Treating Social Phobias and Social Anxiety

Shyness And Social Anxiety System

The Shyness and Social Anxiety System is just as its name says. It is an e-book wherein in-depth discussions about the symptoms, causes and treatment for shyness and social anxiety are made. It is then written for individuals whose extreme shyness or social anxiety prevent them from enjoying a full life filled with social interactions among their family, friends and acquaintances in gatherings during holidays, outings and parties. The author Sean Cooper also suffered from shyness and social anxiety disorder so much so that he tried every trick in the book yet to no avail. And then he set out to conquer his own fears by researching into the psychology, principles and practices behind these two debilitating mental health issues. Read more here...

Shyness And Social Anxiety System Summary


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My Shyness And Social Anxiety System Review

Highly Recommended

All of the information that the author discovered has been compiled into a downloadable pdf so that purchasers of Shyness And Social Anxiety System can begin putting the methods it teaches to use as soon as possible.

When compared to other e-books and paper publications I have read, I consider this to be the bible for this topic. Get this and you will never regret the decision.

Social Anxiety In Children And Adolescents

Social anxiety is often evident early in life and may be diagnosed in children as young as eight years old (Beidel & Turner, 1998). Furthermore, when the social fears of children continue to be expressed through late adolescence they are more likely to be associated with a poor prognosis for recovery (Davidson et al., 1993 Mannuzza et al., 1995). The clinical presentation of social anxiety in children is similar to that of adults, with comparable somatic symptoms and feared situations. However, because of the limited cognitive development of younger children, they may not report specific negative cognitions (Beidel & Turner, 1998). Social anxiety in children is also associated with significant distress and impairment, including poor school achievement, greater loneliness, and difficulties with social relationships (Albano, Chorpita & Barlow, 1996a). Socially anxious children and adolescents may also suffer from elevated rates of general anxiety, depression, and secondary alcohol abuse...

The Existence of Lexical Syntax in Nonhuman Species Is Problematical

Given the widespread use of many subtly different, acoustically distinct vocalizations in different social situations, it seems logical to ask whether nonhuman primates or any other species ever combine vocalizations into compound utterances, and, if they do, whether they do so in accordance with a particular set of rules, or grammar

Personality Traits And Personality Disorders

In DSM-IV (American Psychiatric Association, 2000), overall diagnosis of a personality disorder requires an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture, affecting cognition, affectiv-ity, interpersonal functioning, and impulse control. The pattern must be inflexible and pervasive across a broad range of personal and social situations lead to clinically significant distress or impairment in social, occupational, or other important areas of functioning be stable and of long duration and have an onset that can be traced back at least to adolescence or early adulthood.

Social Factors In Personality Disorders

Avoidant personality disorder could be another example of the interaction between nature and nurture. Kagan (1994) has described a temperamental syndrome of behavioral inhibition in infants that increases the risk for anxious spectrum disorders in adolescence and that can be amplified by overprotective parenting. Similarly, avoidant personality disorder might not be seen in a traditional society, where anxious traits are buffered by family and community structures, while in modern society, anxious traits are more likely to be disabling, pervasive, and to lead to overt disorders (Paris, 1997).

Cognitive Therapy for Anxiety Disorders

Cognitive therapy has been adapted for the full range of anxiety disorders generalised anxiety disorder (Beck & Emery with Greenberg, 1985) panic disorder (Clark, 1986 Craske & Barlow, 2001) social phobia (Heimberg & Becker, 2002) and obsessive-compulsive disorder (Frost & Steketee, 2002 Salkovskis, 1985). For generalised anxiety disorder, Chambless & Gillis (1993) computed effect sizes across five studies in which cognitive therapy was compared with one of several control conditions non-directive therapy (Borkovec & Costello, 1993) or waiting list (Butler etal., 1987, 1991). Substantial effect sizes (1.5-2) at post-test and follow up suggest that cognitive therapy is an efficacious intervention for generalised anxiety disorder. A review of 12 trials of cognitive therapy for panic suggested that 80 of patients achieved full remission at the end of treatment (Barlow & Lehman, 1996). De Rubeis & Crits-Christoph (1998) reviewed 11 outcome studies of cognitive therapy for panic disorder....

Cognitive Therapy for Different Populations and in Different Settings

Individual cognitive therapy is the most common format, although couples, family, groups and organisational consultancy formats have also been developed. In individual therapy it is common to involve spouses, friends, parents or others, either as informants or as people who can help the client change (see Baucom et al, 1998). Cognitive couple therapy has been shown to be acceptable and effective in depression in one spouse, chronic interpersonal problems, and marital problems (Baucom et al., 1998 Dattilio & Padesky, 1990 Epstein & Baucom, 1989). Cognitive therapy in group format has been shown to be acceptable and effective for depression (Robinson, Berman & Neimeyer, 1990) and social phobia (Heimberg etal., 1993).

