Session Four (Social Anxiety Disorder) Flashcards
What is the central fear of social anxiety disorder?
Fear of scrutiny by others, fear that you’ll do something embarrassing and this will result in a negative evaluation by others?
How do the fears in SAD affect the person’s behaviour?
SAD has marked avoidance/coping behaviours to manage the anxiety. Often this includes avoiding certain situations such as parties, public speaking, dating, eating out…
What are ‘safety behaviours’, what detrimental affects can they have and give some examples?
Behaviours or strategies a person with SAD employs to minimise the feared catastrophe. This includes internal, mental processes.
They can have a paradoxical effect of worsening the person’s social skills/drawing attention to their social performance.
Examples including avoiding eye contact or being on your phone the whole time.
Describe the prevalence and onset of SAD?
Prevalence: Most common anxiety disorder, 12.1% lifetime prevalence
Onset: Very early, 50% of cases by age 11, 80% by age 20.
How do you distinguish “shyness” from “SAD”?
Very closely linked, especially in childhood with children often treated as just “shy” who actually have SAD.
Likely exist on a continuum, but a key difference is shyness generally only plays up when meeting strangers, SAD can make people anxious meeting friends they’ve known for years.
What are the common co-morbidities of patients with SAD?
- Major depression
- Panic disorder/agoraphobia
- OCD
- Autism
- Body dysmorphic disorder
What are the main negative impacts of SAD on a person’s life, long term?
- Significant personal impairment.
- Economic burden (secondary to academic under performance, inability to put self forward at work, depression/alcohol use down the line)
- Significant risk factor for the development of Depression and Substance abuse
Why do SAD patients generally seek help later than other forms of anxiety?
- Getting help involves a lot of personal contact, and often face to face CBT, which may be too scary for the patient.
- Generally the resources that can help people are hard to get onto.
What evidence exists to support the claim that SAD is a developmental condition?
It has an abnormally early age of onset (50% by age 11 and 90% by age 23) compared to other disorders such as GAD and depression.
This highlights the need for early intervention.
What changes in sociability are seen during adolescence?
In their teen years, people transition into secondary school and begin to spend more time with their peers and less time with their family. From an evolutionary perspective this makes sense as we need to form our own social ties as we enter our reproductive window.
What do the social tie strength studies tell us about how social skills develop across adolescence?
Heyes (2015)
METHOD:
- Students were asked to fill out a social strength questionnaire, rating how close they were to their classmates.
- This created scores for how much they liked each of their classmates and how much their classmates liked them (social tie strength)
- But also allowed the two values to be compared (reciprocation of social tie strength)
- The researchers then gave the students 100 pennies and asked them to allocate the money based on who they liked most.
FINDINGS:
- In young adolescents, social tie strength alone predicted how much they invested in their classmates
- However in older adolescents, reciprocation also impacted how much they invested
- This suggests that older adolescents are able to recognise when peers place more or less value on their relationship than they do.
CONCLUSION: Theory of mind and social inference skills continue to develop in adolescence.
What is the Theory of Mind and why is it important in adolescence?
The ability to understand that other people have a mind separate to yours, with their own beliefs, knowledge, desires, emotions etc.. that differ from yours.
Allow us to navigate the more complex social situations that begin to arise as we enter our teenage years.
Social Tie Strength studies suggest that social inference skills and ToM continues to develop throughout adolescence, what might be driving these changes?
Neuro-Cognitive changes. Sebastian (2011)
FMRI study looked into how adults and teenagers’ brains responded to various tasks, involving either Affective ToM (deducing emotions) Cognitive ToM (deducing intentions and beliefs) or Physical Causality (control).
Found group differences in BOLD response in the Ventro-Medial Pre-Frontal Cortex when looking at AToM vs PC. Adults and teens both deactivated to the PC questions, but only adults deactivated to the AToM.
This suggests that teens and adults’ brains function differently when presented with a task based on social understanding.
FMRI studies show that adolescents’ brains respond differently to adults to social situations, what effect could this have on their relationships with their peers?
Could distort peer importance, making making valuation by friends seem more important and humiliation seem like a bigger deal.
Again, Sebastian (2011)
This is supported by the Cyber Ball task, where you ‘play’ a computer game with two virtual friends, who eventually start playing with themselves and not you. Both Young Adolescents and Mature adolescents reported greater feelings of Ostracism and less feelings of Inclusion. This shows that younger people react more emotionally to interactions with their peers.
What does the Car Crash game study tell us about the link between adolescence, peer influence and risk taking behaviours?
Gardner (2005)
Teenagers and adults were asked to play a game where you drove a car towards a wall and had to break it just before you ran into it. They first played the game solo then with peers in the room, researchers looked for differences in risk taking behaviour based on peer influence.
