Understanding and Treating Social Phobia

Social phobia, a relatively obscure disorder, is receiving increased attention due to evidence suggesting that it is more prevalent and debilitative than once thought. The purpose of this article is to help counselors better understand the nature of and treatments for this disorder. Effective behavioral and pharmacological approaches are reviewed, and counseling implications are discussed to increase counselors' confidence in providing treatment to people with social phobia.     

基于增强现实和ERPs架构的SNARC效应展望

SNARC效应是人类空间认知的重要组成部分。限于技术手段,现有SNARC研究的理论和技术多以小尺度空间环境为基础,致使其生态效度较低。基于增强现实技术和认知神经科学范式,通过增强现实技术生成的交互情境,从核心加工系统(静态空间SNARC、动态空间SNARC、静态-动态联合SNARC)和加工特性两个方面,研究建立起基于大尺度空间环境的SNARC加工模型。为人类空间认知研究提供了更加完备的知识领域。     

The Treatment of Social Phobia in a Young Boy With Asperger's Disorder

Anxiety disorders, including social phobia, occur often in children with autism spectrum disorders (ASD; Gillott, Furniss, & Walter, 2001; Leyfer et al., 2006; Simonoff et al., 2008); however, little is known about the conceptualization and treatment of social phobia in this population. The current study presents the case of “James,” a 6-year-old male with comorbid Asperger's disorder and social phobia. A cognitive-behavioral treatment (CBT) package, including parent training, psychoeducation, graduated exposure, and reinforced practice, was implemented to decrease avoidance behaviors in social settings. Results showed that James's avoidance behaviors were reduced significantly following intervention, suggesting that a CBT approach may be effective in treating social phobia in children with ASD. The significant influence of CBT on decreasing avoidance behavior in comorbid social phobia and ASD highlights the need for continued investigation of adapting CBT for use with children with ASD.     

Virtual Reality One-Session Treatment of Child-Specific Phobia of Dogs: A Controlled,Multiple Baseline Case Series

Specific phobia (SP) typically onsets in childhood and frequently predicts other mental health disorders later in life. Fortunately, childhood SP can be effectively treated with cognitive behavior therapy (CBT), including the exposure-based one-session treatment (OST) approach. Despite empirical support for CBT and OST, clinicians, for various reasons, frequently fail to implement exposure-based therapy in routine clinical practice, including perceived difficulties in implementing exposure. Virtual reality (VR) exposure therapy may overcome some of these challenges and provides an alternative modality of therapy. This preliminary study examined the efficacy of VR OST for 8 children with a SP of dogs (aged 8–12 years) (M = age 10.25; SD = 2.11) using a multiple-baseline controlled case series. Following a stable baseline period of either 2, 3, or 4 weeks, it was expected that specific phobia severity would significantly decline after VR OST and remain improved over the 3-week maintenance phase. Assessments were conducted posttreatment and at 1-month follow up (study end-point). It was found that phobia symptoms remained relatively stable across the baselines, with significant reductions from pretreatment to posttreatment and to follow-up on clinician severity ratings (pre- to post- g = 1.12; pre- to follow-up g = 2.40), target symptom ratings (g = 1.14; 1.29), and behavioral avoidance (g = -1.27; -1.96). The treatment was also associated with clinically significant outcomes, whereby at one-month follow up, 75% of children were considered “recovered” and 88% completed the BAT (interacted with their feared stimuli). This study provides support for the effectiveness of VR OST.     

Cognitive Avoidance in Phobia

It is suggested that anxious individuals would have a processing bias for threat only in the initial processing stage, whereas in the consecutive stages the more elaborate analysis of the stimulus would be inhibited. The purpose of this study was to investigate the stage in which the bias changed into avoidance and whether cognitive avoidance of threat is restricted to information that refers to the anxiety response as opposed to the threatening stimulus. Therefore, 37 spider phobics and 34 controls were administered a negative priming task and a free recall task, using threat words and neutral words, both divided into stimulus-related and response-related words. There was no indication of cognitive avoidance of the response-related threat words as assessed by the negative priming task. Recall findings indicated an incomplete memory bias in phobics, with a better recall of stimulus-related threat words instead of a worse recall of response-related threat words. This suggests a passive cognitive avoidance mechanism, which may still impede the processing of response-related information, crucial for the success of exposure therapy.     

