About Social Phobia

For most children, social experiences are positive and pleasant, ones which help in building interactive skills and easing individuation and self-sufficiency.

However, for other children social experiences might be troublesome, upsetting and even painful. Indeed, some children struggle in social interactions to the point that they cannot get involved in even basic activities such as going to school, sleeping at friend's house, or talking to strangers. These children are thought to have social phobia.

Social anxiety disorder, formerly known as social phobia, is an anxiety disorder characterized by overwhelming anxiety and excessive self-consciousness in everyday social situations.

People with social anxiety disorder have a persistent, intense and chronic fear of being watched and judged by others and of being embarrassed or humiliated by their own actions. Their fear may be so serious that it intrudes with their work, school or other activities. While many people with social anxiety disorder recognize that their fear of being around people may be excessive or unreasonable, they are unable to overcome it. They often worry for days and weeks in advance of a dreaded situation. In addition, they experience low confidence and depression. When subjected to a social situation, someone with social anxiety disorder is so afraid of being negatively evaluated or judged that it significantly intrudes with his or her ability to live a normal life.

It is perfectly acceptable to be anxious occasionally during social situations. This type of anxiety often helps us to prepare for the upcoming situation. For example: practicing a speech before giving it in front of an audience, or speaking up for various competitions such as elocution and debate, etc. However, usual, expected and normal social situations almost provoke fear or anxiety in individuals with social anxiety disorder. This fear is way out of proportion to the situation.

Social phobia is basically a term that represents a clinical population because its characteristics are excessive, developmentally inappropriate, persistent, resistant to reasonable perverse arguments, and linked to avoidance or maladaptive interference in various areas of daily life functioning. For example, children with social and performance anxiety often become somewhat nervous when confronting a new evaluative situation, eventually become accustomed to social and evaluative situations with repeated exposures to them, and although they attend social events, but with some fear. However, children with social phobia experience debilitating and developmentally inappropriate panic attacks and other symptoms in social and performance situations, they fail to become accustomed to these situations even with repeated exposures. Henceforth, they excessively avoid these situations, and subsequently become impaired in key areas such as academic and social development.

Regarding children with social phobia, or those with more severe fears, similar concerns are often expressed. For example, Strauss and Last (1993) found that youths with social phobia aged 4–17 years tend to fear school (64%), public speaking (57%), blushing (25%), crowds (21%), eating or drinking before others (18%), dressing before others (14%), and using public restrooms (7%). In a more extensive analysis, Beidel, Turner, and Morris (1999) examined the specific targets of fears in 50 children with social phobia aged 7–13 years. Situations feared most by these children, as reported from interview, usually involved performances before others (e.g., reading, playing a musical instrument, writing) and everyday social interactions (e.g., starting a conversation, talking on the telephone, playing with other children).

Review of literature

Lusia Stopa (2009) conducted a research on self-importance in understanding and treating social phobia. Self plays an important maintaining role in the social anxiety disorder. The author has grouped the theories of self into three categories: content, structure and process. Content is the information about self, structure is the way one organises the information about self and process is the ways in which individual regulate self. Therefore, due to the neglected behaviour of an individual towards structural organisation of self-knowledge contribute to social phobia. Hence, high social phobia is related to uncertainty about self-judgements.

Review of literature

Ang?©lico, A. P., Crippa, J. A. S., & Loureiro, S. R. (2010) conducted a research on social phobia. The aim of this article was to show an analysis of the research outlines used in experimental studies that were published between the years 2000 and March 2007 about social phobia disorder and its association with social skills. Seventeen papers were identified and grouped into two classes for analysis, namely: Characterisation of Social Skills Repertoire (N=10) and Therapeutical Modalities- Application and Comparison of Clinical Intervention (N=7). This article points to the necessity of new studies with clinical and non-clinical samples, with random allotment of individuals, with the proposition of providing information about the interaction tasks, to support the generalization as to the association of the social skills and social anxiety disorder. It was also to demonstrate the functionality and process by which anxiety interferes with social performance of an individual.

Review of literature

Leah Brown (2010) conducted a research on social anxiety disorder. Social anxiety disorder is a persistent and strong fear of negative evaluation under social situations. Social anxiety disorder basically develops during teenage with higher level of seriousness and difficulty, depending upon the age of development. People with this disorder fear being judged by others and henceforth, begin to avoid such social situations which eventually impairs with their normal functioning of life. According to the studies this disorder is not only confined to normal shyness in children instead is much greater in intensity.