Study found that by themselves; teens, YAs and adults all drove safely. When peers were introduced, adults maintained their safe driving, but both YAs and adolescents began to show risky behaviours. This effect was significantly more marked in the younger teens.
Suggests adolescents are more likely to be influenced by their peers into committing risky behaviour.
Can the greater influence of peer evaluation seen in teenagers have a positive effect on their decision making?
Studies suggest it can.
Pre-adolescents (10-12) and adolescents (14-16) were asked to perform a odd-one-out recognition task, by themselves and then in collaboration with a peer. Found that when working together they scored better, and this “Collective Benefit” actually increased as the adolescent aged.
This suggests that older adolescents are able to influence each other into making better decisions together.
In short, what changes are seen in adolescence and what is the potential link to the development of SAD?
Teens show:
- Improvements in social understanding (ToM development)
- Probably underpinned by a mix of changes in their brain, and their environment (secondary school, increased time with peers)
- Show heightened awareness and sensitivity to peer feedback and presence.
While these changes are essential to the development of social skills, they also bring out a vulnerability that in at-risk teens can lead to social anxiety
What evidence is there to suggest a genetic influence of SAD?
Stein (2008)
- Family studies; 10x more likely among first degree relatives, Kids of parents with SAD are more likely to develop a number of anxiety disorders.
- Twin studies; Estimates a 48% heritability link
- Candidate gene studies; Some candidate genes have been suggested, mostly to do with Serotonin activity in the brain. Effects have not yet been replicated so unclear.
- Temperaments; Some distinct temperaments/styles of behaviour seen in babies have been linked to the later development of SAD. Largely to do with how the baby responds to novel stimuli (behavioural inhibition)
What does the term “Behavioural Inhibition” mean?
Behavioural inhibition (BI) relates to the tendency to experience distress and to withdraw from unfamiliar situations, people, or environments. It is a trait observed in some babies linked to the later development of SAD.
Describe how Behaviourally Inhibited babies respond to new stimuli?
- Extreme distress to over stimulation by a something novel or unfamiliar (e.g. a mobile).
- Withdraw and become clingy with caregiver when shown new stimulus or unfamiliar people. Was very vigilant and wary of surroundings.
- Inhibit their behaviour in the face of novel stimuli, ceased playing.
- Evidence suggest they show neurobiological features as well; High heart rates generally with an increase in novel situations, Raised cortisol levels (N.B. this might just be in those who are poorly attached as well as BI)
- EEG shows greater right frontal asymmetry (this is associated with withdrawal and avoidance behaviour)
- Increased amygdala activation to novel or emotional stimuli
What does the Highfield-Becker study (2007) tell us about the link between BI and later development of SAD?
- Investigated wether BI in preschool children predicted psych problems in childhood.
- 215 children aged 21 months to 6 years were measured at baseline and once again at 9 years old.
- Found BI could predict Social anxiety, but no other disorders.
- Kids with BI (22%) were twice as likely as those without (11%) to develop Social anxiety.
- Concluded that there IS a temperamental antecedent of social anxiety seen in middle childhood, and that this could be a good way of identifying kids for early intervention
What is the Amygdala responsible for and how could this relate to SAD?
Amygdala has a role in emotion processing.
Adults and adolescents with SAD showed greater response in the amygdala to fearful faces in a simple gender discrimination task. This suggests a link between hyperactive emotion processing and SAD.
What does the Spielberg study (2015) tell us about the link between the Amygdala and SAD?
- Aimed to investigate wether there is a difference in brain activation between socially anxious and non-socially anxious individuals when anticipating peer interactions.
- 42 patients aged 8-17
- Placed in an fMRI and asked to perform a chat room task, evaluate how much they want to talk with a peer and then hear back how much the peer wants to talk with them
- Found that those with SAD showed greater amygdala activation during this anticipation stage.
- Furthermore, SAD Ps showed stronger co-activation between the Amygdala and the Ventrolateral PFC and the Anterior Cingulate Cortex. Unclear what these greater activations mean, but suggests SAD brains respond very differently when placed in a socially stressful situation.
- Interestingly, wether the social interaction was positive or negative had no influence on activation, appears to be a general response.
What evidence is there to suggest a Social Learning Component to SAD?
Van Zalk et al (2011):
- Social ties strength test
- Found that people with SAD had fewer friends and were rated lower by others in their peer group.
- Found they were likely to form closer ties with other socially anxious individuals.
- Followed them up over time, found that people with SAD who were close to other SAD people tended to get worse over time.
- This suggests that people with SAD are more likely to hang out with each other AND can worsen each others symptoms over time.
