Social Anxiety

Chapter

Abstract

Transitory shyness is particularly common among very young children and a large segment of the population will experience symptoms of social anxiety at some point across the lifespan. Fortunately, such episodes pass without major incident for most individuals. For others, the experience of social anxiety is pervasive and leads to substantive distress and impairment. Social anxiety disorder (also known as social phobia) is defined as a “marked and persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others” (American Psychiatric Association, 2000, p. 456). The classic symptom constellation includes heightened physiologic reactivity (e.g., increased heart rate and muscle tension), cognitions reflecting negative evaluation (e.g., “Everyone is looking at how stupid I am”), and overt escape and avoidance and avoidance behaviors (e.g., school refusal, reticence to speak), although primary response modes vary considerably across individuals. As school is children’s primary social venue, it is not surprising that the school context is a significant source of distress for children and adolescents with social anxiety disorder (Essau, Conradt, & Petermann, 1999; Strauss & Last, 1993). As children often do not have the freedom to avoid school and other feared social situations, parents and teachers may misinterpret clinging and crying as oppositional behavior rather than as a symptom of social anxiety, and as such appropriate intervention is delayed or denied. For those for whom more covert cognitive or physiologic modes predominate, parents may be unaware of their child’s distress until the condition becomes quite severe and comorbid conditions such as depression and substance abuse begin to wreak havoc.

Keywords

Placebo Depression Serotonin Stein Fluoxetine 

References

  1. Albano, A. M., Marten, P. A., Holt, C. S., Heimberg, R. G., & Barlow, D. H. (1995). Cognitive-behavioral group treatment for social phobia in adolescents: A preliminary study. The Journal of Nervous and Mental Disease, 183, 649–656.PubMedCrossRefGoogle Scholar
  2. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed. Text Rev.). Washington, DC: American Psychiatric Association.CrossRefGoogle Scholar
  3. Anhalt, K., & Morris, T. L. (2008). Parenting characteristics associated with anxiety and depression: Exploring the contribution of multiple factors. Journal of Early and Intensive Behavioral Intervention, 5, 122–137.Google Scholar
  4. Aune, T., Stiles, T. C., & Svarva, K. (2008). Psychometric properties of the Social Phobia and Anxiety Inventory for Children using a non-American population-based sample. Journal of Anxiety Disorders, 22, 1075–1086.PubMedCrossRefGoogle Scholar
  5. Baer, S., & Garland, E. J. (2005). Pilot study of community-based cognitive behavioral group therapy for adolescents with social phobia. Journal of the American Academy of Child and Adolescent Psychiatry, 44, 258–264.PubMedCrossRefGoogle Scholar
  6. Barrett, P. M., Rapee, R. M., Dadds, M. M., & Ryan, S. M. (1996). Family enhancement of cognitive style in anxious and aggressive children. Journal of Abnormal Child Psychology, 24, 187–203.PubMedCrossRefGoogle Scholar
  7. Barrett, P., Shortt, A., & Healy, L. (2002). Do parent and child behaviours differentiate families whose children have obsessive-compulsive disorder from other clinic and non-clinic families? Journal of Child Psychology and Psychiatry, 43, 597–607.PubMedCrossRefGoogle Scholar
  8. Beck, A. T. (1976). Cognitive therapy and the emotional disorders. New York: International Universities Press.Google Scholar