Review of literature

Lanie J. Torgurd, John R. Walker, Linda Murray, Brian J. Cox, Mariette Chartier and Kevin D. Kjernisted (2006) conducted a research on

Social phobia is simply related with impairment in social and occupational functioning. Only a few studies have determined the relation between social phobia and social support. The present studies examined data from 2 widely used measures of perceived social support administered to 132 individuals with DSM-1V generalized social phobia. These data obtained were compared to several clinical and non-clinical samples reported in literature. People having generalized social phobia scored much lower on both measures of social support compared to the other groups. It is suggested that deficits in perceived social support associated with generalized social anxiety may play a role in the development of co-morbid problems which should be explicitly targeted by treatments for social phobia. Low correlations between perceived social support and social anxiety measures suggest that perceived support should be specifically evaluated in this population.

Review of literature

Candice A. Alfano, Deborah C. Beidel and Samuel M. Turner (2008) conducted a research to examine the role of negative self-images in social phobia during adolescence. During two social tasks negative self-image was tricked among 21 non-phobic adolescents. Self and observer-rated anxiety and performance as well as co-occurring cognition were compared to 21 adolescents with social phobia and 21 control adolescents who were not instructed to use self-imagery. There were differences found in nonphobic adolescent and control group. Thus, adolescents with social phobia were noted to be more nervous and had bad social performance. The reports suggests that anxiety was not associated with the decrement in performance or social skill rather it was due to the presence of negative self-image.

Review of literature

Maria Tillifors(2009) conducted a research on

Review of literature

Calvin S.L. Fones, Giselle Gus Manfro and Mark H. Pollack (2009) conducted a research on the changes that social phobia has undergone. This article reviews the literature on social phobia. Social phobia has undergone considerable diagnostic evolution to reach its present form in DSM-1V. Its differential diagnosis includes panic disorder, depression, and shyness. Cross-cultural issues are important to consider because the disorder may manifest differently in different cultures and social settings. It is common, with a lifetime prevalence of 13.3% in the United States according to recent epidemiological studies. Under recognition of social phobia remains an issue of concern. Comorbidity with other psychiatric disorders, including other anxiety disorders, depression, alcohol abuse and personality disorders frequently occurs. Current conceptualization of the etiology of social phobia reflect psychodynamic theories and evidence from family and genetic studies, neurobiological research and neuroimaging. Drugs such as monoamine oxidase inhibitors, selective serotonin-reputake inhibitors, benzodiazepines and ??-adrenergic blockers have proven to be efficacious, as has cognitive behavioural treatment, including group approaches.

Review of literature

Maria Tillfors, Tomas Furmark, Lisa Ekselius and Mats Fredeikson (2009) conducted a research on

General population data was used to examine if empirically derived subtypes of social phobia with and without avoidant personality disorder could be differentiated on self-report measures of anxiety severity, level of global functioning and the number of fulfilled diagnostic criteria for other personality disorders. Avoidant personality disorder did not modify the effect of social phobia subtypes on anxiety severity. The presence of comorbid avoidant personality disorder in social phobic seems to predict a global functioning decrement independent of anxiety severity. Therefore, social anxiety and avoidance personality disorder may represent different points on a severity continuum rather than easily defined discreet categories suggesting that social phobia and avoidance personality disorder may represent a spectrum of anxiety symptoms related to social anxiety. But better knowledge about childhood experiences may shed light on similarities and differences between the two disorders.

Review of literature

Ronald M. Rapee (2007) conducted a research on social phobia. Social phobia is one of the least studied anxiety disorders. Early studies suggested lack of social skills in the people suffering of social phobia. But more recent search seems to indicate that these individuals possess adequate skills and possess information about their own performance and other's evaluation. Based on such theories treatments which stress on cognitive restricting and exposure have considerable improvement.

Review of literature

Kenneth Abrams, Matt Kushner and Karl Reinersten (2010) conducted a research to show the effects of alcohol on anxiety. There is thus an evidence that alcohol can decrease anxiety responding under certain situations, but the mechanism supporting this evidence remains unknown. One possible mechanism would be the effect of alcohol on the salience of cognitions that either promote or inhibit anxiety in response to anxiety related cues. The individuals with social phobia were asked to record one thought after public speaking and the other after consuming alcohol. According to the thoughts listed by the participants the thoughts after the alcohol were positive regarding public speaking rather than before having the alcohol. Therefore, the impact of alcohol on subject was mediated by the changes in cognitions. Hence, this states the reason behind the co-occurrence of social phobia and alcoholism.

