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Social phobia diagnosis and psychological treatment
Social phobia is a persistent fear of performing in social situations, especially where strangers are present or where the person fears embarrassment. Patients fear that others will think them stupid, weak or crazy, and exposure to the feared situation provokes an immediate anxiety attack. Patients recognise that their fear is excessive, but their anxiety and avoidance behaviour may interfere markedly with their daily routine, work or social life. Blushing is common, and patients may avoid eating, drinking or writing in public.
There is some genetic predisposition, onset may follow a particular stressful or embarrassing experience, or be insidious, and the disorder usually follows a chronic course. Symptoms often start in adolescence or even childhood, and may be associated with poor social or academic performance. The incidence of social phobia is about 2%, but lifetime prevalence ranges from 3% to 13%. In some community studies social phobia is more common in women than men, but the sexes are equally represented in clinical samples. Alcohol is used by many people as a coping strategy. Assessment should include a drinking history.
Social phobias – diagnosis
Extreme, persistent fear of social situations
Fear of humiliation or embarrassment
Exposure provokes extreme anxiety
Fear recognised as excessive or unreasonable
Avoidance of situations
Anxious anticipation
Psychological treatment
Cognitive behavioural therapy has proven efficacy in social phobia. Paradoxically, this does not focus on external threat but on the internal image of how the patient thinks he looks to others. Treatments combining imaginary and actual exposure produce modest gains but seem as effective as more complex regimens. Cognitive behavioural therapy is promising, either alone or in combination with an antidepressant, but seems most effective in the third of cases with circumscribed social phobias.
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Tags: nosis, phobia, psychological, psychological treatment, treatment
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