Social Phobia and the Experience of Shame: Childhood Origins and Pastoral Implications

While social phobia is typically diagnosed in adolescence, the roots of social phobia are found in childhood experiences of shame. When shame occurs because of a failure to meet a child’s need this creates a fundamental uncertainty which can become internalized in the form of self-contempt. Emotions such as sadness are sometimes forbidden by caregivers, and the expression of natural sexual drives are sometimes prohibited. Such experiences create shame and may keep the person from feeling emotions and drives because shame has displaced the real emotion. The fractures in early relationships can be restored through the healing presence of another. The pastor has access to persons with social phobia who may not be willing to seek psychiatric care and is in a unique position to bring the resources of the church to bear in the lives of persons with social phobia. To do so, she moves away from the extroverted frame of reference within which the church frequently operates.Philip Browning Helsel, a graduate of Princeton Theological Seminary, serves as a Chaplain Resident in the Clinical Pastoral Education program at Yuma Regional Medical Center in, Yuma, AZ     

Social anxiety in body dysmorphic disorder

Although clinical impressions suggest that patients with body dysmorphic disorder (BDD) experience distress in social situations, social anxiety in BDD has received little investigation. This study examined social anxiety in 81 patients with BDD and change in social anxiety with pharmacotherapy. Subjects completed the Social Avoidance and Distress Scale (SADS) and were assessed with measures of BDD symptomatology. Participants in a placebo-controlled fluoxetine trial completed measures at baseline and endpoint. The mean SADS score was 1.3 SD units higher than nonclinical sample means but consistent with other clinical sample means. Social anxiety was significantly correlated with BDD severity. Greater depressive symptoms as well as comorbid avoidant personality disorder, but not comorbid social phobia, were also associated with higher SADS scores. Social anxiety did not improve more with fluoxetine than placebo, yet it improved significantly more in fluoxetine responders than in nonresponders. Understanding social anxiety in BDD has implications for reducing rates of misdiagnosis and treatment dropout.     

Do socially anxious individuals fear embarrassment by close others? Development of the Fear of Embarrassment by Others Scale

Social anxiety disorder is characterized by an intense fear of social or performance situations, and a fear of acting in a way that will be humiliating or embarrassing. However, the extent to which socially anxious individuals fear embarrassment due to the behavior of close others remains unknown. The Fear of Embarrassment by Others Scale (FEOS) was developed to assess the extent to which individuals with social anxiety fear being embarrassed by others. To assess the psychometric properties of this measure, 162 undergraduate students low or high in social anxiety completed the FEOS, along with additional questionnaires. An exploratory factor analysis suggested a single factor. The measure demonstrates high internal consistency, and is correlated with measures of social anxiety, fear of negative evaluation, and anxiety sensitivity. Fear of embarrassment by others was not found to be a significant predictor of social anxiety, as compared to anxiety sensitivity and fear of negative evaluation. The FEOS discriminated among participants high and low in social anxiety, as those high in social anxiety scored significantly higher on the measure than did participants low in social anxiety. The utility of this scale for research and clinical practice is discussed.     

Clinical Experiences in Conducting Cognitive-Behavioral Therapy for Social Phobia

Several authors have identified a disconnect between psychotherapy research, including research on cognitive behavioral therapy (CBT), and real-world psychotherapy practice. This disconnect has several negative consequences, potentially including less-than-optimal practice standards as well as a lack of input from practicing psychotherapists on how research can be improved and made more relevant in their day-to-day clinical work. As part of an ongoing effort to engage practicing psychotherapists in a feedback loop with psychotherapy researchers, this study reports the results of a survey of CBT therapists who have used CBT in the treatment of social phobia (SP). The survey was designed primarily to document how often certain potential problems, identified by expert researchers and CBT manuals, actually act as barriers to successful treatment when CBT is employed in nonresearch environments. The participants were 276 psychotherapists responding to email, online, and print advertisements completing the online survey. Participants varied considerably in psychotherapy experience, work environment, experience in using CBT for SP, and in some ways varied in their usual CBT techniques when treating SP. Among the most prominent barriers identified by many of the participants were patient motivation, comorbidity, logistical problems (especially with exposures), patient resistance, and severity and chronicity of SP symptoms. These findings may be useful for psychotherapy researchers as areas for potential study. The results may also suggest topics requiring clinical guidelines, innovations within CBT, and dissemination of successful techniques to address the barriers identified here.     

Emotional facial expressions and the attentional blink: Attenuated blink for angry and happy faces irrespective of social anxiety

Although facial information is distributed over spatial as well as temporal domains, thus far research on selective attention to disapproving faces has concentrated predominantly on the spatial domain. This study examined the temporal characteristics of visual attention towards facial expressions by presenting a Rapid Serial Visual Presentation (RSVP) paradigm to high (n=33) and low (n=34) socially anxious women. Neutral letter stimuli (p, q, d, b) were presented as the first target (T1), and emotional faces (neutral, happy, angry) as the second target (T2). Irrespective of social anxiety, the attentional blink was attenuated for emotional faces. Emotional faces as T2 did not influence identification accuracy of a preceding (neutral) target. The relatively low threshold for the (explicit) identification of emotional expressions is consistent with the view that emotional facial expressions are processed relatively efficiently.     