Cognitive-Behavioral Treatment of Social Phobia

Social phobia can be a chronic disorder, capable of restricting a client's social and occupational functioning. Cognitive-behavioral therapy can help many clients learn to overcome their social inhibitions, and make lasting changes in their interpersonal style. Cognitive-behavioral therapy for social phobia includes four general components for helping clients learn to manage their social anxiety. First, therapy begins with the establishment of a sound therapeutic alliance, a focus on assessment, diagnostic interviewing, and education regarding anxiety symptoms and their treatment. Second, the therapist helps clients to develop competence in social skills, relaxation training, and cognitive restructuring. Third, therapy uses exposure to social situations in order to help clients confront their fears and refine their coping skills. Fourth, relapse prevention strategies are used to help clients learn to tolerate feelings of discomfort and confront challenging social interactions. This treatment framework can be adapted to the specific needs of different clients.     

Psychopathology of Adolescent Social Phobia

Sixty-three adolescents with social phobia and 43 with no psychiatric disorders were compared across a number of clinical variables. In addition to clinically impairing social fear, adolescents with social phobia had significantly higher levels of loneliness, dysphoria, general emotional over-responsiveness and more internalizing behaviors than normal controls and 57.1% of socially phobic adolescents had a second, concurrent diagnosis, 75% of which were other anxiety disorders. In addition, adolescents with social phobia were significantly less socially skilled. Though similar in some respects to childhood social phobia, adolescent social phobia has a unique clinical presentation. The importance of developmental differences on the development of age-appropriate interventions is discussed.     

Witnesses to Reality: Working Psychodynamically With Survivors of Terror 1

As generations of young men and women return from combat scarred not only physically but also psychologically by their experiences, as civil wars and genocide proliferate and refugees seek sanctuary in America from persecution in their native countries, even while others are held in violation of their international human rights by the United States government, this paper asks what role psychoanalysts can play in working with those who have survived violence and terror as adults. Offering a relational formulation of adult onset trauma, the author reviews some of the difficulties inherent in being called upon to bear witness to destructive social forces. The paper concludes with the case of a man who has been detained in Guantanamo Bay for the last 6 years.     

A Multivariate Genetic Analysis of Specific Phobia, Separation Anxiety and Social Phobia in Early Childhood

BACKGROUND: Comorbidity amongst anxiety disorders is very common in children as in adults and leads to considerable distress and impairment, yet is poorly understood. Multivariate genetic analyses can shed light on the origins of this comorbidity by revealing whether genetic or environmental risks for one disorder also influence another. We examined the genetic and environmental influences on the comorbidity between three common childhood anxiety disorders: Specific Phobia, Separation Anxiety and Social Phobia. METHODS: Using a two-phase design 4,662 twin-pairs were screened in the first phase and 854 pairs were assessed in the second phase by maternal-informant diagnostic interview using DSM-IV criteria. RESULTS: Multivariate genetic analysis revealed significant shared environmental over-lap between Specific Phobia and Separation Anxiety and significant familial and non-shared environmental over-lap between Specific Phobia and Social Phobia. CONCLUSIONS: Familial influences, especially shared environment, are central to the comorbidity between Specific Phobia and both Separation Anxiety and Social Phobia.     

Blood-Injection-Injury Phobia and Dog Phobia in Youth: Psychological Characteristics and Associated Features in a Clinical Sample

Blood-Injection-Injury (BII) phobia is a particularly debilitating condition that has been largely ignored in the child literature. The present study examined the clinical phenomenology of BII phobia in 27 youths, relative to 25 youths with dog phobia—one of the most common and well-studied phobia subtypes in youth. Children were compared on measures of phobia severity, functional impairment, comorbidity, threat appraisals (danger expectancies and coping), focus of fear, and physiological responding, as well as vulnerability factors including disgust sensitivity and family history. Children and adolescents with BII phobia had greater diagnostic severity. In addition, they were more likely to have a comorbid diagnosis of a physical health condition, to report more exaggerated danger expectancies, and to report fears that focused more on physical symptoms (e.g., faintness and nausea) in comparison to youth with dog phobia. The present study advances knowledge relating to this poorly understood condition in youth.     