The Clinical Assessment Of Identity

Such a tactful confrontation will permit the patient with good reality testing to be aware of what it is in himself or herself that has created a particular reaction of the interviewer, and provide him or her with an explanation that reduces the strangeness or puzzling aspect of that behavior. This response, in other words, indicates good reality testing. If, to the contrary, such inquiry leads to an increased confusion, disorganization, or abnormal behavior in the interaction with the diagnostician, reality testing is presumably lost. The maintenance of reality testing is an essential aspect of the personality disorders, who may have lost the subtle aspects of tactfulness in social interactions, but maintained good reality testing under ordinary social circumstances. Loss of reality testing presumably indicates an atypical psychotic disorder or an organic mental disorder that finding would lead to further exploration of such behavior, affect, or thought in terms of a standard mental...

The Failure Of The Model Of Biological Classification For The Classification Of Psychopathology

We have discussed several differences between biological classification and psychiatric classification. The lack of mutually exclusive categories is the most obvious reason the model of biological classification does not fit psychiatric classification. In biological classification, if categories are not mutually exclusive, then the inclusion relation among categories is violated and the hierarchical nesting of categories makes little sense. In psychiatric classification, there is extensive overlap in category membership, even across wide branches of the hierarchical tree (e.g., patients with avoidant personality disorder are often very similar to patients with the subtype of anxiety disorder known as social phobia). Notice also that, although clinicians know that an important issue in diagnosis of avoidant personality disorder is its differentiation from social phobia, these two disorders are not included under the same superordinate category.

Empirical Challenges to Conceptual Distinctions

The close association between anxiety and depression in general, and between MDD and GAD in particular, has prompted efforts to revise the related conceptual models and diagnostic frameworks. In one influential alternative, Clark and Watson (1991) suggested that anxiety and depression share a common core of general negative affect. Depression combines this core with low levels of positive emotionality (i.e., anhedonia). In contrast, anxiety combines negative emotionality with high levels of physiological hyperarousal. This overlap has prompted calls for reorganization in the classification of the mood and anxiety disorders. Specifically, Watson (2005) has argued that the mood and anxiety disorders should be collapsed into a broad category of emotional disorders, with three subclasses bipolar disorders, distress disorders (i.e., MDD, dysthymic disorder, GAD, post-traumatic stress disorder), and fear disorders (i.e., panic disorder, agoraphobia, social phobia, specific phobia). The...

Positive Well Being and Health Protective Characteristics

One of the difficulties in evaluating the contribution of positive well-being to health is that it does not occur in isolation, but tends to be associated with a range of other psychosocial characteristics that may themselves have health benefits. This is illustrated in Table 14.1 with data from around 700 men and women aged 60.7 years on average, who were members of the Whitehall II epidemiological cohort (see Steptoe et al, 2008b for further details). Positive affect was assessed using EMA ratings of happiness obtained four times over a single day, while eudaimonic well-being was associated with the autonomy, self-realization, and control scales from the CASP-19 questionnaire (Hyde et al, 2003). The table summarizes the associations between these two dimensions of positive well-being and a series of psychosocial factors relevant to health. All analyses were adjusted for age, gender, socioeconomic status, employment status, and self-rated health. It can be seen that both positive...

The Therapeutic Relationship

A 46 year-old woman suffered from social anxiety and agoraphobia. Initially, treatment (exposure in vivo) appeared to be going smoothly, but as the exercises progressed treatment halted. The patient started cancelling appointments and when she did show up she had not completed the assignments. In view of the initial smooth progress, the therapist hypothesized that the stagnation might have to do with fears associated with definitive improvement of the complaints. Inquiry revealed that the patient dreaded having to go back to work for her father, whom she described as an authoritarian man whom she felt unable to stand up to. As a result of this discussion, the functional analysis and treatment plan were revised and patient and therapist agreed to include assertiveness training as part of the treatment.

Psychophysiological Pathways

One set of physiological parameters that has received attention concerns the stress hormone Cortisol. In general, problem-focused and approach coping styles are related to lower overall levels of cortisol, more favorable diurnal cortisol rhythms, and faster recovery to normal patterns after a stressor (Mikolajczak et al, 2007 Nicolson, 1992 O'Donnell et al, 2008 Sjogren et al, 2006). A number of qualities that reflect social integration and support have also been linked to favorable cortisol profiles. Use of social support relates to lower daily cortisol levels (O'Donnell et al, 2008). Social isolation (living alone and little contact with friends and family) predicts a greater cortisol response at awakening and greater cortisol output over the day (Grant et al, 2009). Higher levels of religiosity have also been associated with favorable cortisol patterns in women with fibromyalgia, even after controlling for social support (Dedert et al, 2004). Chronic occupational stress...

Surgery 421 Cosmetic Effects

Most apparent but not always sufficiently addressed are the cosmetic effects of surgery. Patients may be embarrassed by their own distress from a seemingly minor problem with an otherwise good outcome and consequently may not bring forth their concerns. Nonetheless, visible scars from cancer surgery can result in some cases in social isolation. Other patients find the sight and smell of an ostomy to be repugnant and greatly overestimate how much it is apparent to others around them. It is incumbent on providers caring for these patients to explore these issues with them to ensure that they are as satisfied as possible with long-term cosmesis. If distress is identified, they should look for ways to optimize the cosmetic result, and where this is not possible, try to help the patient best cope with their situation.

