PDF | A greater understanding of the origins of social phobia is much ized social phobia situated at one end and avoidant personality disor-. Social anxiety disorder, also known as social phobia, is one of the most In social anxiety disorder, the fear can occur in vir . soclallunctioning end dioablilly . social phobia offered by the Clinical Research Unit for Anxiety Disorders at St . What you can expect by the end of this program is for your symptoms to have.
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People with social anxiety tend to fear and avoid social situations. They are very concerned that . It's not the end of the world. We all say silly things and most of. other kinds of anxiety disorders, please see the end of this booklet. Social Phobia . Page 4. Social Phobia. Social phobia is a strong fear of being judged by others and of being . You can browse online, download documents in PDF, and order . Social anxiety is a common disorder characterized by a persistent and excessive fear of one or .. tary–adrenal (HPA) axes, and their respective end products.
You may be convinced that everyone is looking at you and judging you. Cult Med Psychiatry. In fact, studies have shown that some of the people who experience or have the following are the most affected by the disorder: In a more recent study conducted by Heijden and Brinkman , VR was used based on the concept of scrutiny anxiety, whereby some people spoke for several minutes to a virtual audience and were assessed by the quality of their spoken interaction. There was also consensus among the scholars that the disorder is arguably one of the most common and prevalent among the various psychiatric disorders. These were held one and three months after the last session involving VR. The other social disorder is agoraphobia.
Such a controversy continues to reign supreme and the resultant effect has been detrimental. It is detrimental in the sense that if it were a disorder capable of being diagnosed and solved by bio medics, then it would have been solved by now.
However, as this paper will be opining at the tail end, the problem is more of the individuals personality embedded in the phenotype and therefore it is difficult to cure bio medically. Such a diagnosis will help in solving the age-old controversy regarding this problem. What scholarly literature provides concerning the problem Many books, journal articles, articles on periodicals and articles on various dailies have addressed this problem albeit, to some, inadequately. In the United States, for example, scholars have argued that the disorder is caused by getting low income D.
Hinton and B. Good, The result, therefore, is the creation of various classes of people depending on their income and who actually rarely engage one another in the day-to-day activities. To other scholars, the problem is prevalent in Asians and African Latinos who live in urban areas Hofmann, The assumption of the proponents of this line of thought is that most of these people live in the rural areas and therefore when they are exposed to urban areas they become anxious.
What they fear is that they shall be seen as not able to adapt to the urban environment and therefore they refuse to have healthy relationships with the inhabitants of those urban areas. The same case also applies to those people living in urban areas and is likely to be exposed to be exposed to rural areas. Education levels have been held by psychologists as a big cause of the disorder.
Less learned people are likely to suffer from the disorder as compared to those that are more learned. The less learned are reluctant to engage in any healthy discussion with the highly educated lot. They always feel belittled, humiliated and lowered in the presence of the people who are more educated than they are.
They will therefore feel anxious and afraid to interact with them Srinivasan, The study which was carried out by scholars in India showed that the more educated class and the less educated class have a tendency to live as two distinct classes who never interact.
This is replicated in other parts of the world as well. In America, scholars have found that the more educated people live separately from the less educated people and in good houses, drive good cars and have more business engagements as compared with their counterparts who are less educated. Kleiman, Fear of humiliation and embarrassment by other people is arguably the biggest cause of social anxiety disorder.
In this perspective, people fear engaging with others in the belief that possibly they possess certain extraneous physical, emotional or social flaws and possibly possess a socially inappropriate behavior. They therefore fear that they may offend others in social gatherings.
This fear is so aggravated that they rarely engage themselves in any interaction with those people who may be said to be socially upright.
In fact, studies have shown that some of the people who experience or have the following are the most affected by the disorder: Various scholars have also found that this disorder is phenotypic. People with the disorder always fear various changes over time the reason as to why they are always anxious. The disorder also depends on whether the people that are affected are male or female.
For male, their fear is dreading how their female friends will perceive them possibly because they possess some inefficiency or are deformed in a way. For females, they fear their female friends more that they fear their male friends. This is because on matters romance, they fear that their female counterparts may pose unhealthy competition for male friends and therefore they are anxious not to engage or relate with them in any way.
In fact they avoid them to the best of their ability Clark, What is common among all the scholars is that the gravity of this fear depends largely on personal orientation and social values. A person who is highly oriented to what is happening everywhere all over the world is likely not to be affected too much by the disorder. This is because they are highly connected, have interacted with various people and they have been assisted to discover and deal with their weaknesses.
In a society where social values are the norm, those people who find it hard to cope with these social values are highly likely to suffer from the disorder. It therefore follows that for there to be less social anxiety disorder, people have to be obedient to and conform to a certain norm, possibly set by the society and which people must conform to D Hinton, Various studies conducted in Asia show that people are highly affected by social values and ties coupled with their personal orientation and ability to conform to various set standards and norms D Hinton, There was also consensus among the scholars that the disorder is arguably one of the most common and prevalent among the various psychiatric disorders.
