Social Phobia

Social PhobiaSocial Phobia

“Characterized by overwhelming anxiety and

excessive self-consciousness in everyday

social situations.”

“Characterized by overwhelming anxiety and

excessive self-consciousness in everyday

social situations.”

http://www.nimh.nih.gov/health/topics/social-phobia-social-anxiety-disorder/index.shtml

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Social Phobia is NOT….

Social Phobia is NOT….

Getting butterflies before you present your disease project or before a first date.

Getting butterflies before you present your disease project or before a first date.

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PrevalencePrevalence

most common anxiety disorderthird most common mental

disorder in the U.S., after depression and alcohol dependence.

An estimated 19.2 million Americans have social anxiety disorder.

most often surfaces in adolescence

most common anxiety disorderthird most common mental

disorder in the U.S., after depression and alcohol dependence.

An estimated 19.2 million Americans have social anxiety disorder.

most often surfaces in adolescence

Physical SymptomsPhysical Symptoms

BlushingDifficulty talkingNausea, diarrheaDifficulty making eye contactProfuse sweating TremblingElevated blood pressureRapid heart rate, palpitations

BlushingDifficulty talkingNausea, diarrheaDifficulty making eye contactProfuse sweating TremblingElevated blood pressureRapid heart rate, palpitations

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SymptomsSymptoms

Can be situation specific or someone may experience symptoms anytime they are around people

Low self esteem fear doing things that will embarrass themworry for days or weeks before a dreaded

situation

Can be situation specific or someone may experience symptoms anytime they are around people

Low self esteem fear doing things that will embarrass themworry for days or weeks before a dreaded

situation

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Life with Social Phobia

Life with Social Phobia

high risk for alcohol or other drug dependence

LonelinessLeads to depression/learned helplessnessCommon fears include:

Attending parties,Meeting new people, Speaking in public,Using public restrooms,Eating, drinking and writing in public

high risk for alcohol or other drug dependence

LonelinessLeads to depression/learned helplessnessCommon fears include:

Attending parties,Meeting new people, Speaking in public,Using public restrooms,Eating, drinking and writing in public

Risk FactorsRisk Factors

Life experiences and eventsbullying

Shyness Increased stressMay be associated with overprotective

parents or limited social opportunitiesGenetics (10x) Increasing among white, married, educated

Life experiences and eventsbullying

Shyness Increased stressMay be associated with overprotective

parents or limited social opportunitiesGenetics (10x) Increasing among white, married, educated

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Amygdala

The Fear ResponseThe Fear Response

SensoryCortex

CS-

CS+

Input(La)

Output (Ce)

Glutamate

Hypo

Inhibitory control

(ITC)

Stimuli

CS+

freezingreflex

potentiation

autonomic arousal

hormones

sustained anxiety

RPCPAGBST

Fear Circuitry

avoidance

Striatum

Medial prefrontal

cortex

Amygdala

Hypothalamus

Hippocampus

BSTThalamus

Sensory cortex

Human Reference

PAG

Striatum

RPC

Ca2+

MAPK

CREBNMDAR

Unconditioned fearUnconditioned fear Conditioned fearConditioned fear

= conditioned danger cue= conditioned danger cue

= unconditioned stimulus= unconditioned stimulus

ExtinctionExtinction Discrimination and Discrimination and

generalizationgeneralization= conditioned safety cue= conditioned safety cue

Unconditioned fearUnconditioned fear Conditioned fearConditioned fear

= conditioned danger cue= conditioned danger cue

= unconditioned stimulus= unconditioned stimulus

ExtinctionExtinction Discrimination and Discrimination and

generalizationgeneralization= conditioned safety cue= conditioned safety cue

Medial Prefront

al Cortex

Thalamus

Hippocampus

Provided by Dr. Lissek

Current researchCurrent research

sensitivity to carbon dioxide, cholecystokinin, and caffeine

effectiveness of selective serotonin reuptake inhibitors- why?