The Empirical Evidence Based Linking Social Networks to Health

Theoretically overcome with prospective observational studies with careful restriction of the study sample at entry to individuals without symptomatic illness (hence, our focus on cohort data in this review). Omitted variable bias is trickier to deal with since there are a number of potential variables - such as personality traits (e.g., hostility, general orneriness) - that could simultaneously account for social isolation and subsequent risk of major disease (e.g., cardiovascular disease). Large-scale prospective studies have seldom controlled for a comprehensive set of potential confounding variables. An additional level of complexity is introduced when the health outcome is in the realm of mental health, where negative affectivity could influence the reporting of social networks and be associated with increased risk of the outcomes of interest (Kawachi and Berkman, 2001). Novel methods for causal inference - such as instrumental variable analysis or propensity score matching...

Experimental Procedures And Manipulations

Members of a social group, honeybees are greatly affected by their social environment, and individuals readily adjust their life history to environmental conditions (Schulz et al., 1998 Pankiw, 2003). For this reason, experimental handling and stress (including social isolation) ought to be minimized or at least carefully controlled.

Management of Depressed Mood

Inactivity being one of Dianne's most salient high-risk situations, we introduced activity training as an intervention to tackle negative mood as well as her drinking problem. Activation training is a fairly common behavioural technique in treating depression, derived from Lewinson's theory of depression. We encouraged Mick to help his wife in organizing her week combining basic daily activities (like getting dressed in the morning), taking care of neglected activities (such as cleaning up the bedroom) and increasing the amount of pleasant activities (listening to music, going out for a cup of coffee with a friend). Given Dianne's social anxiety, a gradual approach was used in having her engage in social situations.

Communication Training

Communication training was introduced from session nine onwards. During this training both partners' personalities became more salient, this may be due to the fact the drinking and depressive symptoms had lessened. In addition, we addressed assertiveness, not only because of Dianne's social anxiety but also because both partners found it difficult to express disapproval and make a request. During these sessions it became clear that Mick had great

Summary And Conclusions

Exposure therapies are the treatment of choice in adult specific phobia, social phobia, agoraphobia, and obsessive-compulsive disorder (Emmelkamp, 2004) and have also been found quite effective in phobic children (Nauta et al., 2003). Studies of the behavioural treatment of depression have come to a standstill due to the rise of cognitive therapy in this area but the lack of further research into the behavioural treatment of depression is not justified by the data. There are still a number of important issues that need to be addressed. For example, we have no idea why cognitive therapy, behavioural interventions, IPT and pharmacotherapy work equally well with depressed patients, although various researchers provide various theoretical explanations. Unfortunately, to date there is no evidence that

Social Information Processing

Of cues, (c) clarification of goals, (d) response access and construction, (e) response decision and evaluation and (e) behavioural enactment. For example, they perceive more aggressive stimuli in social situations, interpret the intentions of others more frequently as being hostile, set more egocentric goals for actions, retrieve more aggressive reaction patterns from their memory, evaluate the consequences of aggressive actions more positively, and possess fewer non-aggressive interaction skills. Such modes of information processing make aggression a subjectively adequate reaction in social interactions. They are important mediators between long-term social influences, personality factors, and situational conditions of delinquent behaviour. However, more research on the relations between the various phases of information processing, social experiences and antisocial behaviour is necessary (Losel et al., in press). There are also not only unidirectional influences but more complex...

Does Levodopa Cause Motor Fluctuations

In a retrospective study, Lesser et al. (62) collected data from 131 PD patients relating to severity of disease and late complications and assessed whether these problems were attributed to duration of disease or levodopa therapy. A relationship was seen between the presence of fluctuations and duration of therapy, since those with fluctuations tended to be treated for four years or more. This was not true for dyskinesia. They, therefore, associated fluctuations with levodopa therapy but did not rule out the possibility that those receiving levodopa longer had a more progressive disease. It was recommended that initiation of therapy be delayed until the patient begins to function unsatisfactorily in occupational or social situations. This is perhaps the most frequently quoted paper on the subject however, the authors themselves pointed out the flaws in a retrospective study and indicated the need for a prospective evaluation of the problem.

Biological Pathways

SES has also been found to impact adolescents' cardiovascular reactivity. Chen et al (2004) demonstrated a relationship between low SES and greater cardiovascular reactivity during ambiguous (but not negative) videos of social situations that participants were presented with. Likewise, Gump et al (1999) reported that children and adolescents from low SES families showed increased cardiovascular reactivity in response to a laboratory stressor. These patterns linking low SES to greater cardiovascular reactivity may be particularly strong among youth from poor neighborhoods. Wilson et al (2000) found that among African American adolescents from poor neighborhoods those with less educated parents exhibited greater diastolic blood pressure in response to a competitive video game. Lastly, these associations may only be apparent in certain subgroups. Jackson et al (1999), for example, found a race by neighborhood SES interaction for systolic blood pressure reactivity such that both low SES...

