obias E-book NOTEBOOK 120 Social anxiety disorder can interfere greatly with one's life (Park et al.,...

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obias E-book NOTEBOOK 120 Social anxiety disorder can interfere greatly with one's life (Park et al., 2020; Tonge et al., 2020). A person who cannot interact with others or speak in public may fail to carry out important responsibilities. One who cannot eat in public may reject meal invitations and other social offerings. Since many people with this disorder keep their fears secret, their social reluctance is often misinterpreted as snobbery, lack of interest, or hostility. MHC 4.4 E-book NOTEBOOK 121 To undo the cycle of problematic social beliefs and behaviors described earlier, cognitive-behavioral therapists combine both behavioral and cognitive techniques (Ashbaugh et al., 2020). On the behavioral side, they conduct exposure therapy, the intervention so effective with phobias. The therapists encourage clients to expose themselves to their dreaded social situations and to remain in these situations as their fears subside. Usually the exposure is gradual, and it often includes homework assignments. On the cognitive side, the clinicians and clients have systematic therapy discussions in which the clients are guided to reexamine and challenge their maladaptive beliefs and expectations, given the less-than-dire outcomes of their social exposures. How Can Social Skills Be Improved? In social skills training, also conducted by cognitive-behavioral therapists, several techniques are combined. The therapists usually model appropriate social behaviors for clients and encourage the individuals to try them out. The clients then role-play with the therapists, rehearsing their new behaviors until they become more effective. Throughout the process, therapists provide frank feedback and reinforce (praise) the clients for effective performances. 4 Reinforcement from other people with similar social difficulties is often more powerful than reinforcement from a therapist alone. Thus in social skills training groups and assertiveness training groups, members try out and rehearse new social behaviors with other group members. Such groups also provide guidance on what is socially appropriate. According to research, social skills training, in both individual and group formats, has helped many people perform better in social situations (Pina et al., 2020; Olivares-Olivares, Ortiz-Gonzlez, & Olivares, 2019). SUMMING UP Social Anxiety Disorder People with social anxiety disorder experience severe and persistent anxiety about social or performance situations in which they may be scrutinized by others or be embarrassed. Cognitive-behavioral theorists believe that the disorder is particularly likely to develop among people who hold certain dysfunctional social beliefs and expectations and who learn to perform corresponding avoidance and safety behaviors. E-book NOTEBOOK 120 What Causes Social Anxiety Disorder? The leading explanation for social anxiety disorder has been proposed by cognitive- behavioral theorists (Ashbaugh et al., 2020; Hofmann, 2019). The explanation features an interplay of both cognitive and behavioral factors. As you read in Chapter 2, cognitive-behavioral theorists start with the contention that people with this disorder hold a group of dysfunctional beliefs and expectations regarding the social realm. These can include: Holding unrealistically high social standards and so believing that they must perform perfectly in social situations. Believing they are unattractive social beings. Believing they are socially unskilled and inadequate. Believing they are always in danger of behaving incompetently in social situations. Believing that inept behaviors in social situations will inevitably lead to terrible consequences. Believing they have no control over the feelings of anxiety that emerge in social situations. Cognitive-behavioral theorists hold that, because of these beliefs, people with social 4.4 Pa SUMMING UP Social Anxiety Disorder III People with social anxiety disorder experience severe and persistent anxiety about social or performance situations in which they may be scrutinized by others or be embarrassed. Cognitive-behavioral theorists believe that the disorder is particularly likely to develop among people who hold certain dysfunctional social beliefs and expectations and who learn to perform corresponding avoidance and safety behaviors. Therapists who treat social anxiety disorder try to reduce social fears by drug therapy and/or cognitive-behavioral therapy (including exposure techniques). They may also try to improve social skills by social skills training. Cognitive-behavioral theorists hold that, because of these beliefs, people with social anxiety disorder keep anticipating that social disasters will occur, overestimate how poorly things go in their social interactions, and dread most social situations (Tonge et al., 2020; Hofmann, 2019). Moreover, they learn to perform "avoidance" and "safety" behaviors to help prevent or reduce such disasters (Ashbaugh et al., 2020). Avoidance behaviors include, for example, avoiding parties or avoiding interactions with new coworkers or acquaintances. Safety behaviors include wearing makeup to cover up blushing or gloves to hide shaking hands. Behaviors of this kind are reinforced by reducing feelings of anxiety and the number of awkward encounters. Researchers have found that people with social anxiety disorder do indeed manifest the beliefs, expectations, interpretations, feelings, and behaviors listed above (Kleberg et al., 2021; Mobach et al., 2020). These dysfunctional cognitions and behaviors have been tied to factors such as genetic predispositions, trait tendencies, biological abnormalities, traumatic childhood experiences, and overprotective parent-child interactions (Buzzell et al., 2021; Rose & Tadi, 2020). Social Anxiety Disorder III MANY PEOPLE ARE UNCOMFORTABLE when interacting with others