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Social Anxiety Disorder

By
Martin M. Antony, PhD
Karen Rowa, PhD/P

Course Outline

Social anxiety disorder (SAD) is characterized by excessive anxiety or discomfort in situations where a person might feel judged or evaluated by others, including performance situations (e.g., being the center of attention, public speaking, working under observation, playing sports, or music in front of an audience) and situations involving interpersonal contact with others (e.g., making small talk, meeting new people, dating). According to large-scale epidemiological studies, SAD is one of the most prevalent psychological disorders. Although prevalence estimates vary, recent studies suggest that approximately 7% of Americans suffer from this disorder. In addition to the high percentage of people with symptoms meeting criteria for this disorder, many other individuals experience social anxiety or shyness to a lesser, but still impairing, degree. SAD is also a common comorbid condition, often diagnosed along with other anxiety disorders.

About Authors

Martin M. Antony, PhD, is Professor in the Department of Psychology at Ryerson University in Toronto. He is also Director of Research at the Anxiety Treatment and Research Centre at St. Joseph’s Healthcare in Hamilton, Ontario. Dr. Antony has published more than 20 books and 100scientific articles and book chapters in the areas of anxiety disorders and cognitive behavior therapy. His contributions to research and training have been recognized by awards from the Society of Clinical Psychology, the Canadian Psychological Association and a number of other professional organizations.

Karen Rowa, PhD, is a psychologist at the Anxiety Treatment and Research Centre at St. Joseph’s Healthcare in Hamilton, Ontario and an Assistant Professor in the Department of Psychiatry and BehavioralNeurosciences at McMaster University in Hamilton. She is active in teaching and supervising students in the assessment and cognitive-behavioral treatment of anxiety and related disorders. She has published a number of scientific articles and book chapters in the area of anxiety disorders and cognitive behavior therapy, and is the co-author of two books.

Learning Objectives

After completing this course you’ll be able to:

  1. Characterize social anxiety disorder.
  2. State how the DSM-IV-TR views SAD.
  3. State when SAD tends to begin.
  4. Define TKS.
  5. Describe the prognosis of untreated SAD.
  6. Define PDA and state its hallmark feature.
  7. List the physical symptoms of GAD.
  8. State the focus of fear in SAD when compared to other phobias.
  9. Discuss comorbidity for SAD and depression.
  10. State the main distinction between the schizoid personality and SAD.
  11. Discuss the findings of Brown et al. regarding the percent of people with SAD who had other psychological disorders.
  12. Discuss the various measures used to diagnose anxiety disorders.
  13. Describe self-report severity measures.
  14. Describe Behavioral Approach Tests for SAD.
  15. List several common negative beliefs people with SAD hold about themselves according to Clark and Wells.
  16. List several safety behaviors in SAD according to Clark and Wells.
  17. Describe how Rapee and Heimberg describe the self-image.
  18. Describe the three pathways associated with fears according to Rachman.
  19. Define behavioral inhibition and give examples.
  20. List the symptoms of a panic attack and how the severity is measured.
  21. Compare avoidance strategies and safety behaviors.
  22. State how social skills impairment is assessed in clinical settings.
  23. List the two reasons assessing impairment in functioning is important.
  24. Describe the three evidence-based, psychological strategies for treating SAD, according to Table 4.
  25. State the usefulness of CBT for children, adolescents, and adults.
  26. List three advantages of self monitoring.
  27. Describe the physical, cognitive and behavioral components of anxiety.
  28. Define Socratic questioning.
  29. Define core beliefs or schemas.
  30. Describe how exposure therapy works.
  31. Describe the five guidelines for effective exposure.
  32. Define interoceptive exposure.
  33. Describe habituation, extinction, and reinforcement-based approaches as discussed in the behavioral model.
  34. Discuss the findings of Stangier et al. (2003) when comparing individual and group cognitive therapy.
  35. List the two variables that contribute to relapse and recurrence of symptoms of SAD, according to Ledley and Heimberg, 2005.
  36. Describe the strict dietary restrictions of phenelzine (Nardil) in the treatment of SAD.
  37. Discuss motivational interviewing.
  38. Describe a fear thermometer.
  39. Discuss the prevalence of SAD in adults of 60 years of age in the United States.
  40. Discuss SAD in various cultures.