Psychological Wellbeing And Quality Of Life

Decreased psychological well-being has been reported in hypopituitary adults despite replacement of all hormone deficiencies with the exception of GH (2). In studies comparing adults with long standing GH-deficiency with matched controls the patients reported lower openness, less assertiveness, less energy, greater emotional lability, more difficulties with sexual relationships and a greater sense of social isolation (2,3). Evi

Information from Human Studies

Wismer Fries et al (2005) reported that children who had lived in orphanages with limited social contact for an average of 17 months before being adopted showed lower overall urinary vasopressin levels for 4 days and lower urinary oxytocin during a game involving lots of mother-child touching compared with age-matched children who had always lived with their parents. Adult men who experienced early parental separation have also failed to show normal inhibition of cortisol following intranasal oxytocin administration (Meinlschmidt and Heim, 2007), while adult women who had experienced childhood abuse or neglect had lower oxytocin levels in their cerebrospinal fluid (Heim et al, 2008). Together, these studies suggest that central oxytocin and vasopressin pathways may show long-term effects of early life events involving parental attachment. In young unmarried adults, higher plasma oxytocin levels were linked to stronger attachment to their parents and to lower...

Prevalence Of Latelife Depression And Anxiety

Social phobia, simple phobia) are considered more common than other anxiety disorders such as panic disorder, obsessive-compulsive disorder and post-traumatic disorder (Stanley & Beck, 2000). Although phobias are the most common form of anxiety disorder among older people, social anxiety is much less prevalent in older people when compared to younger people (Gretarsdottir et al., 2004). As with depression, there is a suggestion that sub-syndromal levels of anxiety, particularly GAD, are common in older people and that minor GAD symptoms may cause enough problems to merit attention from clinicians (Carter et al., 2001 Diefenbach et al., 2003 Wetherell, LeRoux & Gatz, 2003).

Advantages And Limitations

As one further illustration of this difference between the likely criterion validities of SRIs and PBMs in personality assessment, Asendorpf, Banse, and Mucke (2002) observed shyness behavior in 139 participants who completed self-concept measures of both kinds. Implicitly measured self-concepts using an association test were more predictive of spontaneously emerging shy behavior in realistic social situations than were explicit self-ratings. Explicit self-ratings, on the other hand, were more predictive of controlled shyness behavior than was the implicit measure.

Social and Interpersonal Processes

Social relationships are intimately tied to well-being and mental health (Sullivan, 1953). The close association between mental health and social interpersonal processes is highlighted by the pervasiveness of severely impoverished social networks and deficits in social skills of persons with schizophrenia, depression, social anxiety, and eating disorders for example. Primary assumptions embedded in social and interpersonal perspectives in behavioral medicine are that interpersonal disturbances may function as (1) causally disruptive phenomena in the development of mental illness, (2) Neuroimaging research contributes to understandings of the importance of social and interpersonal processes in a variety of ways, including investigating the neural processes which underlie effective social interpersonal interactions and facilitate identification, attachment, and social bonding. Simple social interactions reveal a surprising complexity of coordinated responses, many of which occur outside...

Behavioral and Psychosocial Intervention

A range of psychosocial factors including low socioeconomic status (SES), psychosocial stress, social isolation, and personality factors increase risk for medical and psychiatric conditions and cluster together within groups and individuals (Sobel, 1995). Greater understanding of psychosocial risks in disease processes can inform development of effective interventions, and neuroimaging can contribute by exploring how psychosocial risks influences brain structure and function.

Epidemiology and Population

Population medicine approaches reflect the insight that specific features within a population may be associated with increased risk for certain disease processes, whereas at an individual level these associations may not be as easy to identify. For example, psychosocial and social factors are increasingly recognized as differentiating risk factors to a wide range of disease states. Depression, stress, and social isolation are, at the population level, strongly associated with a range of illnesses including cardiovascular disease and weakened immune responses. Emotional stress including anxiety and depression is associated with increased rates of cardiovascular disease occurrence (Wulsin and Singal, 2003) and cardiovascular disease mortality rates can precipitate cardiac arrhythmia and sudden death in patients with heart disease (Lampert et al, 2005 Oppenheimer et al, 1990 van Melle et al, 2004). Exploring these associations has revealed that mood, trauma, and stress directly influence...

Cognitive and Psychiatric Disturbances

Earlier literature described euphoria as a feature of MS (120). However, depression is now recognized much more commonly, with 50 or more of patients experiencing this affective disturbance in some form during the course of the illness (121-123). Although this is usually relatively mild, major depression can occur (123). Suicide may be a major cause of mortality, accounting for 15 of adult deaths in one series (124). Recently, Feinstein (125) identified warning signs that include living alone, having a family history of mental illness, and reporting social isolation. Patients with a prior history of major depression, anxiety disorder, or alcohol abuse are also particularly vulnerable. The so-called euphoria is actually the inability to inhibit emotional expression, resulting in inappropriate laughing and crying. This occurs with subcortical forebrain lesions (126). Other instances of apparent euphoria seem to be associated with evidence of significant cognitive decline. Euphoria is...

