Social anxiety clinical, developmental, and social perspectives

Front matter......Page 2
Copyright......Page 4
Contents......Page 6
Contributors......Page 16
Introduction: Toward an Understanding of Social Anxiety Disorder......Page 20
Delineation of social anxiety......Page 21
Theoretical perspectives......Page 23
Treatment approaches......Page 25
Conclusion......Page 26
References......Page 27
Part I Delineation of Social Anxiety......Page 29
Introduction......Page 31
Overlapping and contrasting emotional states......Page 33
Definitions......Page 35
Diagnostic nosology classifications......Page 36
Relation of performance deficits and social anxiety......Page 38
Subtypes of SAD......Page 39
Cultural and developmental considerations......Page 42
Coverage across disciplines and subdisciplines......Page 43
Summary and conclusions......Page 44
References......Page 45
Assessment of Social Anxiety and Social Phobia......Page 51
The clinical interview......Page 52
Structured Interviews......Page 54
Interviewer-rated scales......Page 56
Self-report measures......Page 57
The Social Phobia and Anxiety Inventory......Page 58
Social Interaction Anxiety Scale......Page 60
Fear Questionnaire......Page 61
Social Phobia Inventory......Page 62
Measures of theoretically derived components of social anxiety......Page 63
Fear of Negative Evaluation Scale......Page 64
Social Avoidance and Distress Scale......Page 65
Cognitive-Somatic Anxiety Questionnaire......Page 66
Social Phobia and Anxiety Inventory for Children......Page 67
Social Skills Questionnaires......Page 68
Kutcher Generalized Social Anxiety Scale for Adolescents......Page 69
Role-Play Test......Page 70
Simulated Social Interaction Test......Page 72
Thought-listing and thought-endorsement procedures......Page 73
Social Interaction Self-Statement Test......Page 74
Thought-Listing and Thought-Recall......Page 75
Psychophysiological assessment......Page 76
Cardiovascular Assessment......Page 77
Other Physiological Assessments......Page 78
Summary......Page 79
References......Page 80
Introduction......Page 93
Definitions......Page 95
Cultural influences......Page 98
Comorbidity in a shyness treatment sample......Page 99
Development of chronic shyness......Page 100
Age of Onset......Page 102
Adolescent Onset......Page 103
Individual differences in shy and socially phobic individuals......Page 104
Somatic Symptoms......Page 105
Cognitive Features and Perception......Page 106
Behavior......Page 107
Family Characteristics......Page 108
Treatment......Page 109
Addressing Attribution Style in Treatment and Assessing Results......Page 110
Shyness Clinic Treatment......Page 111
Social fitness model......Page 113
References......Page 115
Are Embarrassment and Social Anxiety Disorder Merely Distant Cousins, or Are They Closer Kin?......Page 121
Feelings......Page 122
Physiology......Page 123
Antecedent Events......Page 124
The Development of Embarrassment......Page 126
Individual Differences......Page 128
The Fundamental Cause of Embarrassment......Page 129
Others’ Reactions......Page 131
Embarrassment Across Cultures......Page 132
Reprise: The Nature of Embarrassment......Page 133
Phenomenology......Page 134
Timing......Page 135
Development......Page 136
Normality and Abnormality......Page 137
Conclusions......Page 140
References......Page 141
Social Anxiety Disorder and Its Relationship to Perfectionism......Page 147
Perfectionism and measures of social anxiety in nonclinical samples......Page 149
Perfectionism in patients with social anxiety disorder......Page 153
Perfectionism in social/evaluative contexts......Page 157
Perfectionism and social/evaluative avoidance......Page 162
The effect of treatment for social phobia on perfectionism......Page 166
Summary and conclusions......Page 167
References......Page 168
What Could Account for This Peculiar Pattern of Conduct?......Page 175
The notion of social skills......Page 176
What Are Social Skills?......Page 177
Two Views of Social Skills......Page 178
The Interpersonal View of Social Skills......Page 179
Assessment of the social skills of social phobic individuals......Page 180
The Social Performance Survey Schedule (SPSS; Lowe & Cautela, 1978)......Page 181
The Simulated Social Interaction Test (SSIT; Curran, 1982)......Page 185
Is the Use of Role-Play Tests as Behavioral Measures of Social Skills Warranted?......Page 186
Are Highly Shy/Socially Anxious Individuals Less Skilled than Those Who Are Not?......Page 188
Are the Social Phobics’ Skills Different from Those of Normal Individuals?......Page 192
Are Any Social Phobic Individuals Deficient in Their Social Skills?......Page 195
Uncontrolled Studies......Page 196
Controlled Studies......Page 197
Is Improvement in Performance of Social Tasks Related to Skill-Acquisition?......Page 199
Social phobia as a problem in social functioning......Page 200