  9. Beidel, D. C., Turner, S. M., Hamlin, K., & Morris, T. L. (2000). The Social Phobia and Anxiety Inventory for Children (SPAI-C): External and discriminative validity. Behavior Therapy, 31, 75–87.CrossRefGoogle Scholar
  10. Beidel, D. C., Turner, S. M., & Morris, T. L. (1995). A new inventory to assess child social phobia: The Social Phobia and Anxiety Inventory for Children. Psychological Assessment, 7, 73–79.CrossRefGoogle Scholar
  11. Beidel, D. C., Turner, S. M., & Morris, T. L. (1999). Psychopathology of childhood social phobia. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 643–650.PubMedCrossRefGoogle Scholar
  12. Beidel, D. C., Turner, S. M., & Morris, T. L. (2000). Behavioral treatment of childhood social phobia. Journal of Consulting and Clinical Psychology, 68, 1072–1080.PubMedCrossRefGoogle Scholar
  13. Beidel, B. C., Turner, S. M., Sallee, F. R., Ammerman, R. T., Crosby, L. A., & Pathak, S. (2007). SET-C verses fluoxetine in the treatment of childhood social phobia. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 1622–1632.PubMedCrossRefGoogle Scholar
  14. Beidel, B. C., Turner, S. M., & Young, B. (2006). Social effectiveness therapy for children: Five-year follow-up. Behavior Therapy, 37, 416–425.PubMedCrossRefGoogle Scholar
  15. Beidel, B. C., Turner, S. M., Young, B., & Paulson, A. (2005). Social effectiveness therapy for children: Three-year follow-up. Journal of Consulting and Clinical Psychology, 73, 721–725.PubMedCrossRefGoogle Scholar
  16. Chansky, T. E., & Kendall, P. C. (1997). Social expectancies and self-perceptions in anxiety-disordered children. Journal of Anxiety Disorders, 11, 347–363.PubMedCrossRefGoogle Scholar
  17. Chavira, D. A., & Stein, M. B. (2002). Combined psychoeducation and treatment with selective serotonin reuptake inhibitors for youth with generalized social anxiety disorder. Journal of Child and Adolescent Psychopharmacology, 12, 47–54.PubMedCrossRefGoogle Scholar
  18. Chavira, D. A., Stein, M. B., Bailey, K., & Stein, M. T. (2004). Child anxiety in primary care: prevalent but untreated. Depression and Anxiety, 20, 155–164.PubMedCrossRefGoogle Scholar
  19. Coie, J. D., Dodge, K. A., & Coppotelli, H. (1982). Dimensions and types of social status: A cross-age perspective. Developmental Psychology, 18, 557–570.CrossRefGoogle Scholar
  20. Dadds, M. M., Barrett, P. M., & Rapee, R. M. (1996). Family process and child anxiety and aggression: An observational analysis. Journal of Abnormal Child Psychology, 24, 715–734.PubMedCrossRefGoogle Scholar
  21. Ellis, A., & Harper, R. (1975). A new guide to rational living. North Hollywood, CA: Wilshire.Google Scholar
  22. Epkins, C. C. (2002). A comparison of two self-report measures of children’s social anxiety in clinic and community samples. Journal of Clinical Child and Adolescent Psychology, 31, 69–79.PubMedGoogle Scholar
  23. Erath, S. A., Flanagan, K. S., & Bierman, K. L. (2007). Social anxiety and peer relations in early adolescence: Behavioral and cognitive factors. Journal of Abnormal Child Psychology, 35, 405–416.PubMedCrossRefGoogle Scholar
  24. Essau, C. A., Conradt, J., & Petermann, F. (1999). Frequency and comorbidity of social phobia and social fears in adolescents. Behaviour Research and Therapy, 17, 831–843.CrossRefGoogle Scholar
  25. Fyer, A. J., Mannuzza, S., Chapman, T. F., Liebowitz, M. R., & Klein, D. F. (1993). A direct interview family study of social phobia. Archives of General Psychiatry, 50, 286–293.PubMedGoogle Scholar
