with poor social situations, and those with multiple co-morbidities. Even patients requiring admission after an OU stay derive a measurable benefit from its use. In patients admitted from the OU after failure of therapy, the mean hospital-ization LOS, inclusive of their OU time, was 0.8 days less than patients admitted directly from the ED to the inpatient unit 4 .
The phylogenetic basis of spontaneous imitation is a reasonable hypothesis. However, as Epstein notes, at least three aspects of the experiments suggest that some environmental experience is also necessary. The birds were raised in a colony and may have had social interactions that contributed to imitative performance. Pigeons who are isolated from birth may show smaller effects of exposure to a model (May & Dorr, 1968). In addition, the effects of food reinforcement may have contributed to the results. Although observers were never directly reinforced with food for imitation, they did see the models eat from the feeder. In fact, Epstein remarked that occasionally the naive bird would thrust its head into the feeder hole when the model did, even though it did not receive food. Finally, only one object was present in the right and left sides of the chamber. If three objects were available, would the observer peck or pull the one the model did, without training Each of these aspects...
Estimate, for each chimpanzee in your zoo, the extent to which social interactions with other chimpanzees are satisfying, enjoyable experiences as opposed to being sources of fright, distress, frustration, or some other negative experience. It is not the number of social interactions that should be estimated, but the extent to which social interactions that do occur are a positive experience. Estimate, for each chimpanzee in your zoo, the extent to which it is effective or successful in achieving its goals or wishes. Examples of goals would be achieving desired social interactions, achieving a desired dominance status, and having access to desirable locations, devices, or materials in the enclosure.
Evolutionary biologists distinguish between phenotype and genotype. An organism's phenotype refers to all the characteristics observed during the lifetime of an individual. For example, an individual's size, color, and shape are anatomical aspects of phenotype. Behavioral features include taste preferences, aggressiveness, shyness, and so on. Different phenotypic attributes of individuals may or may not reflect underlying genetic variation.
Earlier research noted the importance of contact comfort and normal social interactions in the typical development of rhesus monkeys (Harlow & Mears, 1979) and chimpanzees (Martin, 2002). Recent research on human subjective well-being suggests that environments of extreme want may lead to populations that are significantly lower in subjective well-being (Myers & Diener, 1995). However, just as a wide range of different sources for social enrichment and other sources of well-being could lead to the typical development of rhesus macaques (and presumably other primates), so a large variety of human societies and parenting techniques could lead to happiness and typi
An organism's phenotype refers to anatomical and behavioral characteristics observed during the lifetime of the individual. For example, an individual's size, color, and shape are anatomical aspects of phenotype. Behavioral features include taste preferences, aggressiveness, and shyness. Different phenotypic attributes of individuals may or may not reflect underlying genetic variation.
You see, when in public, I worry more than the average person about being scrutinized and negatively judged. My anxiety about this is manifest through sweating, constant worry about being inadequate, and avoidance of most, but not all, social situations. What I'd like to do in therapy is build my self-confidence, increase my positive self-talk, and learn to calm myself down when I'm starting to get upset. Interviewer I guess so far we could summarize your major concerns as your depressed mood, anxiety over your career, and shyness. Which of these would you say is currently most troubling to you This client has identified depression as his biggest concern. Of course, an alternative formulation of the problem is that social inhibition and anxiety produce the depressed mood and, therefore, should be dealt with first. Otherwise, the client will never get out of bed because of his strong fears and anxieties. However, it's usually (but not always) best to follow...
Ance of cross-race peers and with their reports of negative intergroup social interactions. Others have found negative consequences as well (Biafora et al., 1993 Rumbaut, 1994 Smith, Atkins, & Connell, 2003). Thus, racial ethnic socialization messages that promote racial mistrust may prompt youth to withdraw from activities that are essential for access to opportunity and reward structures of the dominant society (Biafora et al., 1993). Moreover, they may motivate youth to engage in activities that deviate from accepted norms.
