E-Book, Englisch, Band vol. 12, 96 Seiten
Rowa / Antony Social Anxiety Disorder
2. Auflage 2025
ISBN: 978-1-61334-602-0
Verlag: Hogrefe Publishing
Format: EPUB
Kopierschutz: 6 - ePub Watermark
E-Book, Englisch, Band vol. 12, 96 Seiten
Reihe: Advances in Psychotherapy - Evidence-Based Practice
ISBN: 978-1-61334-602-0
Verlag: Hogrefe Publishing
Format: EPUB
Kopierschutz: 6 - ePub Watermark
This 2nd edition exploring social anxiety disorder (SAD) in the Advances in Psychotherapy series incorporates the latest theory and research on its presentation, prevalence, assessment, and treatment. The authors expertly guide mental health or healthcare professionals at any level of experience through the models for understanding this common psychological disorder, how to select the best assessment measures, and why and how cognitive behavioral therapy (CBT) has the strongest evidence base. The different CBT techniques are explored in detail, with concrete tips for practitioners, and illustrations of client cases bring theory and practice alive. Cultural differences in the presentation of social anxiety and the impact of this on assessment and treatment are highlighted, as are other adaptations to these techniques when working with diverse populations. A detailed case study is provided, outlining the presentation and course of treatment for a client with SAD. Downloadable handouts for clinical use are available.
Zielgruppe
Clinical psychologists, psychiatrists, psychotherapists, and counselors, as well as students.
Autoren/Hrsg.
Fachgebiete
Weitere Infos & Material
1 1 Description
1.1 Terminology
SAD is characterized by fear or apprehension of social or performance situations. The core feature of SAD appears to be fear of negative evaluation, though some research suggests that individuals with SAD may be fearful of positive evaluation as well (Weeks et al., 2008; cf. Wilson et al., 2023). Although many people are nervous or shy in social or performance situations (e.g., some studies suggest that over 20% of individuals consider themselves to be “very shy”; Henderson & Zimbardo, 2010), SAD is diagnosed when this anxiety becomes so intense and pervasive that it causes significant distress for a person or it impairs the person’s ability to function. People with SAD fear numerous situations and settings. The number of situations feared by people with SAD varies from person to person. Some people report concerns about a few situations, or even just one situation (e.g., public speaking), whereas others indicate fear across a broad range of social and performance situations.
1.2 Definition
The most commonly used criteria for diagnosing SAD are those from the text revision of the American Psychiatric Association’s (APA, 2022) Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.; DSM-5-TR). The DSM-5-TR views SAD categorically, meaning that criteria for the disorder are either met or not met. Of course, even though diagnostic systems like the DSM are categorical, social anxiety exists on a continuum from mild shyness to severe symptoms.
The DSM-5-TR defines SAD as a marked and persistent fear of one or more social situations that often leads to avoidance of the feared situations. The individual fears acting in a way or showing anxiety symptoms that would be embarrassing, lead to rejection, or offend others. This fear is persistent, and the person must recognize that the fear is excessive. Some individuals may experience panic attacks cued by social situations (e.g., either when they are in the situation, when they anticipate an upcoming stressful situation, or after a difficult situation). Symptoms of social anxiety must lead to significant distress for the individual, or impairment in the person’s life. 2Impairment in SAD can be severe and individuals with SAD report impairment across multiple domains (Aderka et al., 2012). Functional impairment can lead to serious consequences. For example, one of our clients with SAD was not collecting disability payments he was entitled to because of fears of being criticized by others if he applied, as well as strong anxiety about making phone calls to “strangers” to request an application. Due to this inability to manage his anxiety and apply for disability, he found himself falling into significant debt.
Before the fifth edition of the APA’s (2013) Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5), the DSM provided a descriptor of “generalized” SAD, a subtype of SAD in which an individual reports fear in most social or performance situations. In the DSM-5, the “generalized” subtype was removed and the specifier “performance only” was added. This specifier refers to fear that is restricted to speaking or performing in public.