  26. Greco, L. A., & Morris, T. L. (2002). Paternal child-rearing style and child social anxiety: Investigation of child perceptions and actual father behavior. Journal of Psychopathology and Behavioral Assessment, 24, 259–267.CrossRefGoogle Scholar
  27. Greco, L. A., & Morris, T. L. (2005). Factors influencing the link between social anxiety and Peer Acceptance: Contributions of social skills and close friendships during middle childhood. Behavior Therapy, 36, 197–205.CrossRefGoogle Scholar
  28. Hayward, C., Varady, S., Albano, A. M., Thienemann, M., Henderson, L., & Schatzberg, A. E. (2000). cognitive -behavioral group therapy for social phobia in female adolescents: Results of a pilot study. Journal of American Academyof Child and Adolescent Psychiatry, 39, 721–726.CrossRefGoogle Scholar
  29. Herbert, J. D., et al. (2009). Cognitive behavior therapy for generalized social anxiety disorder in adolescents: A randomized controlled trial. Journal of Anxiety Disorders, 23, 167–177.PubMedCrossRefGoogle Scholar
  30. Higa, C. K., & Daleiden, E. L. (2008). Social anxiety and cognitive biases in non-referred children: The interaction of self-focused attention and threat interpretation biases. Journal of Anxiety Disorders, 22, 441–452.PubMedCrossRefGoogle Scholar
  31. Hirshfeld-Becker, D. R., Micco, J., Henin, A., Bloomfield, A., Biederman, J., & Rosenbaum, J. (2008). Behavioral inhibition. Depression and Anxiety, 25, 357–367.PubMedCrossRefGoogle Scholar
  32. Hudson, J. L., & Rapee, R. M. (2001). Parent-child interactions and anxiety disorders: An observational study. Behaviour Research and Therapy, 39, 1411–1427.PubMedCrossRefGoogle Scholar
  33. Hummel, R. A., & Gross, A. M. (2001). Socially anxious children: An observational study of parent-child interaction. Child & Family Behavior Therapy, 23, 19–41.CrossRefGoogle Scholar
  34. Inderbitzen-Nolan, H. M., Anderson, E. R., & Johnson, H. S. (2007). Subjective versus objective behavioral ratings following two analogue tasks: A comparison of socially phobic and non-anxious adolescents. Journal of Anxiety Disorders, 21, 76–90.PubMedCrossRefGoogle Scholar
  35. Isolan, L., Pheula, G., Salum, G. A., Oswald, S., Rohde, L. A., & Manfro, G. G. (2007). An open-label trial of escitalopram in children and adolescents with social anxiety disorder. Journal of Child and Adolescent Psychopharmacology, 17, 751–759.PubMedCrossRefGoogle Scholar
  36. Kessler, R. C., McGonagle, K. A., Zhao, S., Nelson, C. B., Hughes, M., Eshelman, S., et al. (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Archives of General Psychiatry, 51, 8–19.PubMedGoogle Scholar
  37. King, N. J., Muris, P., & Ollendick, T. H. (2005). Childhood fears and phobias: Assessment and treatment. Child and Adolescent Mental Health, 10, 50–56.CrossRefGoogle Scholar
  38. Kushner, M. G., Sher, K. J., & Beitman, B. D. (1990). The relation between alcohol problems and the anxiety disorders. The American Journal of Psychiatry, 147, 685–695.PubMedGoogle Scholar
  39. La Greca, A. M., Dandes, S. K., Wick, P., Shaw, K., & Stone, W. L. (1988). Development of the social anxiety scale for children: Reliability and concurrent validity. Journal of Clinical Child Psychology, 17, 84–91.CrossRefGoogle Scholar
  40. La Greca, A. M., & Lopez, N. (1998). Social anxiety among adolescents: Linkages with peer relations and friendships. Journal of Abnormal Child Psychology, 29, 83–94.CrossRefGoogle Scholar
  41. La Greca, A. M., & Stone, W. L. (1993). Social anxiety scale for children-revised: Factor structure and concurrent validity. Journal of Clinical Child Psychology, 22, 17–27.CrossRefGoogle Scholar