Meares et al. conducted semi-structured interviews with women primary caregivers of adult inhome hospice patients with terminal cancer 15 . This systematic qualitative study summarises as follows 'Shift in thinking eating is best to not eating is best .' It reports seven elements related to gradual cessation of oral intake (1) the meaning of food (cultural aspects, love, socialised role of food, social situations, dinner hour) (2) the caregiver as sustainer (knowledge of care-giving, difference of emotion and intellect, vigilance, balance of respect and concern in choice of action) (3) concurrent losses (lived experience enmeshed, carer's personal pain) (4) personal responses (patient eats to please family) (5) ceasing to be-starved to death (6) being bereaved - the meaning now (meaning of cooking changed, patient remembered by using
By preschool age, children can play with children that they do not consider to be friends. Toddler-age children's social interactions are more fragile and more dependent on rituals and routines than the social interactions of preschoolers. Therefore, toddlers, more often than preschoolers, play only with their friends. We assume that this is because patterns of interaction between toddlers are highly ritualized.
Common psychosocial problems in patients referred for cardiac rehabilitation include depression, anger, anxiety disorders, and social isolation. Education, counseling, and or psychosocial interventions, either alone or as a component of multi-factorial cardiac rehabilitation, can improve psychosocial well-being and quality of life these are recommended to complement the psychosocial benefits of exercise training. To date, psychosocial interventions have not been documented to alter the prognosis of coronary patients.
Taking care of a chronically ill person can be onerous or even perilous. Yet all the factors that determine the degree of vulnerability for the caregiver remain somewhat poorly conceptualized. The notion of burden, while useful operational concept, is in itself very complex. It has to be assessed in the context of such issues as added financial problems, the need for physical care, social isolation, the caregiver's premorbid health, and the caregiver's gender. This is not a comprehensive list of issues to consider in assessing, the burden, but it provides the basis for clinical investigation. To the factor of burden has to be added loss of partner or spousal support for the well partner, and the grief that may be the result of the significant losses that may be inevitable. Yet, the evidence is that the spouses of chronic pain patients, many of whom are seriously disabled, seem to fare relatively well. Anxiety and depression are the most common complaints noted in these spouses.
You are working with Michael, a 26-year-old African American male. He is single, has a bachelor's degree in business management, and is employed as a manager at a local appliance store. He reports a history of hypertension (high blood pressure), which is well-managed using medication. During the session, he complains that although he can work with his employee team effectively and regularly meet individual and team sales goals, he has a long history of heterosexual social anxiety. He also claims he can socialize outside work without significant problems. When asked what he would like to accomplish in counseling, he states, I want to have a date at least a couple times a month, and I want to ask the person out on the date without feeling like I'm going to have a heart attack every time I start to approach her. Michael also reports intermittent insomnia, muscular tension, and increased irritability, all three of which worsened after his mother passed away nine months ago. Develop a...
Social Phobia A social phobia is a marked, persistent fear of one or more social or performance situations that involve exposure to unfamiliar people or to scrutiny by others. Those afflicted fear that they will act in embarrassing or humiliating ways, as by showing their anxiety. Exposure creates anxiety and possibly a panic attack, and the person avoids precipitating situations. He or she recognizes the fear as excessive or unreasonable. Normal routines, occupational or academic functioning, or social activities or relationships are impaired.
Mouse models of aggression in a laboratory rely on the offensive components of social interactions in mice. Offensive behavior, in this context, is characterized by initiation on the part of the aggressive animal that often leads to damage to the opponents (Krsiak, 1974). It follows a defined temporal course and occurs in episodic fashion, with epochs of intense aggressive behavior alternating with relative quiescence (Miczek, 1983). In male mice, isolation for several weeks induces an extensive repertoire of natural agonistic behaviors namely, aggressive behavior and reactions to aggression (Miczek & Krsiak, 1979). A singly housed mouse is then allowed to interact with a nonaggressive group-housed male mouse in an unfamiliar or neutral arena (isolation-induced aggression paradigm) or in his own home cage (resident-intruder paradigm see Figure 18.1). The basic sequence of acts and postures during offensive attack is simple and stereotyped. The isolated mouse approaches the opponent,...
Sociologists spearheaded investigations of neighborhood contexts as driving forces behind troubling social trends. Shaw and McKay (1942) proposed a social disorganization theory to explain neighborhood-level concentrations of crime. By mapping delinquency rates by neighborhood, they found support for their theory that economic hardship, high residential instability, and racial-ethnic heterogeneity contribute to high neighborhood crime because they undermine community social ties and community-based controls. Wilson (1987) focused attention on neighborhood-level poverty and on concern with the social isolation that accompanies concentrated poverty in urban neighborhoods. Cut off from adequate resources, opportunities, and role models, residents in such neighborhoods are drawn to antisocial and risk behaviors. Based on these and other theories, Jencks and Mayer (1990) identified five emerging theories or models of how neighborhood context influences individual behavior, namely via...
