一例大学生恐怖症的案例报告

本文是一例运用系统脱敏的方法,来对一个大学生恐怖症案例进行咨询的分析报告。通过收集、整理求助者的一般临床资料,并且进行鉴别诊断,求助者的问题诊断为恐怖症。经过治疗,求助者的恐怖症状基本解决,使其恢复了原来的正常学习生活,咨询效果较为明显。     

Mental health of Iranian high school and college students

The objectives of this study were to investigate the mental health of Iranian high school and college students with regard to sex differences and to compare the results with those from other countries. The sample included 159 high school students (79 boys, 80 girls) and 160 college students (80 boys, 80 girls). The Middlesex Hospital Questionnaire was used to measure free floating anxiety, depression, phobia, obsession, and somatization. Significant effects of group and sex were noted for phobia, but for depression only the main effect of group was significant. For other scales neither the main effects of group and sex nor their interactions were significant. Iranian college students showed more anxiety than their British peers.     

Doll Play Narratives About Starting School in Children of Socially Anxious Mothers, and Their Relation to Subsequent Child School-Based Anxiety

Child social anxiety is common, and predicts later emotional and academic impairment. Offspring of socially anxious mothers are at increased risk. It is important to establish whether individual vulnerability to disorder can be identified in young children. The responses of 4.5?year-old children of mothers with social phobia (N?=?62) and non-anxious mothers (N?=?60) were compared, two months before school entry, using a Doll Play (DP) procedure focused on the social challenge of starting school. DP responses were examined in relation to teacher reports of anxious-depressed symptoms and social worries at the end of the child’s first school term. The role of earlier child behavioral inhibition and attachment, assessed at 14?months, was also considered. Compared to children of non-anxious mothers, children of mothers with social phobia were significantly more likely to give anxiously negative responses in their school DP (OR?=?2.57). In turn, negative DP predicted teacher reported anxious-depressed and social worry problems. There were no effects of infant behavioral inhibition or attachment. Vulnerability in young children at risk of anxiety can be identified using Doll Play narratives.     

Psychological Factors Behind Truancy,School Phobia,and School Refusal: A Literature Study

Truancy is a problem that normally leads to treatment interventions within different organizations. Within these organizations different perspectives on the causes and consequences of the above problem can be found. The purpose of this literature study is to map out and describe the current state of research within the fields of school refusal, truancy, and school phobia. The investigation was carried out in the form of a systematic review of the relevant research literature. Research shows that approximately 90% of all young people who refuse to go to school have some form of psychiatric diagnosis.     

Disgust sensitivity, trait anxiety and anxiety disorders symptoms in normal children.

There is evidence to suggest that disgust sensitivity plays a role in the development of small animal fears and phobias. Recently, Phillips, Senior, Fahy, and David (1998) [Phillips, M. L., Senior, C., Fahy, T., & David, A. S. (1998). Disgust: the forgotten emotion of psychiatry. British Journal of Psychiatry, 172, 373-375.] suggested that disgust sensitivity is also involved in various other anxiety-based symptoms (e.g. obsessive-compulsive complaints, social phobia). The present study sought to test this suggestion in a large sample of normal school children (N = 189). Children completed a measure of disgust sensitivity, the trait anxiety version of the Spielberger State-Trait Anxiety Inventory for Children and the Screen for Child Anxiety Related Emotional Disorders, an instrument that measures DSM-defined anxiety disorders symptoms. Disgust sensitivity was indeed found to be correlated with a broad range of anxiety disorders symptoms. However, results also indicated that these correlations were predominantly carried by trait anxiety. That is, when controlling for levels of trait anxiety, only specific phobia symptoms (including animal phobia, blood-injection-injury phobia and situational-environmental phobia) and separation anxiety disorder symptoms were significantly related to disgust sensitivity, although correlations were rather modest. Taken together, these findings cast doubts on the claim that disgust sensitivity is an unique and independent factor that contributes to a broad range of anxiety disorders.     

社交焦虑个体外显与内隐自尊的研究

社交恐惧图式理论、社交恐惧模式、和社交恐惧认知行为模式等认知理论,都认为社交恐惧产生于不良的自我图式。为了探讨社交恐惧个体是否具有不良的自我图式,要求40名高社交恐惧个体和30名低社交焦虑个体完成了自尊量表和内隐联想任务。结果发现：高社交恐惧个体在自尊量表上的得分显著低于低社交恐惧个体,但在内隐自尊上,他们都有着积极的自尊,且无显著差异。这一研究结果不支持社交恐惧的认知理论。根据自我呈现理论讨论了研究结果。     