or talking or performing in front of others. A number of entertainers and sports figures, from the singers Adele, Harry Styles, and Rihanna to the actress Jennifer Lawrence, have described episodes of significant anxiety before performing. Social fears of this kind certainly are unpleasant, but usually the people who have them manage to function adequately. People with social anxiety disorder, by contrast, have severe, persistent, and irrational anxiety about social or performance situations in which they may face scrutiny by others and possibly feel embarrassment (APA, 2022) (see Table 4-6). The social anxiety may be narrow, such as a fear of talking in public or eating in front of others, or it may be broad, such as a general fear of functioning poorly in front of others. In both forms, people repeatedly judge themselves as performing less competently than they actually do (see MindTech). 4.2 Phobias How Can Social Fears Be Reduced? Medication often helps alleviate social fears (Rappaport et al., 2021; Neufeld et al., 2020). Such fears are reduced to some degree in 55 percent of patients who take either benzodiazepines or antidepressant drugs, compared to 24 percent of similar patients who take placebo drugs. It appears that these medications bring about relief by improving functioning in the brain's fear circuit, which tends to be hyperactive for people with social anxiety disorder, just as it is in cases of generalized anxiety disorder (Lai, 2020; Schneier, 2019). At the same time, cognitive-behavioral therapy has proved to be at least as effective as medication at reducing social fears, and people helped by this approach seem less likely to relapse than those treated with medications alone (Stein, 2020b). This finding suggests to some clinicians that this form of therapy should always be featured in the treatment of social fears, either alone or in combination with medication. > Why do so many professional performers seem prone to performance anxiety? Might their repeated exposure to audiences have a therapeutic effect? AA 4.4 Panic Disord 2 Phobias E-book NOTEBOOK 121 Treatments for Social Anxiety Disorder Only in recent decades have clinicians been able to treat social anxiety disorder successfully (see Table 4-7). Their success is due in part to the growing recognition that the disorder has two distinct features that may feed upon each other: (1) sufferers have overwhelming social fears, and (2) they often lack skill at starting conversations, communicating their needs, or meeting the needs of others. Armed with this insight, clinicians now treat social anxiety disorder by trying to reduce social fears, by providing training in social skills, or both. One-Year Female- Prevalence to-Male TABLE: 4-7 Profile of Anxiety Disorders and Obsessive-Compulsive Disorder Percentage Receiving Clinical Treatment Typical Age at Ratio Onset Prevalence Among Close Relatives Currently Generalized 4.0% 2:1 0-40 Elevated 43% anxiety years disorder Specific phobia 9.0% 2:1 Variable Elevated 32% Agoraphobia 1.0% 2:1 15-35 Elevated 46% 4.4 Panic obias E-book NOTEBOOK 120 Social anxiety disorder can interfere greatly with one's life (Park et al., 2020; Tonge et al., 2020). A person who cannot interact with others or speak in public may fail to carry out important responsibilities. One who cannot eat in public may reject meal invitations and other social offerings. Since many people with this disorder keep their fears secret, their social reluctance is often misinterpreted as snobbery, lack of interest, or hostility. MHC 4.4 E-book NOTEBOOK 121 To undo the cycle of problematic social beliefs and behaviors described earlier, cognitive-behavioral therapists combine both behavioral and cognitive techniques (Ashbaugh et al., 2020). On the behavioral side, they conduct exposure therapy, the intervention so effective with phobias. The therapists encourage clients to expose themselves to their dreaded social situations and to remain in these situations as their fears subside. Usually the exposure is gradual, and it often includes homework assignments. On the cognitive side, the clinicians and clients have systematic therapy discussions in which the clients are guided to reexamine and challenge their maladaptive beliefs and expectations, given the less-than-dire outcomes of their social exposures. How Can Social Skills Be Improved? In social skills training, also conducted by cognitive-behavioral therapists, several techniques are combined. The therapists usually model appropriate social behaviors for clients and encourage the individuals to try them out. The clients then role-play with the therapists, rehearsing their new behaviors until they become more effective. Throughout the process, therapists provide frank feedback and reinforce (praise) the clients for effective performances. 4 Reinforcement from other people with similar social difficulties is often more powerful than reinforcement from a therapist alone. Thus in social skills training groups and assertiveness training groups, members try out and rehearse new social behaviors with other group members. Such groups also provide guidance on what is socially appropriate. According to research, social skills training, in both individual and group formats, has helped many people perform better in social situations (Pina et al., 2020; Olivares-Olivares, Ortiz-Gonzlez, & Olivares, 2019). SUMMING UP Social Anxiety Disorder People with social anxiety disorder experience severe and persistent anxiety about social or performance situations in which they may be scrutinized by others or be embarrassed. Cognitive-behavioral theorists believe that the disorder is particularly likely to develop among people who hold certain dysfunctional social beliefs and expectations and who learn to perform corresponding avoidance and safety behaviors. E-book NOTEBOOK 120 What Causes Social Anxiety Disorder? The leading explanation for social anxiety disorder has been proposed by cognitive- behavioral