Some scholars even went overboard to state that the disorder mostly strikes on adolescence. In school, the disorder is characterized by lower grades while at work it is characterized by unemployment or laxity at work. In relationships, it is characterized by low marriage rates. Most Western scholars are in agreement that the disorder is characterized by social phobia, shyness and tendency of people to avoid other personality traits.
Scholars in the world over agree that exposure to any social situation for a person suffering from the disorder may trigger the following: Profuse sweating, blushing anyhow, embarrassment, palpitations, trembling and in some instances the person may experience difficulty in speaking publicly Kleimann, However, there are so many discrepancies when it comes to what really causes the disorder. As outlined earlier in this paper, the disorder is a disorder, properly so called.
It should never be mistaken to a disease. That is why some researchers have even gone ahead to prescribe medication for the same. The result has been to improperly address the disorder, the reason as to why it has persisted to-date. We therefore see the need for new studies towards ensuring that the disorder is properly diagnosed. We stated from the outset that the intention of this paper was to outline the various reasons as to why there has been no solution so far to the disorder of social anxiety.
In this part, we have lived to our promise by stating the diagnostic challenges that eventually lead to poor prescription of solutions towards solving the disorder. Chances are that the solution might never be found.
In our ensuing session, we make a few recommendations towards this end. Recommendations for future research Following the inability of various researchers to come up with a tangible solution towards solving social anxiety disorder, this paper has come up with some recommendations for any possible future research. First of all, we appreciate the fact that there have comparatively been no adequate studies regarding social anxiety disorders.
The absence of such studies leaves the affairs of the disorder in a precarious position as it has not been adequately diagnosed. We therefore recommend urgent and serious studies towards this end. Such studies must put into consideration the fact that the disorder is just an abnormal behavior; a personal and social values problem that can only be cured by social means, not medical prescriptions.
The future researcher must consider the disorder as part of the personality of the individual, culture, society or a value problem and not a medical illness that requires bio-medical treatment or psycho-analytical diagnosis. It should also not be diagnosed as mere shyness, as has been the case previously.
The future researcher must base their research on personal values, social values, culture and personality of various individuals. We highly recommend that such research be comprehensive, detailed and prompt. A cognitive Approach To Panic. Behav Res Ther. D Hinton, L. Anxiety Disorder Presentations in Asian Populations. P1 reported feeling happy for having managed to expose himself and that he frequently received adequate answers from the teacher a reinforcing consequence for the behavior of asking questions in the classroom.
Other descriptions, on Charts 4, 6 and 7, presented situations of social interaction with family members. P1 faced up to the interaction situations and reported on Chart 4: An increase in the frequency of the behavior of social interaction with family members can be seen after the intervention started, when compared to the frequency reported in the initial interview, and the behaviors shown were seen to be strengthened by the situation of interaction with family members.
P2 showed little commitment to the task of filling in the Recording Charts.
He experienced tachycardia and sweating. He asked his questions but did not get satisfactory answers. Generally speaking, at the beginning of the intervention, P2 had a restricted behavioral repertoire which was insufficient for social interactions. Near to the end of the procedure, P2 reported having gone to social events where he interacted verbally with other guests and with friends of his girlfriend.
The SPI scores were calculated by adding together the scores of each item and were then adjusted to this scale. The SUDS score did not need to be adjusted. The vertical dotted lines after Sessions 5 and 13 indicate, respectively, the beginning and the end of the intervention. SUDS was administered at the end of exposure and scores close to zero indicate a low level of anxiety having been felt. P1 varied between 0 and 3 only in the baseline sessions.
After this point, the minimum measurement found was 1 last intervention session , whilst in most of the sessions the measurement was 2. P1 varied between 2 and 9 whilst P2 varied between 3 and P2 showed a slight increase after the intervention stage started and in some sessions alterations in the score of the measurement reached 10 Sessions 8 and The sessions in which P2 had high measurement alterations coincided with the sessions in which the scenarios were changed Sessions 6, 8, 10 and Data recorded via SPI application showed less variation when compared to the other measurements 7 to 10 for P1 and 4 to 7 for P2.
SPI data both for P1 and for P2 showed 3-point amplitude on the scale. SPIN scores above 19 indicate the presence of symptoms compatible with social anxiety disorder, whilst BDI and BAI scores above 20 indicate the possibility of depression and anxiety, respectively, at moderate levels. Test application occurred in the initial session, at the end of the baseline, at the end of the intervention and in the 1st and 2nd follow-up sessions. The scores for the three inventories decreased in the final application Follow-up 2 in relation to the initial score in both cases.
The effects of the intervention program conducted using exposure to VR as a therapeutic resource will be discussed in order to verify behavioral changes related to the internal and external validity of the intervention.
Internal validity, taken to be behavioral change observed during the intervention, was verified through the measurement instruments used before and after the intervention SPIN, BDI and BAI. The behaviors reported by P1 and P2 during the initial session and at baseline can be interpreted as being in the diagnostic category of social anxiety disorder, as described by Rocha, Bolsoni-Silva and Verdu and Zamignani and Banaco , both from the history of acquisition of the behavioral repertoire and also from the history of its maintenance.