Shyness: relationship to social phobia and other psychiatric disorders

The relationship between shyness, social phobia and other psychiatric disorders was examined. The prevalence of social phobia was significantly higher among shy persons (18%) compared with non-shy persons (3%). However, the majority of shy individuals (82%) were not socially phobic. A significant and positive correlation was found between the severity of shyness and the presence of social phobia, but the data suggest that social phobia is not merely severe shyness. Social phobia was also positively and moderately correlated with introversion and neuroticism. Thus, shy persons with social phobia were shyer, more introverted, and more neurotic than other shy people, but none of these factors was sufficient to distinguish shy persons with social phobia from those without social phobia. The proportion of the shy group with psychiatric diagnoses other than social phobia was significantly higher than among the non-shy group, indicating that various diagnostic categories are prominent among the shy. The results are discussed in terms of the overlap in shyness and social phobia and the relationship of shyness to other psychiatric diagnoses and personality dimensions.     

The shyness spectrum

Debate continues regarding the relationship between shyness and social phobia. Some have proposed that this relationship is best understood by adopting a spectrum approach where increasing levels of shyness eventually merge into the clinical disorder of social phobia. This paper begins to explore the validity of this spectrum by reviewing similarities and differences between shyness and social phobia and investigating how shyness relates to social phobia subtypes. This paper will also explore precursors to social phobia, namely childhood behavioral inhibition.     

Threat perception bias in nonreferred, socially anxious children

Investigated whether socially anxious children display a threat perception bias. A sample of 252 primary school children ages 8 to 13 years were exposed to ambiguous stories of social situations and instructed to find out as quickly as possible whether a story was scary. Furthermore, children were invited to tell how each story would end and to judge how they would feel when actually confronted with that situation. The main results can be summarized as follows. First, socially anxious children displayed lower thresholds for threat perception than control children. In other words, compared with control children, socially anxious children needed to hear fewer sentences of a story before deciding it was scary. Furthermore, socially anxious children more frequently perceived threat while listening to the stories than did control children. Finally, socially anxious children more often interpreted the stories as threatening and displayed higher levels of negative feelings and cognitions in relation to these stories compared with control children. These findings fit nicely in current information-processing theories of childhood anxiety. An additional aim of this study was to investigate the convergent validity of the social phobia scales of 2 recently developed self-report questionnaires for measuring anxiety disorder symptoms in children: the Spence Children's Anxiety Scale (Spence, 1998) and the Screen for Child Anxiety Related Emotional Disorders (Birmaher et al., 1997). Results indicated that the social phobia scale of the Spence Children's Anxiety Scale and the extended social phobia scale of the Screen for Child Anxiety Related Emotional Disorders correlated substantially with a specific measure of social anxiety, the Social Anxiety Scale for Children-Revised.     

Frequency, comorbidity, and psychosocial impairment of specific phobia in adolescents

Investigated the frequency, comorbidity, and psychosocial impairment of specific phobia and specific fears among 1,035 adolescents 12 to 17 years old. The adolescents were recruited from 36 schools in the province of Bremen, Germany. Specific phobia and other psychiatric disorders were coded based on Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994) criteria using the computerized Munich version of the Composite International Diagnostic Interview (Wittchen & Pfister, 1996). Thirty-six (3.5%) of the adolescents met DSM-IV criteria for specific phobia sometime in their life. Of all the subtypes of specific phobia, animal and natural environment phobia were the most common. More girls than boys received the diagnosis of specific phobia. One third of the adolescents with specific phobia also had depressive and somatoform disorders. Despite the high level of psychosocial impairment experienced by individuals with specific phobia both during the worst episode of their disorder and in the last 4 weeks, only a small portion of them sought professional help.     

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.     

The structure of specific phobia symptoms among children and adolescents.

Previous research [Frederikson, M., Annas, P., Fisher, H. & Wik, G. (1996). Gender and age differences in the prevalence of specific fears and phobias. Behaviour Research and Therapy, 34, 33-39.] has shown that specific phobia symptoms of adults cluster into three subtypes: animal phobia, blood-injection-injury phobia and environmental-situational phobia. The present study examined whether these specific phobia subtypes can also be found in children. 996 children aged between 7 and 19 years completed a brief questionnaire regarding the frequency with which they experienced specific phobia symptoms. Confirmatory factor analysis was employed to examine the structure of these data. Results showed that childhood specific phobia symptoms indeed cluster into the three subtypes as described by Frederikson et al. and that these subtypes are either intercorrelated or the product of a single higher order factor. This structure appeared to be largely invariant across genders and age groups.     