Course Contents

  1. Description
    • 1.1 Terminology
    • 1.2 Definition
    • 1.3 Epidemiology
    • 1.4 Course and Prognosis
    • 1.5 Differential Diagnosis
    • 1.5.1 Panic Disorder with Agoraphobia
    • 1.5.2 Generalized Anxiety Disorder
    • 1.5.3 Specific Phobia
    • 1.5.4 Depression
    • 1.5.5 Avoidant Personality Disorder
    • 1.5.6 Schizoid Personality Disorder
    • 1.6 Comorbidity
    • 1.7 Diagnostic Procedures and Documentation
    • 1.7.1 Interviewer Administered Measures
    • 1.7.2 Self-Report Severity Measures
    • 1.7.3 Behavioral Approach Tests (BATs)
    • 1.7.4 Assessing Suitability for Treatment
  2. 2. Psychological Approaches to Understanding Social Anxiety Disorder
    • 2.1 The Cognitive Model of Clark and Wells
    • 2.2 The Cognitive Behavioral Model of Rapee and Heimberg
    • 2.3 Negative learning Experiences and Social Anxiety
    • 2.4 Temperamental Bases of SAD
    • 2.5 Implications for Treatment
  3. Diagnosis and Treatment Indications
    • 3.1 Key Features to be Assessed
    • 3.1.1 Situational Triggers
    • 3.1.2 Physical Features
    • 3.1.3 Cognitive Features
    • 3.1.4 Avoidance Strategies
    • 3.1.5 Safety Behaviors
    • 3.1.6 Anxiety Sensitivity
    • 3.1.7 Social Skills
    • 3.1.8 Environmental Factors
    • 3.1.9 Comorbidity
    • 3.1.10 Functional Impairment
    • 3.2 Overview of Effective Treatment Strategies
    • 3.3 Factors That Influence Treatment Decisions
    • 3.3.1 Age, Sex, and Ethnicity
    • 3.2 Education
    • 3.3.3 Family and Relationship Factors
    • 3.3.4 Client Preference
    • 3.3.5 Treatment History
    • 3.3.6 Ability to Articulate Cognitions
    • 3.3.7 Anxiety Sensitivity and Fear of Sensations
    • 3.3.8 Severity of Avoidance and Safety Behaviors
    • 3.3.9 Social Skills
    • 3.3.10 Comorbidity
    • 3.3.11 Group Versus Individual Treatment
  4. Treatment
    • 4.1 Methods of CBT
    • 4.1.1 Self-Monitoring
    • 4.1.2 Psychoeducation
    • 4.1.3 Cognitive Strategies
    • 4.1.4 Exposure-Based Strategies
    • 4.1.5 Social Skills Training
    • 4.1.6 Relaxation and Arousal Management Strategies
    • 4.2 Mechanisms of Action
    • 4.2.1 Cognitive Models
    • 4.2.2 Behavioral Models
    • 4.2.3 Emotional Processing Models
    • 4.3 Efficacy
    • 4.3.1 Efficacy of CBT
    • 4.3.2 Predictors of Outcome
    • 4.3.3 Preventing Relapse and Return of Symptoms
    • 4.4 Combination Treatments
    • 4.4.1 Medication Treatments
    • 4.4.2 Comparing and Combining Medications and CBT
    • 4.5 Overcoming Barriers to Treatment
    • 4.5.1 Treatment Ambivalence
    • 4.5.2 Homework Noncompliance
    • 4.5.3 Adapting Treatment for Comorbidity
    • 4.6 Adapting Treatment for Different Age Groups
    • 4.6.1 Children and Adolescents
    • 4.6.2 Older Adults
    • 4.7 Adapting Treatment for Different Cultures
  5. Case Vignettes
    • Case 1: Susan’s Public Speaking Fears
    • Case 2: Jeremy’s Generalized Social Fears
  6. Further Reading
  7. References
  8. Appendix: Tools and Resources

Customer Comments

“This book fills an important gap in the literature – filled with clinical examples and advice, its straight-forward presentation will allow clinicians with various levels of expertise to implement these efficacious interventions. [The authors] provide not only a valuable tools for their colleagues, but also hope for the millions who suffer from SAD.”

– Deborah C. Beidel, PhD
Professor and Director of Clinical Training, University of Central Florida, Orlando, FL

“A well-organized, reader-friendly guide… As a guide to clinical practice, this book has much to recommend it.” 

– Lynn Alden, PhD
Professor, Department of Psychology, University of British Columbia, Vancouver, BC

“Very appropriate pertaining to NIH guidelines for practice. Well done!”

– A.S., Lake Forest, CA

“Extremely comprehensive–can be a very useful tool for those clinicians dealing hands on with asthma patients on a frequent basis.”

– C.W., Palo Alto, CA