Description Of The Disorder

Social anxiety disorder, also referred to as social phobia (Liebowitz et al., 2000), has as its essential feature an extreme fear of appearing anxious or doing or saying something embarrassing in social or performance situations, accompanied by a fear of negative evaluation by others (American Psychiatric Association, 1994). For a diagnosis to be made in adults, the individual must recognize that the fear is excessive. Frequently feared situations include public speaking, going to parties, meeting strangers and talking to people in authority (Holt et al., 1992). The individual becomes anxious in anticipation of feared situations and often avoids them, leading to significant distress and interference in the person's life. When the person's anxiety is experienced in most social situations, he or she is further described as having the generalized subtype of social anxiety disorder. The majority of persons presenting for treatment for social anxiety disorder are of the generalized...

Cognitive And Behavioural Therapies

Over the past decade, a number of studies have examined the efficacy of psychological (mostly cognitive-behavioural) treatments for social anxiety disorder. The most commonly investigated treatments have been in vivo exposure (with or without the addition of cognitive restructuring techniques), social skills training, and relaxation training. The International Consensus Group on Depression and Anxiety's 'Consensus Statement on Social Anxiety Disorder' concluded that there is good evidence for the efficacy of exposure-based cognitive-behavioural interventions for social anxiety (Ballenger et al., 1998). Accordingly, these interventions receive the bulk of our attention in this review. Exposure to feared situations is a central component of most treatments for social anxiety disorder. Exposure can be conducted either imaginally, in role plays or in vivo, to help clients habituate to anxiety-provoking situations and to provide an opportunity to gather disconfirmatory information and...

Comparisons And Combinations Of Cbt And Medication

The few studies that have compared the efficacy of CBT to that of medication treatments have been difficult to interpret because of a variety of methodological problems. One study indicated that CBT was more effective than buspirone for socially anxious musicians (Clark & Agras, 1991) and another reported that combined imaginal and in vivo exposure was more effective than the beta-adrenergic blocker atenolol (Turner, et al., 1994a). However, neither atenolol nor buspirone has surpassed placebo in the treatment of social anxiety disorder (Liebowitz et al., 1992 van Vliet et al., 1997). Phenelzine has long been considered the best established pharmacological treatment for social anxiety, demonstrating the largest effect size across controlled trials (Blanco et al., 2003). However, it is not considered a first-line medication because of the risk of hypertensive reaction and the associated need for dietary restrictions. In a large, multisite collaborative study, Heimberg et al. (1998)...

Interpersonal Psychotherapy

A review of the literature suggests that a small number of non-cognitive or behavioural treatment alternatives exist for the treatment of social anxiety (for a review see Lipsitz & Marshall, 2001). These studies show promising results but are limited by a lack of rigorous methodology, such as incorporation of control groups or larger sample sizes. Promising results come from a recent uncontrolled trial applying interpersonal psychotherapy (IPT) to nine individuals with social anxiety disorder (Lipsitz et al., 1999). IPT is a time-limited treatment approach that focuses on disruptions in the psychosocial and interpersonal context which may underlie psychological disorders. Treatment includes the identification and exploration of primary interpersonal problems, examination of communication styles, decisions analysis and role playing. Following 14 weeks of treatment, seven (78 ) clients were classified as responders by independent evaluators and general symptom improvement was found on...

Gaps In The Evidence Base

An important issue in treatment outcome is that many clients do not achieve as much change as would be desirable, either in terms of symptoms or in terms of the impact of symptom change in other areas of life. Previous research on the clinical significance of symptom change immediately following a course of CBGT for social anxiety demonstrated a significant improvement in clients' self-perceived quality of life (Safren et al., 1997). Further, improvements from CBGT were shown to be maintained for several months after treatment (Eng et al., 2001). However, these improved ratings still fell below the normative average at post-test and follow-up. Of major concern is the limited number of therapists who can recognize and effectively treat social anxiety disorder. Clinicians are most likely to recognize and diagnose a psychological problem in socially anxious persons who present with a comorbid condition -typically major depressive disorder or alcoholism - and are most likely to treat the...

Historical Considerations

He believed that possible means to counteract such an infection (e.g., yogurt) would be helpful to delay aging. Given the strong biological and medical orientation of early gerontology, the explicit consideration of the socio-physical environment was an important step in its historical development toward a strong interdisciplinary research field. This paradigm shift was mainly driven by the growing role of a social and behavioral science perspective within gerontology and life course research, which began evolving since the late 1920s. For instance, Hall (1922) and Hollingsworth (1927) in the United States provided early contributions to aging research from a developmental psychologist's view, promoting the idea that improved understanding of life-span development is possible only when considering the social situations of aging individuals. Similarly, developmental psychologist Charlotte Biihler (1933) argued in her key work, The Human Life Course as a Psychological Problem, that the...