  42. Last, C. G., Perrin, S., Hersen, M., & Kazdin, A. E. (1992). DSM-III-R anxiety disorders in children: Sociodemographic and clinical characteristics. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 928–934.CrossRefGoogle Scholar
  43. March, J. S., Entusah, A. R., Rynn, M., Albano, A. M., & Tourian, K. A. (2007). A randomized controlled trial of venlafaxine ER versus placebo in pediatric social anxiety disorder. Biological Psychiatry, 62, 1149–1154.PubMedCrossRefGoogle Scholar
  44. Masia, C. L., & Morris, T. L. (1998). Parental factors associated with social anxiety: Methodological limitations and suggestions for integrated behavioral research. Clinical Psychology: Science and Practice, 5, 211–228.CrossRefGoogle Scholar
  45. Masia-Warner, C., Fisher, P. H., Shrout, P. E., Rathor, S., & Klein, R. G. (2007). Treating adolescents with social anxiety disorder in school: An attention control trial. Journal of Child Psychology and Psychiatry, 48, 676–686.PubMedCrossRefGoogle Scholar
  46. Masia-Warner, C., Klein, R. G., Dent, H. C., Fisher, P. H., Alvir, J., Albano, A. M., et al. (2005). School-based intervention for adolescents with social anxiety disorder: Results of a controlled study. Journal of Abnormal Child Psychology, 33, 707–722.PubMedCrossRefGoogle Scholar
  47. Morris, T. L. (2001). Social phobia. In M. W. Vasey & M. R. Dadds (Eds.), The developmentalpsychopathology of anxiety (pp. 435–458). Oxford: Oxford University Press.Google Scholar
  48. Morris, T. L., Hirshfeld-Becker, D. R., Henin, A., & Storch, E. A. (2004). Developmentally sensitive assessment of social anxiety. Cognitive and Behavioral Practice, 11, 13–27.CrossRefGoogle Scholar
  49. Morris, T. L., & Masia, C. L. (1998). Psychometric evaluation of the social phobia and anxiety inventory for children: Concurrent validity and normative data. Journal of Clinical Child Psychology, 27, 459–468.CrossRefGoogle Scholar
  50. Morris, T. L., Messer, S. C., & Gross, A. M. (1995). Enhancement of the social interaction and status of neglected children: A peer-pairing approach. Journal of Clinical Child Psychology, 24, 11–20.CrossRefGoogle Scholar
  51. Mowrer, O. H. (1947). On the dual nature of learning–a reinterpretation of “conditioning” and “problem-solving”. Harvard Educational Review, 17, 102–148.Google Scholar
  52. Mowrer, O. H. (1960). Learning theory and behavior. New York: Wiley.CrossRefGoogle Scholar
  53. Mrakotsky, C., Masek, B., Biederman, J., Raches, D., Hsin, O., Forbes, P., et al. (2008). Prospective open-label pilot trial of mirtazapine in children and adolescents with social phobia. Journal of Anxiety Disorders, 22, 88–97.PubMedCrossRefGoogle Scholar
  54. Öst, L. G. (1987). Age of onset in different phobias. Journal of Abnormal Psychology, 96, 223–229.PubMedCrossRefGoogle Scholar
  55. Parr, C. J., & Cartwright-Hatton, S. (2009). Social anxiety in adolescents: the effect of video feedback on anxiety and the self-evaluation of performance. Clinical Psychology & Psychotherapy, 16, 46–54.CrossRefGoogle Scholar
  56. Rapee, R. M., & Melville, L. F. (1997). Recall of family factors in social phobia and panic disorder: Comparison of mother and offspring reports. Depression and Anxiety, 5 7–11.PubMedCrossRefGoogle Scholar
  57. Rapee, R. M. (2001). The development of generalized anxiety disorder. In M. W. Vasey & M. R. Dadds (Eds.), The developmental psychopathology of anxiety(pp. 481–504). Oxford, UK: University Press.PubMedCrossRefGoogle Scholar
  58. Reijntjes, A., Dekovic, M., & Telch, M. J. (2007). Support for the predictive validity of the SASC-R: Linkages with reactions to an in vivo peer evaluation manipulation. Journal of Anxiety Disorders, 21, 903–917.PubMedCrossRefGoogle Scholar
