Lectiure 10 - Social Phobias and Panic Disorder Flashcards
What are the learning objectives for this lecture?
1) Understand what anxiety is and
specifically, what Social Phobia and Panic Disorder are
2) Understand the various approaches to
studying and understanding Social
Phobia and Panic Disorder
3) Understand various treatment options
for the two presentations
4) A real-life example
What is the difference between fear and anxiety? What functional value do they have?
Fear = basic emotion that involves activation of the ‘fight-or- flight’ response of the autonomic nervous system; helps escape
from imminent threat
Anxiety = complex blend of diffuse and unpleasant emotions and cognitions
Functional value: alarm response to escape imminent danger;
helps to prepare and plan for possible threat
Talk about the adaptive value of anxiety
Anxiety is not maladaptive in and of itself.
It has been selectively favoured in an
evolutionary sense: organisms able to
response quickly and efficiently to life-threatening situations
Allows us to learn to anticipate upcoming
frightening events by mobilising resources
What are some of the DSM 5 criteria in diagnosing social phobia?
A.Marked fear or anxiety about one or more social situations in
which the individual is exposed to possible scrutiny by others.
Examples include social interactions (e.g., having a conversation,
meeting unfamiliar people), being observed (e.g., eating or
drinking), and performing in front of others (e.g., giving a speech).
B.The fear or anxiety is out of proportion to the actual threat posed
by the social situation and to the sociocultural context.
C.The social situations almost always provoke fear or anxiety.
D.The social situations are avoided or endured with intense fear or
anxiety.
E.The fear, anxiety, or avoidance causes clinically significant
distress or impairment in social, occupational, or other important
areas of functioning
… lasting for 6 months or more
… not due to he physiological effects of a substance (e.g., a drug of
abuse, a medication) or another medical condition
… not due to symptoms of another mental disorder, such as panic
disorder, body dysmorphic disorder, or autism spectrum disorder
What is the behavioural perspective on social phobia?
Classical conditioning = a neutral social
situation paired with a negative outcome
Also can be vicarious
Hackmann et al. (2000) found close
relationship between negative social
encounter and onset of Social Phobia
What is the cognitive perspective?
Where someone develops a belief that social situations are dangerous
People with social phobia might have certain vulnerabilities to it
Someone might have high standards for social performance ie they cannot fumble over their words or they are incompetent
They may have negative expectations about social interaction
Might have negative beliefs about the self as well
What does the cognitive approach mean about ‘processing the self as a social object’?
People with social phobia often have image of themselves in a social situation is almost a charicature of someone who is frightened.
If you think this, you might feel at risk at someone pointing this out to you.
It is someone who is paying attention to themselves. You focus in on yourself, am I trembling? am i swetting? Then you find anything like oh maybe I am trembling?
What about safety behaviours in cognitive model?
Keeps social anxiety going. I am doing something to keep myself safe.
ie. vetting what you say when you speak to make sure I am not mumbling and if I do not do that there would be catatrophes ie offended someone, made a fool of myself
Keeps the worry going
In therapy we look to try and reduce the safety behaviour
What is the cognitive model
Social situation -> activates assumption -> perceived social danger -> processing of self as a social object
Safety behaviours and somatic and cognitive symptoms feed into the processing of self as a social object
What does CBT do?
Targets the processing of self as a social object - you are doing it as a coping strategy as you do not want people to humiliate you so you monitor what you do
Help someone to practice 1) try socialisation paying attention to self and body and vet what you do
2) try not to pay attention to yourself but pay attention to the other person and see what happens
This could be paired with role play - therapist pretends to be the person the patient might interact with to practice say changing their focus of attention
this thing I am scared of, does it actually happen?
More about the set parts of CBT
Role Play
Video and audio feedback (contrast how you felt versus how you actually appear)
Cognitive restructuring through logical re-analysis
Exposure (without safety behaviours) + self-monitoring
Education about Social Anxiety
What are the DSM criteria for panic disorder?
A. Recurrent unexpected panic attacks. A panic attack is an abrupt surge of intense
fear or intense discomfort that reaches a peak within minutes, and during which
time four (or more) of different symptoms occur
B. At least one of the attacks has been followed by 1 month (or more) of one or both
of the following:
1. Persistent concern or worry about additional panic attacks or their
consequences
2.A significant maladaptive change in behaviour related to the attacks
What is agraphobia
Fear of going outside or fear of certain spaces or places where escape feels it might be difficult
A. Marked fear or anxiety about two (or more) of the following situations:
Using public transportation | Being in open spaces
Being in enclosed places | Standing in line or being in a crowd
Being outside or home alone
B. The individual fears or avoids these situations because of thoughts that escape
might be difficult or help might not be available in the event of developing panic-
like symptoms or other incapacitating or embarrassing symptoms
C. … almost always provoke fear or anxiety
D. … actively avoided, require the presence of a companion
… see textbook Chapter 6
Features of panic disorder and agaraphobia in the literature
80-90% panic attacks develops after
negative life event
More prevalent in women
Men cope by drinking, smoking & enduring panic attack
Women cope by increasing avoidance > agoraphobia
Different gender prevalence less evident for social anxiety
What is the behavioural perspective to panic disorder?
Interoceptive conditioning: the link / association between a panic attack or extreme anxiety AND thing that happen in our own physiology
Internal stimulus: physical / cognitive symptoms
- When someone has the experience of extreme anxiety and they link it to another experience ie being dizzy so body goes dizzy = panic attack
Exteroceptive conditioning: an external event
External stimulus: specific situation
- I had a panic attack in the library. Now library = panic.