As for the study of sympathy and personal distress, we have been interested in the additive and multiplicative contributions of emotionality and regulation. In general, we predicted that high emotionality, particularly frequency and intensity of negative emotion, combined with low regulation, would be associated with externalizing types of behavior problems and low social competence. In contrast, low regulation of emotion (e.g., through low attentional control) combined with high behavioral inhibition low impulsivity and high emotionality (especially negative emotionality) was expected to predict internalizing types of problems such as high levels of shyness and withdrawn behavior. For both externalizing and internalizing behavior, prediction is expected to be greater when measures of both emotionality and regulation are obtained. Further, we hypothesized that moderational effects would be found for emotionally driven internalizing or externalizing problem behaviors (e.g., that...
Numerous studies consistently show that psychological and psychosocial factors contribute to increased risk for CHD. A cluster of negative emotions are related to increased risk, such as depression, anxiety, hostility, type D personality. Among psychosocial risk factors are low socioeconomic status (SES) and social isolation. These have been described in detail in Chapter 30. When CHD has manifested itself, the risk factor pattern is more complex, and findings are less consistent. However, the overall conclusions from studies point to hostility, depression, low SES, and social isolation contributing to increased risk for recurrence. Depression in particular has received considerable attention in recent studies.15 These issues are discussed in other chapters, particularly depression (Chapter 32) and stress management (Chapter 34). Research has shown that such psychological risks are more prevalent among women. Since they are also generally older, the presence of social isolation and...
Hand, no sex differences have been reported in social anxiety, impulsiveness, activity levels, reflectiveness, locus of control, and orderliness. To the extent that these personality traits influence appraisal of life events and the degree to which such events are perceived as threatening challenging and controllable, they are likely to influence sex differences in stress responses in men and women.
Depression has been shown to be a risk factor for cardiovascular disease, and the presence of persistent depression following a myocardial infarction may be a marker for a recurrence. The mechanism may be physiological and or the adverse influence depression has on behavior modification and program adherence. Anxiety, chronic psychological stress, social isolation, and a high hostile anger personality profile have all been associated in various degrees with adverse cardiovascular outcomes. In light of this it is recommended that patients undergo a psychosocial screening. This need not be time-consuming, and can be incorporated into the initial assessment. As part of a pilot project conducted in the province of Ontario in 2002,8 the use of various questionnaires such as the Beck Depression Scale, the Hospital Anxiety and Depression Scale, and the Medical Outcomes Study (MOS) Short Form 36 was found to be expeditious and effective.
While the concept of active covariance (niche picking) has been the focus of much theoretical speculation (e.g., Plomin, 1994 Scarr & McCartney, 1983), remarkably little research exists that actually documents how individuals with different temperaments act in ways that result in their inhabiting different types of contexts. One of the few examples we have of the process of active temperament-context covariance is seen in the work of Matheny (1986), showing how more active children, or children with less tractable temperaments, have a higher probability of putting themselves in dangerous situations that result in a greater frequency of physical injuries. Based on an underlying model where low arousability promotes high sensation seeking (Strelau, 1994), individual differences in sensation seeking have been linked to a variety of contextually relevant behavioral characteristics, such as substance abuse, sexual patterns, and reckless behavior, that could act to increase the individual's...
And symptoms can legitimize the avoidance of tasks that the patient dislikes. If a patient in the throes of a headache chooses not to go to work or chooses to avoid social situations, there is no convincing way to persuade the patient to do otherwise. Intimacy can also be avoides or postponed due to pain. The following case provides a very convincing example of a young man for whom his chronic head pain provided such an escape.
A potentially rich milieu to learn about what others think and feel is the give and take of social interactions within the family. Through discussions, arguments, and negotiations with parents and siblings, children confront a variety of perspectives, both intellectual and affective, that over time may help them discover that other people may view the world differently than they do.
Retirement can lead to reduced household income and thus to insecurity about buying food and then to weight loss 29 . Moreover, retirement can also lead to social isolation, changes in life style, and loss of contacts. All of these add up to the risk of weight loss and cachexia following retirement. Simple changes, such as the expansion of commercial shopping areas, the erection of high-rise apartments, or the increasing diversity of the neighbourhood, may elicit a strong sense of insecurity within an environment the older adult previously perceived as safe 29 .