Compression as a Universal Principle of Animal Behavior

A key aim in biology and psychology is to identify fundamental principles underpinning the behavior of animals, including humans. Analyses of human language and the behavior of a range of non‐human animal species have provided evidence for a common pattern underlying diverse behavioral phenomena: Words follow Zipf's law of brevity (the tendency of more frequently used words to be shorter), and conformity to this general pattern has been seen in the behavior of a number of other animals. It has been argued that the presence of this law is a sign of efficient coding in the information theoretic sense. However, no strong direct connection has been demonstrated between the law and compression, the information theoretic principle of minimizing the expected length of a code. Here, we show that minimizing the expected code length implies that the length of a word cannot increase as its frequency increases. Furthermore, we show that the mean code length or duration is significantly small in human language, and also in the behavior of other species in all cases where agreement with the law of brevity has been found. We argue that compression is a general principle of animal behavior that reflects selection for efficiency of coding.     

General or specific? The memory–experience gap for individuals diagnosed with a major depressive disorder or a social phobia diagnosis,and individuals without such diagnoses

ABSTRACT

Psychological treatment and assessment necessarily rely on patients’ recall. Yet several empirical studies have documented a gap between memory and real-life experience (i.e., memory–experience gap; MeG). We investigated and compared the MeG of sadness, social anxiety, happiness, and physical activity for participants diagnosed with a major depressive disorder (MDD), a social phobia (SP), and participants without such diagnoses (CG). The study included 118 participants diagnosed with a MDD, 47 with a SP, and 119 CG. Using event-sampling methods (ESM), participants were asked via smartphone to report their experiences throughout a week and then to recall those again retrospectively at the end of the study week. Results indicate significant differences in the MeG with respect to the experience that was salient to them (e.g., MDD group – sadness; SP group – social anxiety; CG group – happiness). Furthermore, all groups showed a MeG for physical activity and, the results indicate significant group differences in the magnitude of the MeGs.

This study demonstrated the presence of a MeG in individuals in a MDD, SP, and CG group and in positive and negative affective experiences. Differential patterns across the samples contribute to a better understanding of this gap and its implications.     

Thought Suppression in Spider-Fearful and Nonfearful Individuals

The authors examined the suppression of spider-related thoughts in spiderfearful (n = 23) and nonfearful (n = 22) individuals. Participants were primed with vivid pictures of spiders and a story about spiders. Next, they were randomly assigned to 1 of 2 conditions: (a) suppression of thoughts associated with the previously presented spiderrelated stimuli or (b) free expression of any thoughts, including those related to the spider-related stimuli. All participants completed a subsequent free-expression exercise. Results indicated that spider-fearful individuals expressed thoughts about the spider-related stimuli for a longer length of time than did nonfearful individuals, particularly in the suppression condition. Participants in both groups demonstrated a rebound of thoughts associated with the spider-related stimuli following suppression. The authors propose that the priming of feared stimuli makes suppression of fear-related thoughts particularly difficult for fearful individuals, perhaps by activating a state of heightened arousal.     

Dental anxiety in the elderly

Abstract

This review of the literature shows that dental anxiety in the elderly has been estimated at a much lower level than that found in the general population. However, it is thought that the problem may have been underestimated because older persons may have masked their feelings by minimizing their needs for dental treatment. It is suggested that dentists need to address the special needs of the older dental patients if they wish to have them utilize their services. Older persons' needs can be met only with a greater understanding and tolerance of ageing processes than has been shown in the past. The decrease of dental anxiety with age found in cross-sectional studies needs to be confirmed by longitudinal studies.     

Social skills and social phobia: An investigation of DSM-IV subtypes

Social phobia is characterized as pervasive social timidity in social settings. Although much is known about this disorder, aspects of its clinical presentation remain unexplored, in particular characteristics that distinguish the generalized and non-generalized subtypes. For example, it remains unclear whether patients with the non-generalized subtype display social skills deficits in social interactions, and if so, are these deficits clinically, as well as statistically, significant? In this study, adults with either the non-generalized (NGSP; n = 60) or generalized (GSP; n = 119) subtype of social phobia and adults with no psychological disorder (n = 200) completed an extensive behavioral assessment of social skill and social anxiety. As expected, adults with NGSP and GSP reported equal distress and displayed similar rates of avoidance during an Impromptu Speech Task when compared to adults with no disorder. In contrast, the three groups were distinctly different when interacting with another person in various social situations. Adults with NGSP displayed social skill deficits when compared to individuals with no disorder, but they had fewer deficits than the GSP subtype. However, the identified skill deficits were clinically as well as statistically significant only for the GSP subtype. The results are discussed in terms of the contribution of skill deficits to the conceptualization and treatment of social phobia.