Shared Reality: Experiencing Commonality With Others' Inner States About the World

ABSTRACT— Humans have a fundamental need to experience a shared reality with others. We present a new conceptualization of shared reality based on four conditions. We posit (a) that shared reality involves a (subjectively perceived) commonality of individuals' inner states (not just observable behaviors); (b) that shared reality is about some target referent; (c) that for a shared reality to occur, the commonality of inner states must be appropriately motivated; and (d) that shared reality involves the experience of a successful connection to other people's inner states. In reviewing relevant evidence, we emphasize research on the saying-is-believing effect , which illustrates the creation of shared reality in interpersonal communication. We discuss why shared reality provides a better explanation of the findings from saying-is-believing studies than do other formulations. Finally, we examine relations between our conceptualization of shared reality and related constructs (including empathy, perspective taking, theory of mind, common ground, embodied synchrony, and socially distributed knowledge) and indicate how our approach may promote a comprehensive and differentiated understanding of social-sharing phenomena.     

Treating Elders With Compulsive Hoarding: A Pilot Program

Hoarding among elderly clients can have serious health and safety consequences, including death. Because medications and standard behavioral treatments have yielded limited benefits for people with serious hoarding problems, we employed a specialized cognitive behavioral treatment (CBT) based on Frost and colleagues' model of hoarding problems. Of 11 elderly clients who met screening criteria for hoarding at a community mental health center, 6 completed an average of 35 sessions of therapy administered by a B.A.-level therapist trained and supervised in CBT methods. Treatment consisted of weekly home visits that included motivational interviewing, organizing and decision-making skills, cognitive therapy regarding hoarding and related beliefs, and practice sorting, discarding, and not acquiring. Modest improvement was evident in ratings of clutter, risky situations in the home, and functioning. Clients were generally satisfied with treatment. Challenges in treating hoarding in elderly clients include health and safety risks as well as reduced physical capacity that required problem-solving strategies.     

Post-event Processing in Children with Social Phobia

In the aftermath of a distressing social event, adults with social phobia (SP) engage in a review of this event with a focus on its negative aspects. To date, little is known about this post-event processing (PEP) and its relationship with perceived performance in SP children. We measured PEP in SP children (n = 24) and healthy controls (HC; n = 22), aged from 8 to 12 years, after the Trier Social Stress Test for Children (TSST-C). Children also rated their performance immediately after the TSST-C and 2.5 h later. SP children reported more negative and less positive PEP than controls. Regression analyses indicated that negative PEP was associated with social anxiety and perceived task performance independent of comorbid depression. The SP group rated their performance immediately after the TSST-C as worse compared to HCs and ratings remained stable over the following 2.5 h. Results are discussed in relation to current theories of SP.     

A Cross-Cultural Comparison of Social Phobia Symptoms

This study examined two forms of social anxiety or phobia, social phobia as defined by DSM-IV and Taijin Kyofusho (TKS, a Japanese form of social anxiety), in relation to their respective culturally prescribed self-construals as independent and interdependent. Japanese university students (N = 124) and U.S. university students (N = 123) were administered the Social Interaction Anxiety Scale, the Social Phobia Scale, the TKS Scale, and the Self-Construal Scale. From the results of a hierarchical regression analysis, TKS symptoms are more likely to be expressed by individuals who are Japanese and individuals who construe themselves low on independence but high on interdependence. In addition, social phobia symptoms are more likely to be expressed by individuals who construe themselves low on independence but high on interdependence irrespective of culture. Implications for therapists from each culture who have clients who present social anxiety or phobia symptoms are discussed.     

Treating Youths With Selective Mutism With an Alternating Design of Exposure-Based Practice and Contingency Management

Selective mutism is a severe childhood disorder involving failure to speak in public situations in which speaking is expected. The present study examined 9 youths with selective mutism treated with child-focused, exposure-based practices and parent-focused contingency management via an alternating treatments design. Broadband measures of functioning were employed, but particular focus was made on behavioral assessment of words spoken audibly and daily in public situations. Treatment ranged from 8 to 32 sessions and resulted in positive end-state functioning for 8 of 9 participants. Broader analyses indicated greater effectiveness for exposure-based practice than contingency management. The results support recent case reports of behavioral treatment for this population but in more rigorous fashion. Clinical and research challenges are discussed, including caveats about length and intensity of treatment for this population and need to develop standardized daily measures.