Participants P1 and P2 showed great difficulty in facing up to and remaining in activities in social contexts, starting and maintaining dialogues with other people, engaging in intimate interactions and forming ties, frequenting public places, taking part in meetings, forming bonds of affection with other people. The contexts were generally under the scrutiny of other people, situations of performing activities in public, situations of spoken intimate interaction and situations in which assertive behavior was required.
With regard to the degree of familiarity with technical resources, Barbosa and Zacarin et al. In this study the Sense of Presence Inventory SPI was applied at the end of each exposure and high levels of presence were found for P1, in the 15 exposure sessions, with the same variation over the study.
P2 showed slight variation between the stages of the study. In general, P2 described less presence than P1 throughout the entire study. However, P2 reported a gradual increase in presence from the beginning of the intervention sessions and reached levels reported by P1. According to Barbosa , environments requiring a larger number of actions by the immersed individual can produce higher levels of presence.
This fact was seen in this study, whereby one of the changes occurring between baseline and intervention is characterized by an increase in environmental stimuli in general, these are aversive stimuli for an individual with social anxiety disorder, such as a gathering of avatars having spoken interaction between themselves and with the participant and an increase in interactive resources.
In the intervention stage, P1 and P2 altered the environment significantly through the way in which they interacted with the simulator, this being a possible indicator of increased sense of presence in P2 in comparison with the baseline. Both P1 and P2 were exposed to the same sequence of scenarios in the intervention stage, but the way in which the participants responded to the SUDS requests were not similar to the changes in their galvanic skin response measurements.
These findings suggest that: Findings in studies in the biography relating to positive correlation between sense of presence and measurements of anxiety see Hartanto et al. Nevertheless, the alterations in the galvanic skin response did not show patterns that could be related to the scenario changes which, generally, included the addition of new and potentially anxiogenic stimuli, such as new avatarsin the environment, programmed spoken interactions and performance of tasks under the scrutiny of other avatars.
According to criteria described by Cunha , the scores obtained by P1 and P2 the first time BAI was applied 55 and 18, respectively and the first time BDI was applied 24 and 18, respectively indicate severe anxiety for P1 and mild anxiety for P2, as well as moderate depression for P1 and mild depression for P2. The scores obtained the last time the two inventories were applied indicate minimum states of anxiety and depression.
It should be emphasized that the tests applied covered a time period of one week. When verifying the items contained in BAI, it can be seen that what is treated as symptoms of anxiety also correspond to what Zamignani and Banaco describe as respondent behaviors of a behavioral repertoire characteristic of anxiety: The results of the SPIN inventory also show considerable change during the procedure.
However, it should be emphasized that when performing adequate functional analysis, based on the behavior-analytic approach, other events apart from responses should be considered, such as the occasion on which the response occurs and the consequences of responding, as well as the establishing operations that momentarily determine events as reinforcements.
Taking the records obtained from the Behavior Recording Chart and unsystematic records of oral accounts given during the sessions, changes could be seen in behavior patterns of approaching situations that previously were avoided or endured with considerable suffering. During the last follow-upsession, P2 reported that he had begun working for a company as a call-center operator and described it as a dynamic environment in workstations.
From his brief account, it can be seen that his work was carried out in a highly social context. When the intervention began, P2 was seen to have low frequency of leisure activities in social contexts. Social competencies can also be seen in P1, with generalization to the natural context, as can be verified in an account provided by P1 on one of the Behavior Recording Charts. P1 reported that once when he was on his way to the Psychology Clinic, by chance he met a classroom colleague who was also going there.
P1 found this interaction pleasant and the consequence was social approval by his colleague and company on the way to the Psychology Clinic, both of these being positive reinforcement for further behaviors of starting conversations, maintaining ties and intimacy. These results corroborate the external validity of the procedure by demonstrating that competencies developed by using exposure to VR were generalized outside of the clinically controlled environment.
During the course of the procedure, uncontrolled variables were encountered which may have interfered with the results relating to: We suggest that new studies be performed regarding environmental variables capable of interfering with measurements, such as ambient temperature and relative humidity of the air, hormonal issues, lack of sleep and food, expectations as to results.
Studies like these could, in the future, contribute to more efficacious interventions, with importance also being given to possible analysis of sense of presence in each scenario, as well as the impact of interactive resources that are more realistic for the individuals involved, such as gloves that are touch sensitive in relation to virtual stimuli.
Development of VR technology is fully underway and it is characteristic of psychology sciences to incorporate the formal evaluation of new technologies into studies in this field in order to measure the impact of their use as alternative therapeutic resources. In addition, VR can contribute as a useful context for promoting spoken therapy along with other resources already in use.
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Wolpe, J. Clark Jr. Zacarin, M. Acta Comportamentalia. Zamignani, D. Revista Brasileira de Terapia Comportamental e Cognitiva, 7, Services on Demand Journal. Abstract Virtual Reality VR was used in this study as a therapeutic tool in a behavior-analytic intervention with two subjects who had social anxiety disorder. Method Participants The study participants were two male university students aged 20 and 27, referred to as P1 e P2, respectively. Place and Materials The sessions were held in a room of the Psychology Clinic of a public university.