The treatment of social phobia as an antidote to its etiology, or, social skills training for social skills deficits......Page 202
References......Page 204
Comorbidity in studies using DSM-III and DSM-III-R criteria......Page 211
Comorbidity in studies using DSM-IV criteria......Page 216
Lifetime Comorbidity Rates......Page 217
Current Comorbidity Rates......Page 221
Body Dysmorphic Disorder......Page 225
Psychosis......Page 226
Suicidality......Page 227
Cross-cultural expressions of comorbidity......Page 228
Comment and future directions......Page 229
References......Page 230
Diagnostic issues using the DSM......Page 235
Studies Comparing SP to APD......Page 237
Psychological Treatments......Page 238
Recent Empirical Evidence on the Construct of APD......Page 244
State Personality Effects......Page 245
Discussion......Page 246
References......Page 247
Social Anxiety in Children and Adolescents: Biological, Developmental, and Social Considerations......Page 251
History and morphology of social anxiety disorder (social phobia)......Page 252
Biological factors......Page 253
Genetic Influence......Page 254
Brain/Cognitive Development......Page 255
Amygdala......Page 256
Prefrontal cortex......Page 258
Amygdala-Prefrontal Cortex Connectivity......Page 259
Puberty......Page 260
Attachment......Page 264
Temperament......Page 265
Parenting Style......Page 267
Peer Influence......Page 268
The maintenance of childhood social anxiety: A cognitive behavioral model......Page 270
Evidence-based treatment of social anxiety......Page 271
Conclusion/future directions......Page 276
References......Page 277
Part II
Theoretical Perspectives......Page 299
Introduction......Page 301
Neuroendocrinology of social anxiety disorder......Page 302
Brain Imaging and Neurophysiological Approaches......Page 306
Structural Brain Imaging......Page 308
Functional Brain Imaging: Task-related “Activation” Studies......Page 309
Emotional Face Processing......Page 311
Symptom Provocation – Public Speaking......Page 315
Social Interactions......Page 317
Negative Emotional Processing......Page 318
Summary of “Activation” Studies......Page 319
Functional Brain Imaging: ‘Resting State’ Studies......Page 321
Dopamine System......Page 322
Serotonin System......Page 324
Other Neurotransmitter–Neurochemical Systems......Page 325
Integrating neuoroendocrine and neuroanatomical studies......Page 326
General conclusions......Page 327
Future directions......Page 328
References......Page 329
Linkage studies in social anxiety disorder......Page 341
Association studies in sad......Page 342
Neuroticism......Page 343
Extraversion......Page 344
Behavioral Inhibition......Page 346
References......Page 347
How many temperaments?......Page 351
Genes and neurochemistry......Page 353
Other origins of temperament......Page 355
Sources of evidence......Page 356
Variation in reactions to the unfamiliar......Page 358
High- and low-reactive infants......Page 359
Assessment in the second year......Page 360
Assessment at four-and-a-half years......Page 361
Assessment at seven-and-a-half years......Page 362
Assessment at 11 years......Page 363
Sources of Worry......Page 365
Biology......Page 366
Implications......Page 368
References......Page 370
Introduction......Page 375
Current status of behavioral theory of social anxieties and social anxiety disorder......Page 378
Initiation of Social Anxiety and Phobia......Page 380
Generalization of Social Anxiety Disorder......Page 382
Stimulus Equivalence......Page 383
Functional Equivalence......Page 384
Response Generalization......Page 385
Matching Law......Page 386
Rule-governed Behavior......Page 388
Delay, Amount, and Certainty of Reinforcement......Page 389
Signal Detection......Page 391
Summary and conclusions......Page 394
References......Page 395
Introduction......Page 401
Attention......Page 402
Interpretation......Page 406
Memory......Page 410
Conclusions......Page 415
References......Page 416
A Cognitive Behavioral Model of Social Anxiety Disorder: Update and Extension......Page 423
Perceived Audience......Page 424
Mental Representation of the Self as Seen by the Audience......Page 425
Comparison of One’s Mental Representation of the Self as Seen by the Audience with One’s Appraisal of the Audience’s Expected Standard......Page 426
Behavioral Symptoms......Page 427
External Indicators of Negative Evaluation......Page 428
Imagery in social anxiety disorder......Page 429
Do Socially Anxious Persons Spontaneously Engage in Imagery that May Have a Negative Effect on the Mental Representation of the Self as Seen by the Audience?......Page 430
Do Socially Anxious Persons Preferentially Recall Social Situations from the Perspective of the Audience and Is This Perspective Associated with Negative Outcomes?......Page 431