1.3 Epidemiology
SAD is a common psychological disorder, with a 12-month prevalence rate ranging between 2.4 and 6.8% and a lifetime prevalence rate between 4 and 12.1% (Kessler et al., 2005; Stein et al., 2018) with higher rates occurring in high-income countries and North and South America . Recent data suggest that levels of social anxiety increased as a result of the COVID-19 pandemic and those with an existing SAD diagnosis experienced a deterioration of their mental health (Kindred & Bates, 2023). SAD tends to begin in adolescence (i.e., mid to late teens), but can also occur earlier in childhood or later in adulthood. A meta-analysis of epidemiological studies suggests a median age of onset of 13 years (Solmi et al., 2022). SAD is routinely diagnosed in specialty anxiety clinics for children, validating the fact that this disorder commonly begins in childhood or adolescence. Cases of SAD beginning in later adulthood are less common (20% in one study; Koyuncu et al., 2015), but do exist and tend to be associated with higher rates of comorbidity and poorer quality of life (Peyre et al., 2022).
Epidemiological studies have tended to dichotomize gender into women and men; thus, we have used this language when describing these studies. Research using a broader perspective on gender diversity is needed. Epidemiological studies from the United States and Canada suggest that SAD is more common (Asher & Aderka, 2018; MacKenzie & Fowler, 2013) and severe (Asher et al., 2019) in women than in men. Studies from other countries are equivocal with respect to gender differences in prevalence (e.g., Jefferies & Ungar, 2020). There are some gender differences in the presentation of SAD. For example, men and women have different patterns of comorbidity, with women more likely than men to have other anxiety disorders (Asher & Aderka, 2018) and major depression (MacKenzie & Fowler, 2013) as comorbidities, whereas men were more likely than women to have comorbid substance use disorders (Xu et al., 2012) and conduct disorder (3Asher & Aderka, 2018). Men are more likely than women to seek treatment, but also more likely to drop out of treatment (Asher et al., 2019).
SAD is a broad cultural phenomenon, appearing in diverse cultures. Although the general presentation of SAD is fairly consistent across cultures, there are some interesting differences, highlighting cultural influences on the presentation of SAD (see Meidlinger and Hope (2014) for a detailed review). For example, rates of elevated social anxiety symptoms in the Arabian Gulf country Oman were high compared to reports from other populations, especially Western and European countries (Ambusaidi et al., 2022), suggesting that cultural norms may be related to the experience or expression of these symptoms. Rates of social anxiety on self-report measures are typically higher in collectivist cultures (especially East Asian cultures), while rates of diagnosed SAD are lower in East Asian cultures (Hofmann et al., 2010). Further, the types of situations that produce anxiety differ across cultures. One study compared people with SAD from Sweden, Australia, and the United States (Heimberg et al., 1997). Results suggested that Swedish individuals were more fearful of situations involving public observation (e.g., writing in public, eating or drinking in public, and public speaking). Individuals from Australia were more fearful of dating and starting conversations. Another study comparing individuals with SAD from the United States, Canada, Puerto Rico, and Korea found that fears of speaking to strangers were more pronounced in the Korean sample than in the other groups (Weissman et al., 1996). Research on severity of social anxiety symptoms across cultures suggests that European Americans report lower levels of social anxiety than East Asians (Hambrick et al., 2010), while they typically report higher levels of social anxiety than African Americans (Beard et al., 2011). Individuals from collectivist Latin American countries score lower on measures of SAD than those from individualistic cultures (Schreier et al., 2010).
In Japan and Korea, individuals may suffer from taijin kyofusho syndrome (TKS), which has been described as having a neurotic subtype and an offensive subtype. The neurotic subtype is most similar to the presentation of SAD in Western cultures (Choy et al., 2008) whereas the offensive subtype focuses on concerns that one may offend or embarrass others rather than themselves. For example, an individual with TKS may worry that they will offend others by emitting an unpleasant odor, by staring at others, or by making an improper facial expression. Although TKS is thought to be a culture-specific variation of SAD, research suggests that Western individuals with SAD have elevated scores on measures of TKS as compared to controls, suggesting that TKS may be relevant in Western ...