Reduced striatal dopamine and uptakeReduced GABAadrenergic abnormalities

sensitivity to carbon dioxide, cholecystokinin, and caffeine

effectiveness of selective serotonin reuptake inhibitors- why?

Reduced striatal dopamine and uptakeReduced GABAadrenergic abnormalities

Gentili et.al.Gentili et.al.

Increased activity in parts of brain when exposed to faces expressing various emotions (including neutral):Evaluation of intentions, personality traits

of others, expression, emotional responses, social evaluation of others (hypervigilance)

Decrease in areas for attention and processing identity (avoidant)

Increased activity in parts of brain when exposed to faces expressing various emotions (including neutral):Evaluation of intentions, personality traits

of others, expression, emotional responses, social evaluation of others (hypervigilance)

Decrease in areas for attention and processing identity (avoidant)

NIMH StudyNIMH Study

Heightened responses to negative comments in two brain areas: the medial prefrontal cortex

(MPFC), is involved in the sense and evaluation of self;

the amygdala, is central to emotional processing.

Heightened responses to negative comments in two brain areas: the medial prefrontal cortex

(MPFC), is involved in the sense and evaluation of self;

the amygdala, is central to emotional processing.

Classroom implications

Classroom implications

Create a safe climateIf a student is experiencing a

fear response they are learning, but not what you want them to be

Skipping school

Create a safe climateIf a student is experiencing a

fear response they are learning, but not what you want them to be

Skipping school

Positive Lifestyle Changes

Positive Lifestyle Changes

Regular exercise, adequate sleep, regularly scheduled meals

Reduce/avoid use of caffeine and other stimulants

Reduce alcohol intakeAvoid smoking

Regular exercise, adequate sleep, regularly scheduled meals

Reduce/avoid use of caffeine and other stimulants

Reduce alcohol intakeAvoid smoking

Cognitive Behavioral Therapy

Cognitive Behavioral Therapy

Based on the idea that our thoughts control our feelings and behaviors

Control physical symptoms with:Relaxation and breathing techniquesReplacing negative thoughts with more

balanced thoughtsFacing social situations that you fear in

a gradual, systematic way Building relationships by improving

communication and taking initiative

Based on the idea that our thoughts control our feelings and behaviors

Control physical symptoms with:Relaxation and breathing techniquesReplacing negative thoughts with more

balanced thoughtsFacing social situations that you fear in

a gradual, systematic way Building relationships by improving

communication and taking initiative

Medication Medication

Beta blockers-blocks adrenaline production to reduce symptoms

Antidepressants-Benzodiazepines-sedatives

that reduce anxietyEx. valiumHighly addictiveOnly successful with

generalized/free floating anxiety

Beta blockers-blocks adrenaline production to reduce symptoms

Antidepressants-Benzodiazepines-sedatives

that reduce anxietyEx. valiumHighly addictiveOnly successful with

generalized/free floating anxiety

SourcesSources

www.pubmed.gov www.mayoclinic.com www.socialanxietyinstitute.org http://dbic.dartmouth.edu/haxby/papers/

Gentili_BRB_2008.pdf http://www.nimh.nih.gov/science-news/2008/social-

phobia-patients-have-heightened-reactions-to-negative-comments.shtml

http://www.webmd.com/anxiety-panic/guide/mental-health-social-anxiety-disorder

http://brainblogger.com/2010/04/22/the-neurobiology-of-social-anxiety-disorder/

http://psycnet.apa.org/psycinfo/1998-11070-001 Helpguide.org

www.pubmed.gov www.mayoclinic.com www.socialanxietyinstitute.org http://dbic.dartmouth.edu/haxby/papers/

Gentili_BRB_2008.pdf http://www.nimh.nih.gov/science-news/2008/social-

phobia-patients-have-heightened-reactions-to-negative-comments.shtml

http://www.webmd.com/anxiety-panic/guide/mental-health-social-anxiety-disorder

http://brainblogger.com/2010/04/22/the-neurobiology-of-social-anxiety-disorder/

http://psycnet.apa.org/psycinfo/1998-11070-001 Helpguide.org