Social Anxiety Disorder
Social anxiety disorder is a common and debilitating disorder, often leading to complications such as depression, substance abuse and increased suicide risk. During the past two decades, research on the cognitive, behavioral, interpersonal and physiologic
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Timothy M. Emge . Debra A. Hope
Abstract: Social anxiety disorder is a common and debilitating disorder, often leading to complications such as depression, substance abuse and increased suicide risk. During the past two decades, research on the cognitive, behavioral, interpersonal and physiological aspects of social anxiety and subsequent theoretical models have greatly increased our understanding of the nature and maintaining factors for social anxiety disorder. Well-validated assessment procedures including self-report, interview and behavioral measures, are now available. Therapeutic exposure, typically combined with cognitive interventions, is the most established evidencebased treatment. Comparisons of psychosocial treatment to pharmacotherapy and some promising innovative treatment approaches are discussed as well. Emerging work on mechanisms of change suggest that changes in judgments about the probability and costs of negative outcomes are key to clinical change. Competencies for clinicians include expertise with basic cognitive and behavioral therapies, therapeutic exposure and adaptations for the unique characteristics of social anxiety disorder. Especially important is the impact of socially anxious individuals’ fears in interpersonal relationships on the therapeutic relationship. Expert competencies include treatment of more severe cases, overcoming extreme social isolation, complex presentations and social anxiety disorder that presents within the context of serious mental illness. Working in a multicultural context, particularly with language differences and sexual minorities are also discussed. Transition to expert competency relies on traditional educational venues, written material and utilizing expert consultation that is available on electronic venues.
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Overview
Social anxiety, an experience of fear in interpersonal or performance situations, may occur commonly for many people, especially in novel or personally important situations, such as a wedding. However, for most people, the fear is transient and does not significantly interfere with functioning. Individuals who frequently experience high levels of social anxiety and either extreme distress or avoidance of social/performance situations may warrant the diagnosis of social phobia, also known as social anxiety disorder (American Psychiatric Association, 2001, DSM-IV-TR).1 Research into social anxiety disorder, which was once one of the least-studied anxiety disorders (Liebowitz, Gorman, Fyer, & Klein, 1985), has increased dramatically over the last 20 years with new insight into its etiology, theoretical framework, and effective treatments. While social anxiety disorder was once considered rarely incapacitating (DSM-III-R; American Psychiatric Association, 1987), it is now known to be associated with impairments extending The DSM-IV-TR includes social anxiety disorder as an alternative name for social phobia in order to underscore its pervasiveness and high level of impairment, as well as to indicate that it is conceptually differe
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