Self Psychologically Influenced Framework For Personality Disorders

My intention in delineating these self psychological mechanisms is to emphasize how each promotes striving to manage a particular psychological task for consolidating a vulnerable self. These functions are neither pure forms nor are they identical to selfobject functions, although they clearly make important use of selfobject functions in how they operate. For example, the first mechanism I delineate, sustaining self-esteem when the self has been left substantially diminished or unmirrored, does presume a central mirroring selfobject disturbance. Schizoid, schizotypal, or avoidant personality disorders represent adapting to prominent mirroring selfobject deficits by distancing or aversion to protect a vulnerable self. Two of the concepts I described earlier, optimal frustration versus optimal responsiveness and trailing edge versus forward edge strivings, help to explain how the devitaliza-tion and depletion of an unmirrored self may themselves result from diminished attunement to...

Early Onset Course And Outcome In Personality Disorders

Similarly, infants with unusual shyness and reactivity (behavioral inhibition) may be at risk for anxiety disorders (Kagan, 1994) and for anxious cluster personality disorders as adults (Paris, 1998). Although we do not have as much data on Cluster C disorders, there is some evidence (Head, Baker, & Williamson, 1991) that the environment also plays a role in their etiology. Cluster B disorders tend to burn out by middle age (Paris, 2003). In contrast, disorders in Clusters A and C show little improvement over time (Seivewright, Tyrer, & Johnson, 2002). These differences reflect the trait dimensions behind personality disorders Im-pulsivity is a trait that normally levels out over time, while cognitive abnormalities and social anxiety do not.

Pathways Linking Positive Well Being with Health

The second possibility is that positive well-being is a marker of the broader set of psychosocial factors discussed in Section 2, which are themselves related to health, and has no direct functional role. This possibility has not been investigated very thoroughly to date, since although studies of positive well-being and health have controlled for factors such as socioeconomic status, age, and negative affect, they have seldom included the wide range of potential social and psychological mediators. However, in one investigation we studied the associations between sleep problems and both positive affect and eudaimonic well-being in a population of middle-aged men and women (Steptoe et al, 2008c). Poor sleep was related both to low positive affect and impaired eudaimonic well-being, and both effects remained significant after controlling for socioeconomic position, stress factors (financial strain and neighborhood crime), psychological distress, and social factors (social isolation,...

Aging Related Outcome Physical Decline and Disability

In an extensive literature review by Stuck et al (1999), confirmative evidence for various other psychosocial determinants of physical function decline was described. Higher anxiety levels were associated with more physical decline in some studies, and a low level of social activity, low frequency of social contact, and high emotional support were associated with physical decline in at least ten studies (Stuck et al, 1999). For example, Moritz et al (1995) found that social isolation and lack of participation in social activities were associated with incident limitations in activities of daily living. Also, widowhood in elderly men was found to be a risk factor for dependence in instrumental activities of daily living and mobility (van den Brink et al, 2004).

Social Factors

People with such disorders experience innumerable social disadvantages, ranging from poverty, limited access to employment, social isolation, neglect, and unequal treatment by statutory services to financial, verbal and physical, and sexual, victimisation (Sobsey, 1994 Brown et al., 1995 Hirsch and Vollhardt, 2002 Mencap, 1999 Williams andKeating, 1999 Glendenning, 1999 British Psychological Society, 2000 Davis and Hill, 2001 Nosek et al., 2001). The extent of different forms of victimisation among the three groups is unclear, and reported rates vary greatly. In part this is likely to reflect different definitions of victimisation and variation in the ways in which the populations are defined. (See Brown and Turk (1992) for a discussion of these issues in relation to the sexual abuse with people with intellectual disabilities.) Furthermore the likelihood of sexual, and other, victimisation coming to light in people with a mental disorder may be much lower than for the general...

Case Example

Thomas was a 68-year-old married man, diagnosed with Parkinson's disease four years previously. As a consequence of the disease he had become uncertain and fearful of others' reactions to him in professional and social situations and had increasingly avoided such situations. This had profoundly affected his self-concept he was experiencing many features of depression. The onset and progression of the Parkinson's disease had activated Thomas's beliefs about his acceptability as a person as conditional on being respected and regarded as competent, because it had compromised his competence in what he believed were key areas. He had begun to doubt his self-worth and acceptability as he put it, 'people will think I am at the end of the pier a lesser person if they know about the Parkinson's disease.' Because Thomas tried to 'camouflage' the disease and its impact on him from friends and family, he had started to avoid many social situations. This had in turn maintained the social fears and...

Other Applications

The success of IPT in treating unipolar mood disorders has led to its expansion to treat other psychiatric disorders. Frank and colleagues in Pittsburgh have been assessing a be-haviourally modified version of IPT as a treatment adjunctive to pharmacotherapy for bipolar disorder. Further, IPT is increasingly being applied for a range of non-mood disorders. There are intriguing applications of IPT as treatment for bulimia (Agras et al., 2000 Fairburn et al., 1993 Wilfley et al., 1993, 2000) and anorexia nervosa social phobia (Lipsitz et al., 1999), posttraumatic stress disorder, borderline personality disorder and other conditions. Life events, the substrate of IPT, are ubiquitous, but how useful it is to focus on them may vary from disorder to disorder. There have been two negative trials of interpersonal therapy for substance disorders (Carroll, Rounsaville & Gawin, 1991 Rounsaville et al., 1983), and it seems unlikely that an outwardly focused treatment such as IPT would be useful...