Review of literature

Maria Tillfors, Gerhard Andersson, Lisa Ekselius (2011) conducted a research on cognitive based therapy to treat social phobia. University level students have shown response towards internet based cognitive behaviour therapy to treat social anxiety disorder and public speaking fears. Similar was done with 19 speech anxious high school students with social anxiety disorder. They were randomly allocated 9 weeks of internet delivered cognitive behaviour therapy or to a wait-list control group. Significant improvements were found in social anxiety, general anxiety and depression. Effects were maintained at 1-year follow-up. The average number of modules completed in the cognitive behaviour therapy was low, but the results suggest that internet based guided self-help is effective in the treatment of high school students with social anxiety disorder.

Review of literature

John Eastwood, Daniel Smile, Jonathan Oakman, Peter Farvolden (2011) conducted a research to evaluate whether individuals with social phobia are inclined to become aware of negative faces. The individuals who participated looked through visual displays containing different number of neutral distractors for the location of positive and negative faces. Individuals with social phobia were found to be inclined to become aware of the negative faces more easily as compared to the positive faces. But, no such inclination was found with control participants.

Review of literature

Stephanie E. Cassin and Neil A. Rector (2011) conducted an experiment to study the ability of metacognitive strategies to reduce the distress associated with post-event processing. Individuals with social phobia were randomly picked to train them in mindfulness, distraction or no training, i.e. control group. Then they went through a post-event processing. During the experiment they were asked to apply the mindfulness or distraction strategies they were taught or to continue thinking about the past event the way they would normally have done (control group). The participants rated their distress on a visual analogue scale before the induction of post-event processing. Then for 5 minutes they rated every minute while applying the strategies and after applying the strategies. According to the results, mindfulness resulted in a positive affect than without training post and event. But, distraction does not reduce the distress post an event. Therefore, mindfulness can be helpful in the treatment of social phobia.

Review of literature

J.R. Baker and J.L. Hudson (2014) conducted a research on children with social phobia having lower quality friendships than children with other anxiety disorder. Clinical children -39 anxiety-disordered children with social phobia and 28 anxiety-disordered children without social phobia presented for psychological treatment and 29 nonclinical children were recruited from the community. Same sex close friends were invited to participate using an unrestricted nomination procedure. All children were aged between 7-13 years. Both target child and friend completed the friendship quality questionnaire and the spence children's anxiety scale. Henceforth, children with social phobia were reported to have lower friendship quality than the children with no social phobia but had higher friendship experiences relative to nonclinical children.

Review of literature

Asie Hoffart, Finn-Magnus Borge, Harold Sexton and David M. Clark (2009) conducted a research to examine the role of common factors in residential cognitive therapy and residential interpersonal therapy for social phobia. 80 individuals suffering from social phobia were randomly allocated residential cognitive therapy or residential interpersonal therapy for 10 weeks. The individuals and their personal therapists completed the therapy and outcomes on weekly basis. The outcomes were examined using linear mixed models. Most patient rated process variables showed U-shaped patterns over the course of time. Therapist rated first week alliance and empathy predicted improvement in social role security over the course of therapy.

Review of literature

Alexandra L. Hoff, Phillip C. Kenaal, Audro Langly (2015) conducted a research on developmental differences in functioning in youth with social phobia. Social phobia in teenage may show differently in development because of the involvement of parents in their social lives changes and social expectations increases. 488 treatment seeking anxiety disorder youth (age 7-17) and their parents were collected using child anxiety impact scale and were evaluated using generalized estimating equations. In teenagers with social phobia the social difficulties and academic difficulties increase with age. Adolescents may avoid social situations because involvement of parents in their social lives decrease. Therefore, their retreating behaviour increases difficulty in the social domain. Their academic performance may be affected drastically due to avoidance of class participation. Early detection of social phobia is helpful to prevent the increased impairment over the course of development.

References

1. American Psychological Association Division, 12 Society Of Clinical Psychology (APA Div 12 SCP), 2013.
2. Burnstein, M., He, J.P, Kattan, G., Albano, A.M., Avenevoli, S. & [Merikangas, K.R.] (2011)

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