  59. Rork, K., & Morris, T. L. (2009). Influence of parenting factors on childhood social anxiety. Direct observation of parental warmth and control. Child and Family Behavior Therapy, 31, 220–235.CrossRefGoogle Scholar
  60. Schneier, F. R., Johnson, J., Hornig, C. D., Liebowitz, M. R., & Weissman, M. M. (1992). Social phobia: Comorbidity and morbidity in an epidemiologic sample. Archives of General Psychiatry, 49, 282–288.PubMedGoogle Scholar
  61. Segool, N. K., & Carlson, J. S. (2008). Efficacy of cognitive-behavioral and pharmacological treatments for children with social anxiety. Depression and Anxiety, 25, 620–631.PubMedCrossRefGoogle Scholar
  62. Silverman, W. K., & Albano, A. M. (1996). Anxiety disorders interview schedule for DSM-IV child version. San Antonio: Psychological Corporation.Google Scholar
  63. Skinner, B. F. (1953). Science and human behavior. New York: Macmillan.Google Scholar
  64. Spence, S. H., Donovan, C., & Brechman-Toussaint, M. (1999). Social skills, social outcomes and cognitive features of childhood social phobia. Journal of Abnormal Psychology, 108, 211–221.PubMedCrossRefGoogle Scholar
  65. Spence, S. H., Donovan, C., & Brechman-Toussaint, M. (2000). The treatment of childhood social phobia: The effectiveness of a social skills training-based, cognitive-behavioural intervention, with and without parental involvement. Journal of Child Psychology and Psychiatry and Allied Disciplines, 41, 713–726.CrossRefGoogle Scholar
  66. Storch, E. A., Masia-Warner, C., Crisp, H., & Klein, R. G. (2005). Peer victimization and social anxiety in adolescence: A prospective study. Aggressive Behavior, 31, 437–452.CrossRefGoogle Scholar
  67. Strauss, C. C., & Last, C. G. (1993). Social and simple phobias in children. Journal of Anxiety Disorders, 1, 141–152.CrossRefGoogle Scholar
  68. Turner, S. M., & Beidel, D. C. (1989). Social phobia: Clinical syndrome, diagnosis, and comorbidity. Clinical Psychology Review, 9, 3–18.CrossRefGoogle Scholar
  69. Turner, S. M., Beidel, D. C., Dancu, C. V., & Keys, D. J. (1986). Psychopathology of social phobia and comparison to avoidant personality disorder. Journal of Abnormal Psychology, 95, 389–394.PubMedCrossRefGoogle Scholar
  70. Vasey, M. W., Daleiden, E. L., Williams, L. L., & Brown, L. M. (1995). Biased attention in childhood anxiety disorders: A preliminary study. Journal of Abnormal Child Psychology, 23, 267–279.PubMedCrossRefGoogle Scholar
  71. Wagner, K. D., Berard, R., Stein, M. B., Wetherhold, E., Carpenter, D. J., Perera, P., et al. (2004). A Multicenter, randomized, double-blind, placebo-controlled trial of paroxetine in children and adolescents with social anxiety disorder. Archives of General Psychiatry, 61, 1153–1162.PubMedCrossRefGoogle Scholar
  72. Walkup, J. T., Albano, A. M., Piacentini, J., Birmaher, B., Compton, S. N., Sherrill, J. T., et al. (2008). Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. The New England Journal of Medicine, 359, 2753–2766.PubMedCrossRefGoogle Scholar
  73. Watson, J. B. & Rayner, R. (1920). Conditioned emotional reactions. Journal of Experimental Psychology, 3, 1–14.PubMedCrossRefGoogle Scholar
  74. Yonkers, K. A., Dyck, I. R., & Keller, M. B. (2001). An eight-year longitudinal comparison of clinical course and characteristics of social phobia among men and women. Psychiatric Services, 52, 637–643.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Department of PsychologyWest Virginia UniversityMorgantownUSA

Personalised recommendations