It is worth emphasizing that there were no selection criteria for this trial. Patients were eligible to participate regardless of depression or trait anger or social support levels and while the active treatment arm showed marked improvements at the end of training and 3-months follow-up, those patients randomized to the attention-placebo control condition showed further deterioration in all measures, with the mean depression score for the group being in the clinical range at follow-up. This suggests that rather than selecting - and potentially stigmatizing - patients for this sort of intervention on the basis of elevated hostility anger, depression and or social isolation levels, it may be better to train (rather than treat ) all patients in stress-coping skills, much the same as all CHD patients are seen as needing training in good nutrition and exercise habits. The relevance of this point for clinical practice is highlighted by the results of the ENRICHD study - a large randomized...

Anxiety Epidemiology

In addition to generalized anxiety disorder (GAD), patients with PD regardless of sex also experience panic disorders and social phobias with a prevalence of approximately 30 . (17,19,20). The presence of anxiety not only contributes to mental and somatic discomfort, but may also contribute to existing motor symptoms or fluctuations (7). For example, patients will report that episodic states of anxiety will aggravate preexisting tremor or dyskinesia, and fear of falling has been associated with impaired postural stability (21). Additionally, an internal tremor is frequently associated with anxiety (22). Consequently, in patients with high levels of anxiety or significant episodic anxiety, the initiation of appropriate anxiolytic therapy may improve motor symptoms as well as mental and psychosocial functioning.

All Cause Mortality

Two additional observations from the table are that (a) social networks are more consistently associated with mortality risk among men compared to women (more on this later) and (b) the association between social networks and mortality is characterized by a dose response relation between the degree of social connectedness (e.g., greater size and frequency of social contacts, greater network diversity across different social domains) as opposed to a threshold effect of social isolation compared to everyone else. In other words, more is better. The benefits of social networks extend beyond having just one strong social bond (e.g., being married). Moreover, one type of bond may substitute for another - for example, having a close friend confidante may be just as beneficial as being married.5


Concerning Dianne, there were four major related and intertwining issues her drinking, her depressive mood, her anxious symptoms and marital problems. In addition, Dianne met criteria for both the avoidant personality disorder and the obsessive-compulsive personality disorder.


To our knowledge, only two prospective studies to date (based on the Alameda County Study and a study of a health maintenance organization's members in the USA) have examined the association between social isolation (paucity of social networks) and overall cancer incidence. The Alameda County Study found elevated risks of cancer incidence and mortality in socially isolated women, but not in men. The study also found elevated risk of cancer mortality, particularly for tobacco-related cancers in socially isolated women. On the other hand, social connections were not associated with incidence or mortality in men, though the socially isolated had a significantly lower risk of cancer survival. The study of health maintenance organization members did not find an elevated risk of cancer incidence, but poorer cancer survival in persons with fewer social networks. When we turn to studies of cancer mortality, however, the evidence is quite mixed, with three of five studies indicating no...

Affective Disorders

Feelings of intense sadness, hopelessness, pessimism, low self-esteem, loss of appetite and interest, insomnia, fatigue, aches and pains, and memory problems that are symptomatic of depression can also occur as a reaction to the loss of a loved one, physical disorders, financial insecurity, social isolation, or any other serious problem. Unlike psychotic depression, in which guilt, self-deprecation, and bodily complaints are extreme and grossly unrealistic, the apathy, inertia, and withdrawal seen in neurotic or reactive depression are less bizarre and more closely associated with external circumstances.

Families and Friends

A person's first social experiences usually take place in a family setting. These early encounters with other people condition the individual to expect certain things and to behave in specific ways in preparation for entry into the larger society. As representatives of that society, parents, siblings, and other family members can instill a sense of personal confidence and capability in the individual on the one hand, or feelings of insecurity and anxiety on the other. These feelings, initiated in a family setting, generalize to other social situations and set the stage for the person's lifestyle in adulthood.

Qualityof Life

Ferrell (18) uses four domains to define QOL (1) physical well-being, (2) psychological well-being, (3) social well-being, and (4) spiritual strength. Physical well-being includes the ability to maintain functional activities, self care, exercise tolerance, ability to work, appearance, overall physical health, degree of independence, sleep and rest, and symptom control. Psychological well-being provides a sense of control in the face of illness, altered life priorities, and fear ofthe unknown. Diagnosis can causes anxiety, depression, fear, stress, and mood swings. Psychological well-being includes enjoyment of life, intellectual function, adjustment to the disease as well as confidence, acceptance, and satisfaction with treatment. Social well-being includes family issues, adjustment of children, changes in roles and relationships, family stress, patient's social appearance, social isolation, ability to communicate, ability to work, and financial situation. Also included is sexual...