Does Holding a Negative Image of Oneself in Mind While Performing Social Tasks Adversely Affect Performance?......Page 433
Post-event processing......Page 435
The combined cognitive biases hypothesis......Page 437
Fear of positive evaluation......Page 440
Emotion dysregulation in social anxiety disorder......Page 441
Implications for the Rapee–Heimberg model of social anxiety disorder......Page 442
References......Page 445
The self......Page 451
A social-cognitive perspective......Page 452
Theoretical and research perspectives on social anxiety......Page 454
Research Focus......Page 455
The Relational Self (Baldwin, 1992)......Page 456
Analysis......Page 457
The Vulnerable Self (Beck, 1996; Beck & Emery, 1985)......Page 460
The Distorted Self (Clark & Wells, 1995)......Page 461
Research Focus......Page 462
The Threatened Self (Rapee & Heimberg, 1997)......Page 463
Analysis......Page 464
Comparison of Domains......Page 465
Future directions......Page 467
References......Page 468
Social Anxiety, Positive Experiences, and Positive Events......Page 475
A self-regulation perspective on social anxiety......Page 476
Social anxiety and positive experiences......Page 477
Testing a Self-Regulatory Model......Page 479
Absence of a Normative Positive Interpretation Bias......Page 480
Fear of Positive Evaluation......Page 483
Interpreting Positive Events as Threats of Future Failure......Page 485
Life Satisfaction and Quality of Life......Page 486
Biological markers of diminished rewards in social anxiety......Page 487
Meaningful heterogeneity in social anxiety......Page 488
Summary......Page 490
References......Page 493
Social Anxiety as an Early Warning System: A Refinement and Extension of the Self-Presentation Theory of Social Anxiety......Page 499
The original self-presentation theory......Page 500
Extending the self-presentation approach: sociometer theory......Page 502
Social Anxiety as Output from the Sociometer......Page 504
The Link to Self-Presentation......Page 506
Social anxiety and interpersonal behavior......Page 507
Antecedents of Trait Social Anxiety......Page 508
Treating Trait Social Anxiety and Social Phobia......Page 509
References......Page 511
Part III Treatment Approaches......Page 515
Psychopharmacology for Social Anxiety Disorder......Page 517
Irreversible, Nonselective Monoamine Oxidase Inhibitors......Page 518
Moclobemide......Page 520
Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin Norepinephrine, Reuptake Inhibitors (SNRIs)......Page 521
Paroxetine......Page 522
Escitalopram and Citalopram......Page 524
Fluoxetine......Page 526
Venlafaxine......Page 527
Bupropion......Page 528
Benzodiazepines......Page 529
Beta-Adrenergic Blockers......Page 531
Buspirone......Page 532
Pregabalin......Page 533
Valproic acid......Page 534
Pharmacotherapy in children and adolescents......Page 535
Recommendations......Page 538
References......Page 540
Treatment of Social Anxiety Disorder: A Treatments-by-Dimensions Review......Page 547
Treatment impact on physiological symptoms......Page 548
Treatment impact on cognitive symptoms......Page 551
Irrational Beliefs......Page 552
Subjective Probabilities......Page 553
Attributions and Locus of Control......Page 555
Conclusions about Cognitive Propositions......Page 556
Endorsement – SISST......Page 557
Endorsement Other than SISST......Page 559
Production Methods of Assessing Cognitive Content......Page 561
Cognitive Process......Page 562
Conclusions about Cognitive Change......Page 563
Fear of Negative Evaluation......Page 564
Treatment impact on overt behavioral performance......Page 568
Escape and Avoidance......Page 569
Behavioral Ratings of Performance Quality......Page 570
Conclusion about Performance Quality......Page 572
Overall conclusions......Page 573
Changes in Measures and Research Questions Over Time......Page 575
Summary......Page 576
References......Page 577
Psychosocial treatments......Page 583
Comparison of psychosocial and pharmacological treatments: meta-analyses......Page 585
Comparison of psychosocial and pharmacological treatments: individual trials......Page 586
Advantages of pharmacological treatment......Page 590
Novel therapeutics: combining “cognitive enhancers” with psychosocial treatment......Page 591
Clinical implications and discussion......Page 594
References......Page 597
Mechanisms of Action in the Treatment of Social Anxiety Disorder......Page 605
A model of social anxiety disorder......Page 606
Mechanisms of treatment: pharmacotherapy......Page 608
Mechanisms of treatment: CBT......Page 612
Combined pharmacotherapy and CBT......Page 618
Acceptance and commitment therapy......Page 619
Other psychosocial treatments......Page 620
Summary......Page 621
References......Page 622
A
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D......Page 629
G......Page 630
M......Page 631
P......Page 632
Q......Page 633
S......Page 634
Y......Page 636