The procedures used in the treatment overlap with some of the procedures used in more recent CBT programmes, therefore CT can validly be considered to be a variant of CBT. However, it is distinguished from many CBT programmes for social anxiety disorder by the fact that it takes a somewhat different approach to exposure with less emphasis on repetition and more on maximising disconfirmatory evidence and it does not use thought records. Instead, the key components of treatment are: developing an individual version of Clark and Wells' model using the service user's own thoughts, images and behaviours; an experiential exercise in which self-focused attention and safety behaviours are manipulated in order to demonstrate their adverse effects; video and still photography feedback to correct distorted negative self-images; training in externally focused non-evaluative attention; behavioural experiments in which the person tests specific predictions about what will happen in social situations when they drop their safety behaviours; discrimination training and memory rescripting for dealing with memories of past social trauma.
The treatment is usually delivered on an individual basis. However, there is a need for the therapist to be able to call on other people to participate in within-session role plays. It is common for the therapist and the person with social anxiety disorder to also leave the office to conduct behavioural experiments in the real world during therapy sessions. This is easier to do if sessions are for 90 minutes, rather than the usual 50 minutes.
Interpersonal psychotherapy IPT was originally developed as a treatment for depression but was modified by Lipsitz and colleagues for use in social anxiety disorder. Treatment is framed within a broad biopsychosocial perspective in which temperamental predisposition interacts with early and later life experiences to initiate and maintain social anxiety disorder. There are three phases to the treatment. In the first phase, the person is encouraged to see social anxiety disorder as an illness that has to be coped with, rather than as a sign of weakness or deficiency.
In the second phase, the therapist works with the person to address specific interpersonal problems particularly in the areas of role transition and role disputes, but sometimes also grief. Role plays encouraging the expression of feelings and accurate communication are emphasised. People are also encouraged to build a social network comprising close and trusting relationships. In the last phase, the therapist and the person review progress, address ending of the therapeutic relationship, and prepare for challenging situations and experiences in the future.
Sessions are typically 50 to 60 minutes of individual treatment. Psychodynamic psychotherapy sees the symptoms of social anxiety disorder as the result of core relationship conflicts predominately based on early experience. Therapy aims to help the person become aware of the link between conflicts and symptoms. The therapeutic relationship is a central vehicle for insight and change.
Expressive interventions relate the symptoms of social anxiety disorder to the person's underlying core conflictual relationship theme. Supportive interventions include suggestion, reassurance and encouragement. Clients are encouraged to expose themselves to feared social situations outside therapy sessions. Self-affirming inner dialogues are also encouraged. Mindfulness training is a psychological intervention that has developed out of the Buddhist tradition and encourages individuals to gain psychological distance from their worries and negative emotions, seeing them as an observer, rather than being engrossed with them.
Treatment starts with general education about stress and social anxiety. Participants then attend weekly groups in which they are taught meditation techniques. Formal meditation practice for at least 30 minutes per day using audiotapes for guidance is also encouraged. Several different pharmacological interventions have been used in the treatment of social anxiety, many of which were originally developed as antidepressants. A fifth class, tricyclic antidepressants TCAs , have also been used in the past but this is no longer the case.
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They are thought to act by increasing serotonin concentration in the brain and, after obtaining licences for major depression, many pharmaceutical companies carried out additional studies that indicated their efficacy in social anxiety disorder as well as in other anxiety disorders. The only SNRI that has been studied extensively is venlafaxine and it is possible that its effects in social anxiety disorder are mediated solely through changes in serotonin at usually prescribed doses.
MAOIs inhibit the breakdown of noradrenaline, dopamine, serotonin, melatonin, tyramine and phenylethylamine. This effect is not limited to the brain and affects other parts of the body rich in monoamine oxidase MAO , for example, the gut. Therapeutic effects in social anxiety disorder are again thought to be related to increased levels of serotonin and dopamine in the brain. However, inhibition of MAO may result in a potentially dangerous interaction with foods containing tyramine which may lead to episodes of dangerously high blood pressure.
Because of this, moclobemide prescription comes with far fewer dietary restrictions than the older MAOIs, such as phenelzine. MAOIs are now rarely prescribed because of their perceived risks. Benzodiazepines are restricted by the fact that it is preferable not to administer them for prolonged periods of time because of potential tolerance and dependence.
In addition they may complicate some of the more prevalent comorbidities such as PTSD and depression. Finally, alpha2delta calcium gated channel blockers, such as pregabalin, reduce neuronal excitability but it is not at all clear why these should work when other anticonvulsants have no known therapeutic effects in social anxiety disorder. Social anxiety disorder imposes substantial economic costs on individuals, their families and carers and society, as a result of functional disability, poor educational achievement, loss of work productivity, social impairment, greater financial dependency and impairment in quality of life.
A UK study by Patel and colleagues assessed the economic consequences of social anxiety disorder for individuals, health services and the wider society using information from the Adult Psychiatric Morbidity Survey conducted in England in Singleton et al. People with social anxiety disorder were less likely to be in the highest socioeconomic group and had lower employment rates and household income compared with those with no psychiatric morbidity. Health service costs and social benefits were higher in people with social anxiety when a comorbidity condition was present compared with those with pure social anxiety disorder.
Another study from the Netherlands Acarturk et al. Costs assessed included direct medical costs related to mental healthcare services for example, GP visits, sessions with psychiatrists, hospital days , direct non-medical costs for example, service users' transportation, parking, and waiting and treatment time and productivity losses. Other costs falling on other sectors like education and social services were not considered in the study. Despite the debilitating nature of the condition, social anxiety disorder is often unrecognised and under-treated with little information existing on the resource implications of the disorder on the individual, healthcare sector or society den Boer, ; Jackson, ; Ross, A more detailed review of the cost of social anxiety disorder indicated that the economic cost relating to poor educational attainment, social impairment, functional disability and poor quality of life may be greater than the direct healthcare costs.
In contrast to the studies summarised above, some evidence indicates that social anxiety disorder alone is not associated with greater use of mental and other health services, with only 5. Similarly, an Australian study Issakidis et al. A review of cost-of-illness studies confirmed that social anxiety disorder has been consistently found to cost less than other anxiety disorders. In summary, social anxiety disorder is associated with a range of indirect and intangible costs relating to reduced productivity, social impairment and reduction in quality of life.
On the other hand, the often lower healthcare cost incurred by people with social anxiety disorder compared with those with other anxiety disorders reflects the under-utilisation of healthcare services by these individuals. Relatively high costs in some groups are often due to comorbidity with conditions like depression and alcohol dependence. Although the costs due to social anxiety disorder vary significantly across studies, countries and groups, they are nevertheless consistently lower than the costs associated with other anxiety disorders.
This is understandable given the underlying primary problem, which is chiefly social avoidance. All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. Enquiries in this regard should be directed to the British Psychological Society.
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Turn recording back on. National Center for Biotechnology Information , U. Search term. What is social anxiety disorder? How common is social anxiety disorder? When does social anxiety disorder start and how long does it last? What other mental disorders tend to be associated with social anxiety disorder? How does social anxiety disorder interfere with people's lives? Are there different types of social anxiety disorder?
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How many people seek treatment? How can we know whether a treatment is effective? Pharmacological interventions Several different pharmacological interventions have been used in the treatment of social anxiety, many of which were originally developed as antidepressants. In this Page. Other titles in this collection. Recent Activity.
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