Behaviour Therapy

Argyle et al. (1974) found that these patients benefited from both social skills training and psychodynamic therapy Stravynski et al. (1994) compared social skills training conducted in the clinic with training in the clinic plus in vivo and found both equally effective, although dropout rates were much higher when in vivo work was included. Alden (1989) Cappe & Alden (1986) and Marzillier et al. (1976) evaluated social skills training, exposure and systematic desensitisation and found that patients with APD made modest gains with all three relative to a waiting-list control. Alden & Capreol (1993) concluded from a trial of 76 patients with APD that individuals presenting as angry and distrustful benefited more from exposure therapy while those whose primary problem was lack of assertiveness responded better to social skills training. Results suggest that patients with APD are likely to demonstrate only modest improvements in social functioning...


Changes in cortisol secretion are involved in the etiology or are part of the early stages of fatigue. In another study that used data from the Whitehall II cohort, cortisol output over the day was inversely related to adaptive coping styles such as seeking social support and problem engagement, independently of potential confounders (O'Donnell et al, 2008). This suggests that neuroendocrine pathways may partly mediate the relationship between psychological coping and health. Additional studies have investigated associations between cortisol output and low socioeconomic status, social isolation, and other psychosocial risk factors (Grant et al, 2009 Li et al, 2007).

Flying Phobia

Nevertheless, studies of comorbid disorders in people with flying phobia, claustrophobia, agoraphobia with panic and social phobia, suggest imaginings (McNally & Louro, 1992 Van Gerwen et al., 1997 Wilhelm, 1997) such as suffocating and dying of a heart attack during a panic or causing a visible commotion and provoking ridicule. Those who report agoraphobia express little concern about the occurrence and consequences of the aircraft crashing (McNally & Louro, 1992). Although there have been descriptions of passengers using alcohol to excess and losing control, so that airlines now enforce prosecution, there appear to be no surveys of alcohol use and fear of flying. In civilians, quality of life may be impaired by flying phobia. For example, it might prevent them from flying when it is essential in their employment. In military personnel, whose training entails great expense, the phobia may require aircrew to be retrained or taken off flying duties.


Exposure alone on both post-treatment and follow-up measures of social anxiety, cognitive symptoms, depression and general anxiety. Taylor (1996) compared the effect sizes of cognitive restructuring alone, exposure treatments, cognitive restructuring combined with exposure, and SST. Effect sizes for all interventions on measures of social anxiety were similar, and all surpassed those of waiting-list controls. However, only the combination of cognitive restructuring and exposure showed greater effect sizes than placebo controls. Furthermore, within-in group effect sizes for all active treatments tended to increase from post-treatment to follow-up assessment. Two more meta-analyses examined the relative effectiveness of cognitive-behavioural treatments and pharmacotherapy for social anxiety disorder. After examining 24 studies, Gould et al. (1997) reported that both CBT (including cognitive restructuring, exposure, SST, systematic desensitization, flooding, and anxiety management) and...

Further Reading

Washington, DC American Psychological Association. Heimberg, R.G. & Becker, R.E. (2002). Cognitive-Behavioral Group Therapy for Social Phobia Basic Mechanisms and Clinical Strategies. New York, NY Guilford Press. Hope, D.A., Heimberg, R.G., Juster, H.R. &Turk, C.L. (2000). Managing Social Anxiety A Cognitive-Behavioral Therapy Approach. San Antonio, TX Psychological Corporation.

Emotional Problems

While all children have developmentally appropriate fears, some are referred for treatment of anxiety problems when their fears prevent them from completing developmentally appropriate tasks such as going to school or socializing with friends. The overall prevalence for clinically significant fears and anxiety problems in children and adolescents is approximately 2 to 9 (Anderson, 1994 American Psychiatric Association, 1994 World Health Organization, 1992). With respect to age trends, simple phobias and separation anxiety are more common among preadolescents and generalized anxiety disorder, panic disorder, social phobia, and obsessive compulsive disorder are more common among adolescents (Klein, 1994).

Milne Edwardss sifaka

It lives in groups of 3-9, composed of multi-male, multi-female, one-male, or one-female. Females are dominant to males in both feeding and social situations. The group sleep huddled together on a broad horizontal branch about 49-82 ft (15-25 m) high off the ground. If the group is large, paired individuals sleep in nearby trees. The same sleep trees are used over time, but usually not on consecutive nights. During the day the family spends over 45 of the day in close contact, grooming or resting. Feeding occupies about one-third of their time, with 15 of time traveling. In contrast to indris, sifakas do not give daily long calls. Milne-Edwards's sifakas have over seven discrete calls. Lost individuals give long, warbling whistles that are answered by group members. Quieter contact moos are given among group members to indicate position and propose group movement. Alarm calls alerting for aerial predators are loud, raucous barking by all group members. Often males first sight...

Slaying Social Anxiety

Slaying Social Anxiety

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