theorists (Ashbaugh et al., 2020; Hofmann, 2019). The explanation features an interplay of both cognitive and behavioral factors. As you read in Chapter 2, cognitive-behavioral theorists start with the contention that people with this disorder hold a group of dysfunctional beliefs and expectations regarding the social realm. These can include: Holding unrealistically high social standards and so believing that they must perform perfectly in social situations. Believing they are unattractive social beings. Believing they are socially unskilled and inadequate. Believing they are always in danger of behaving incompetently in social situations. Believing that inept behaviors in social situations will inevitably lead to terrible consequences. Believing they have no control over the feelings of anxiety that emerge in social situations. Cognitive-behavioral theorists hold that, because of these beliefs, people with social 4.4 Pa SUMMING UP Social Anxiety Disorder III People with social anxiety disorder experience severe and persistent anxiety about social or performance situations in which they may be scrutinized by others or be embarrassed. Cognitive-behavioral theorists believe that the disorder is particularly likely to develop among people who hold certain dysfunctional social beliefs and expectations and who learn to perform corresponding avoidance and safety behaviors. Therapists who treat social anxiety disorder try to reduce social fears by drug therapy and/or cognitive-behavioral therapy (including exposure techniques). They may also try to improve social skills by social skills training. Cognitive-behavioral theorists hold that, because of these beliefs, people with social anxiety disorder keep anticipating that social disasters will occur, overestimate how poorly things go in their social interactions, and dread most social situations (Tonge et al., 2020; Hofmann, 2019). Moreover, they learn to perform "avoidance" and "safety" behaviors to help prevent or reduce such disasters (Ashbaugh et al., 2020). Avoidance behaviors include, for example, avoiding parties or avoiding interactions with new coworkers or acquaintances. Safety behaviors include wearing makeup to cover up blushing or gloves to hide shaking hands. Behaviors of this kind are reinforced by reducing feelings of anxiety and the number of awkward encounters. Researchers have found that people with social anxiety disorder do indeed manifest the beliefs, expectations, interpretations, feelings, and behaviors listed above (Kleberg et al., 2021; Mobach et al., 2020). These dysfunctional cognitions and behaviors have been tied to factors such as genetic predispositions, trait tendencies, biological abnormalities, traumatic childhood experiences, and overprotective parent-child interactions (Buzzell et al., 2021; Rose & Tadi, 2020). Social Anxiety Disorder III MANY PEOPLE ARE UNCOMFORTABLE when interacting with others or talking or performing in front of others. A number of entertainers and sports figures, from the singers Adele, Harry Styles, and Rihanna to the actress Jennifer Lawrence, have described episodes of significant anxiety before performing. Social fears of this kind certainly are unpleasant, but usually the people who have them manage to function adequately. People with social anxiety disorder, by contrast, have severe, persistent, and irrational anxiety about social or performance situations in which they may face scrutiny by others and possibly feel embarrassment (APA, 2022) (see Table 4-6). The social anxiety may be narrow, such as a fear of talking in public or eating in front of others, or it may be broad, such as a general fear of functioning poorly in front of others. In both forms, people repeatedly judge themselves as performing less competently than they actually do (see MindTech). 4.2 Phobias How Can Social Fears Be Reduced? Medication often helps alleviate social fears (Rappaport et al., 2021; Neufeld et al., 2020). Such fears are reduced to some degree in 55 percent of patients who take either benzodiazepines or antidepressant drugs, compared to 24 percent of similar patients who take placebo drugs. It appears that these medications bring about relief by improving functioning in the brain's fear circuit, which tends to be hyperactive for people with social anxiety disorder, just as it is in cases of generalized anxiety disorder (Lai, 2020; Schneier, 2019). At the same time, cognitive-behavioral therapy has proved to be at least as effective as medication at reducing social fears, and people helped by this approach seem less likely to relapse than those treated with medications alone (Stein, 2020b). This finding suggests to some clinicians that this form of therapy should always be featured in the treatment of social fears, either alone or in combination with medication. > Why do so many professional performers seem prone to performance anxiety? Might their repeated exposure to audiences have a therapeutic effect? AA 4.4 Panic Disord 2 Phobias E-book NOTEBOOK 121 Treatments for Social Anxiety Disorder Only in recent decades have clinicians been able to treat social anxiety disorder successfully (see Table 4-7). Their success is due in part to the growing recognition that the disorder has two distinct features that may feed upon each other: (1) sufferers have overwhelming social fears, and (2) they often lack skill at starting conversations, communicating their needs, or meeting the needs of others. Armed with this insight, clinicians now treat social anxiety disorder by trying to reduce social fears, by providing training in social skills, or both. One-Year Female- Prevalence to-Male TABLE: 4-7 Profile of Anxiety Disorders and Obsessive-Compulsive Disorder Percentage Receiving Clinical Treatment Typical Age at Ratio Onset Prevalence Among Close Relatives Currently Generalized 4.0% 2:1 0-40 Elevated 43% anxiety years disorder Specific phobia 9.0% 2:1 Variable Elevated 32% Agoraphobia 1.0% 2:1 15-35 Elevated 46% 4.4 Panic