Different sources of loneliness are associated with different forms of psychopathology in adolescence

The present study investigated associations between loneliness in different social relationships and indicators of psychopathology in adolescence. A nationally representative sample of 1009 high school students completed measures of three types of loneliness and six indicators of psychopathology. Results indicated that peer-related and family-related loneliness were associated with depression, anxiety, and suicide ideation, whereas peer-related and romantic loneliness were associated with social phobia. In contrast, only family-related loneliness was associated with deliberate self-harm and eating disorders. It is important, therefore, to distinguish between experiences of loneliness in different social relationships, in particular the peer versus the family setting, when investigating loneliness and psychopathology in adolescence.     

The role of disgust propensity in blood-injection-injury phobia: Comparisons between Asian Americans and Caucasian Americans

There is a growing body of evidence suggesting the potential role of disgust propensity in blood-injection-injury (BII) phobia. The current study examined associations between disgust propensity and BII phobia symptom severity in Caucasian Americans (n=310) and Asian Americans (n=223). Asian Americans typically scored higher than Caucasian Americans on the BII and disgust measures. The present study also examined the structural relations between gender, cultural background, disgust propensity, and BII phobia symptom severity. According to the structural equation model, disgust propensity was significantly related to levels of BII phobia symptom severity and fully mediated the relationships between BII phobia symptom severity and the demographic variables of gender and cultural background. The implications of the results for cultural refinements to our understanding of disgust propensity and BII phobia are discussed.     

Frequency and comorbidity of social phobia and social fears in adolescents.

This report presents findings on the frequency, comorbidity and psychosocial impairment of social phobia and social fears among 1035 adolescents, aged 12-17 years. The adolescents were randomly selected from 36 schools in the province of Bremen, Germany. Social phobia and other psychiatric disorders were coded based on DSM-IV criteria using the computerized Munich version of the Composite International Diagnostic Interview. Seventeen (1.6%) of the adolescents met the DSM-IV criteria for social phobia sometimes in their life. More girls than boys received the diagnosis of social phobia and the frequency of the disorder increased with age. The lifetime frequency of social fears were much higher than that of social phobia. The most common types of feared social situations were fear of doing something in front of other people, followed by public speaking. Social phobia comorbid highly with depressive disorders, somatoform disorders and substance use disorders. Despite the high level of psychosocial impairment experienced by cases with social phobia and those with any social fears, only a small portion of them did receive professional help.     

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.     

Gaze avoidance in social phobia: Objective measure and correlates

Gaze aversion could be a central component of the physiopathology of social phobia. The emotions of the people interacting with a person with social phobia seem to model this gaze aversion. Our research consists of testing gaze aversion in subjects with social phobia compared to control subjects in different emotional faces of men and women using an eye tracker. Twenty-six subjects with DSM-IV social phobia were recruited. Twenty-four healthy subjects aged and sex-matched constituted the control group. We looked at the number of fixations and the dwell time in the eyes area on the pictures. The main findings of this research are: confirming a significantly lower amount of fixations and dwell time in patients with social phobia as a general mean and for the 6 basic emotions independently from gender; observing a significant correlation between the severity of the phobia and the degree of gaze avoidance. However, no difference in gaze avoidance according to subject/picture gender matching was observed. These findings confirm and extend some previous results, and suggest that eye avoidance is a robust marker of persons with social phobia, which could be used as a behavioral phenotype for brain imagery studies on this disorder.     

The Social Thoughts and Beliefs Scale: a new inventory for assessing cognitions in social phobia

Development and initial psychometric features of a new inventory to assess cognitions associated with social phobia are described. The Social Thoughts and Beliefs Scale (STABS) is designed to assess cognitions in individuals with social phobia. In the 1st study, an initial pool of 45 items was reduced to 21. In the 2nd study, psychometric features of the scale were examined in a sample of individuals with social phobia, other anxiety disorders, and no psychiatric disorder. Total scores and two factor scores significantly differentiated individuals with social phobia from those in the other groups and were found to have adequate test-retest reliability and internal consistency. Potential usefulness of the STABS for assessing cognitions associated with social phobia is discussed.     

What Is the Core Fear in Social Phobia? A New Model to Facilitate Individualized Case Conceptualization and Treatment

What, exactly, do individuals with social phobia fear? Whereas fear of anxiety-related bodily sensations characterizes and defines panic disorder, is there a fundamental focus of anxiety that unifies individuals under the diagnostic category of social phobia? Current conceptualizations of social phobia suggest several possible candidates, including the fear of negative evaluation, embarrassment, and loss of social status. However, it is argued here that these conceptualizations are fundamentally flawed and confusing, and the lack of clarity with respect to this question has hampered our ability to conceptualize and treat patients with social phobia in a manner that is tailored to individual differences in symptom presentation. In the present article, I will propose a novel conceptualization of core fear in social phobia, demonstrate how this conceptualization can be used to classify individuals with social phobia in a manner that eliminates confusion and accounts for symptom heterogeneity, and illustrate its potential utility for both clinical practice and research.