Research is unequivocal in placing alcoholics and other substance abusers in a high-risk category (Fawcett et al., 1990 R. Hall et al., 1999 G. Murphy & Wetzel, 1990 Ohberg, Vuori, Ojanpera, & Loenngvist, 1996). The problems of suicide and substance abuse are closely linked. Abuse of alcohol and other substances places individuals at risk for suicide, especially if such abuse is associated with depression, social isolation, and other suicide risk factors.
Clinical interviewing involves a systematic modification of normal social interactions. Although the relationship established between interviewer and client is a friendly one, it is much different from friendship. Clinical interviews serve a dual function to evaluate and to help clients.
Home to a life as independent as possible. Depression may lead to loneliness and a feeling of helplessness with the consequence of social isolation. Cardiovascular rehabilitation programs in elderly patients have to be targeted to help the patient during this difficult phase after an acute event by counseling, care, and physical training. Progress during physical training often leads to positive psychosocial changes including a decrease in anxiety and depression and improved social integration.35,36 Elderly patients take particular advantage of group dynamics when participating in a physical training program that is offered in groups.
Treating the young people in groups provides useful developmental information. In the group setting, opportunities to observe the adolescents and their parents in normal social situations rather than in the shorter intense therapeutic relationship occur. This allows the team to identify other developmental issues that may make change more difficult for certain children. An example is the observation of poor social skills or awkward peer interactions. If this is occurring in the therapeutic group, then it will also be happening at school and will need to be addressed if the young person is to return successfully to education. Specific learning difficulties that may interfere with the management of pain can also be observed during the therapeutic tasks, for example, poor sequencing and problem
A similar new positive approach to animal happiness is emerging. King and Landau (2003) created a rating scale for zoo-housed chimpanzees comparable to those used to assess human happiness (see Table 19.1). It included items designed to measure the balance of positive versus negative moods, ability to achieve goals, and the amount of pleasure derived from social interactions it also included a global item asking the rater how happy he or she would be if the rater were the rated chimpanzee. Although on the surface these items may seem subjective, the interrater reliabilities were high (see Table 2 in King & Landau, 2003). In addition, ratings of chimpanzee subjective well-being were stable over time and were strongly correlated with personality dimensions namely, dominance, extraversion, and dependability (King & Landau, 2003).
Several studies reporting sources of practice knowledge used by nurses are published all used survey methods (140-142). We located no studies that asked clinicians themselves to describe and categorize the kinds of knowledge needed to practice or any that attempted to understand how clinicians privilege various knowledge sources. Drawing on individual and card sort interviews, as well as participant observations, in the research utilization studies described above, we identified nurses' sources of practice knowledge. Our findings suggested that nurses categorize their sources of practice knowledge into four broad groupings social interactions, experiential knowledge, documents, and a priori knowledge (143). Experiential knowledge and knowledge produced in and shared via interactions were the most commonly identified sources. In addition, the choice of knowledge source is influenced by factors such as trust, hierarchy, question specificity, time, and knowledge presentation style (144)....
We use the term preparation for bias to refer to such practices as parents' efforts to promote their children's awareness of racial bias, and to prepare them to cope with prejudice and discrimination. These efforts have also been emphasized as a critical component of racial ethnic socialization. Several scholars have suggested that enabling children to navigate around racial barriers and to negotiate potentially hostile social interactions are normative parenting tasks within ethnic minority families (Thornton et al., 1990 Fisher et al., 1998 Garcia Coll & Magnuson, 1997 Garcia Coll, Meyer, & Brillon, 1995 Kibria, 1997 Harrison, Wilson, Chan, Buriel, & Pine, 1995).
Further, individual differences in regulation and emotionality predicted real-life behavior when children were angered in their social interactions at school (Eisenberg, Fabes, Nyman, et al., 1994). Real-life, naturally occurring events involving anger and frustration were observed over the school year. Children who were relatively likely to use nonabusive verbalizations to deal with anger a constructive strategy were high in teacher-rated constructive coping and attentional control (both of these finings were only for boys) and low in nonconstructive coping and negative emotional intensity (for boys and girls). In addition, such children were viewed by mothers as high in instrumental coping and coping by seeking support, and low in aggressive coping and negative emotional intensity (Eisenberg, Fabes, Nyman, et al., 1994). There were fewer findings for other modes of coping with anger, although, for example, teachers' reports of children's negative emotional intensity were related to...
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