social anxiety disorder (SAD) Flashcards
What is social anxiety disorder (SAD)?
Marked fear of one or more social or performance situations in which the person is exposed to the possible scrutiny of others and fears he will act in a way that will be humiliating
FEAR OF BEING JUDGED
How do people with SAD deal with the fear?
The feared situation is avoided or endured with distress
The avoidance, fear or distress significantly interferes with their routine or function (can lead to social phobia)
avoidance feeds the fear
Are people with SAD able to read the room?
no, usually misinterpret social cues/situations and observations negatively
How is SAD related to anxiety?
Exposure to the feared situation almost invariably provokes anxiety
Anxiety is out of proportion to the actual threat posed by the situation
The anxiety lasts more than 6 months to be diagnosed
what is the prevalence of SAD?
Prevalence: most common anxiety disorder; third most common psychiatric disorder
- Lifetime: 7-14%; 13.3% NCS
- Recent: 4-8%
Women>Men (60/40): HARP study (Keller, 2003)
- Women»_space; Men (2/1): (Kessler, 2003)
Is SAD recognized as a separate diagnostic entity in DSM3?
yes
What is the onset of SAD?
Onset: mid-teens; gradual or abrupt
What factors contributing to getting SAD?
Factors: 1st degree relative w/anxiety disorder, separation from parents (Bandelow et al. 2004)
learn through modeling
What are the course types of SAD?
Course: continuous, recurring
- HARP: after 8 yrs, only 36% remission
Types:
- Generalized: fear of most social situations
-Non-generalized: limited # situations; single
situation → specific SAD
Does SAD respond well to CBT?
yes, really effective for SAD
What is the comorbidity of SAD?
-70-80% SAD patients: at least 1 other psychiatric disorder (commonly anxiety disorder)
-Depression is common in SAD: 56% depressive disorder (33% MDD)
-In addition to comorbid anxiety and depression, 44% have comorbid PD (actually way lower)
-Most common: Avoidant PD
What are the components of the CB models for SAD?
-Trigger: actual/imagined social interaction
-Fear of negative evaluation
-Comparison between ideal self and perceived self
-Perceived self is (negatively) distorted
-Self-focused attentional bias
-Negatively biased post-event processing
-Avoidance, escape, safety behaviours
Explain Rapee and Heimberg’s (1997) cognitive-behavioural model for SAD?
- In a sit where think they will be evaluated socially when not the case
- Have a mental representation of self as seen by audience negatively
- Compare their mental representation of self as seen by audience (negative) w/appraisal of audience’s expected standards (think that ppl see them neg and that everyone is better than them and judging them)
- Look for indications of negative evaluation in env and interpret cues wrongly cause of negative self schema
- Internal cues telling them there is something wrong when not the case and think will be judged by others
- Judgment of probability and consequence of negative evaluation
- Leads to Behavioural anxiety symptoms, Cognitive anxiety symptoms, and Physical anxiety symptoms
Do people with SAD lack social skills?
no, often say they do but is just anxiety
What are the cultural differences in SAD?
In general:
- Western cultures: independent selves
-Asian cultures: interdependent selves
SAD:
-Western model: fear of negative evaluation
-Asian concern: distress to others
-Japan/Korea: Taijin Kyofusho (mental disorder):
fear of offending others by blushing, staring, etc.
Is shyness just a milder form of SAD?
The discomfort and inhibition in presence of others; derived directly from interpersonal nature of situation
-they still go out and talk to people
Is Avoidant PD a more severe form of SAD?
APD: relations to others, something else altogether while SAD: performance in situations
Explain SAD and perfectionism studies:
-SAD patients score higher on perfectionism measures (Juster et al., 1995);
-people will social anxiety disorder are more
perfectionist, differentiating between ideal self
(perfection) and their self (imperfection)
-high standards vs. maladaptive self appraisal (Hewitt and Flett, 2002)
Schneier argues for a continuous trait.
Multidimensional perfectionism scale.
What is the relation between low SE and SAD?
low self esteem = thinks people are better than them = feeds into fear of being judged
interpret situations negatively because of their negative bias towards themselves
