Social Anxiety Disorder: Rumination and CBT Strategies

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Questions and Answers

What primary distinction sets pre-event rumination apart from worry in individuals with social anxiety disorder (SAD)?

Worry involves memories of past social situations.

Pre-event rumination is more future-oriented. (correct)

Worry is mediated by cognitive restructuring.

Pre-event rumination is primarily focused on past failures.

Which of the following factors is identified as a predictor of pre-event rumination?

Poor self-efficacy beliefs

Post-event threat appraisal

High levels of emotional support

Anticipated self-appraisals of performance (correct)

Which therapeutic strategy has been shown to effectively reduce post-event rumination for SAD?

Medication management only

Group therapy sessions

Gradual exposure therapies

Cognitive restructuring and mindfulness (correct)

Why are reductions in post-event rumination particularly important for treatment outcomes in individuals with SAD?

They are inversely related to the severity of symptoms. Signup and view all the answers

Classical CBT for SAD should include which of the following components?

Gradual exposure to feared social situations. Signup and view all the answers

What is the primary fear associated with social anxiety disorder?

Fear of social evaluation and humiliation Signup and view all the answers

Which of the following is NOT a common anxiety symptom experienced in fear-inducing social situations?

Insomnia Signup and view all the answers

What is the typical lifetime prevalence rate of social anxiety disorder in Western societies?

4-13% Signup and view all the answers

At what age range does social anxiety disorder typically onset?

Early to middle teens (before 18 years) Signup and view all the answers

What behavioral strategy do individuals with social anxiety disorder often use to try to reduce their anxiety?

Avoiding eye contact Signup and view all the answers

Which demographic shows more severe social fears in social anxiety disorder?

Women, particularly in performance-related situations Signup and view all the answers

Which factor contributes to the lower prevalence of social anxiety disorder reported in East Asian countries?

Different cultural expressions of social anxiety Signup and view all the answers

What do people with social anxiety disorder (SAD) tend to underestimate in social situations?

Their own social skills Signup and view all the answers

How do high socially anxious participants perceive positive feedback from observers after a speech?

They tend to ignore it altogether Signup and view all the answers

Which cognitive pattern is commonly found in individuals with SAD?

Unrealistically high standards for their social interactions Signup and view all the answers

What effect does self-focused attention have on individuals with SAD during social performances?

They believe their visible anxiety matches their internal feelings Signup and view all the answers

What is a consequence of excessive post-event processing in individuals with SAD?

Maintenance of negative self-evaluations Signup and view all the answers

What type of treatment is commonly effective for social anxiety disorder?

Both pharmacological treatments and CBT Signup and view all the answers

How do socially anxious individuals tend to recall social memories?

From an observer's perspective Signup and view all the answers

What is a notable belief held by people with SAD concerning their social performance?

They should never make mistakes Signup and view all the answers

Which of the following behaviors is characterized by socially anxious individuals in social settings?

Focusing heavily on their internal anxiety responses Signup and view all the answers

What is the primary goal of exposure therapy in treating social anxiety disorder?

To gradually face feared social situations Signup and view all the answers

Which of the following elements is NOT involved in social skills training for social anxiety disorder?

Self-focused attention Signup and view all the answers

What role do monoamine-oxidase inhibitors and SSRIs play in the treatment of social anxiety disorder?

They provide immediate improvements in symptoms. Signup and view all the answers

Which therapy builds on cognitive behavioral therapy to emphasize mindfulness and values?

Acceptance and commitment therapy (ACT) Signup and view all the answers

At what stage in life does agoraphobia most commonly begin?

In the early 20s Signup and view all the answers

What is a common characteristic of individuals suffering from agoraphobia?

They avoid leaving their homes alone. Signup and view all the answers

What percentage of adults have experienced occasional panic attacks?

28% Signup and view all the answers

Which population is more commonly affected by agoraphobia?

Women Signup and view all the answers

Why is it important to combine drug therapy with cognitive behavioral therapy (CBT) for effective treatment?

CBT is necessary to maintain gains after medication is stopped. Signup and view all the answers

What does mindfulness-based intervention aim to teach individuals experiencing social anxiety?

To focus on and relax in the present moment. Signup and view all the answers

What is the major role of cognitive-behavioral therapy (CBT) in treating panic disorder?

CBT helps patients identify and challenge catastrophizing thoughts. Signup and view all the answers

Which of the following drug therapies is NOT typically used for treating panic disorder?

Beta-blockers Signup and view all the answers

During CBT sessions for panic disorder, why might a therapist induce panic symptoms?

To help patients understand their physiological responses. Signup and view all the answers

What conclusion can be drawn about the use of biological challenge tests in panic disorder patients?

These tests induce panic attacks through neurochemical disorders unique to panic disorder. Signup and view all the answers

What is a common misconception about the onset of panic attacks in individuals with panic disorder?

They can often appear to come out of nowhere. Signup and view all the answers

How does CBT compare to drug therapies in terms of preventing relapse after treatment for panic disorder?

CBT is significantly better at preventing relapse post-treatment. Signup and view all the answers

Which physiological procedure has NOT been demonstrated to induce panic attacks in panic disorder patients?

Prolonged inhalation of nitrous oxide Signup and view all the answers

What cognitive error is commonly addressed in CBT for panic disorder?

Catastrophizing of benign bodily sensations Signup and view all the answers

Why might patients with panic disorder find it difficult to focus during an attack?

They often experience intense physical discomfort. Signup and view all the answers

What underlying assumption is made about individuals susceptible to panic attacks during biological challenge tests?

They may have a neurochemical disorder. Signup and view all the answers

Study Notes

SAD is a severe and persistent fear of social or performance situations.
Anxiety is so pervasive it predicts comorbidities (e.g., mood & anxiety disorders, substance abuse).
Individuals fear showing anxiety symptoms, leading to humiliation, rejection, or offending others.
Avoidance of public eating/drinking due to anxiety about visible symptoms (e.g., shaking hands).
Symptoms include palpitations, sweating, gastrointestinal distress, muscle tension, blushing, confusion.
Severe cases may lead to panic attacks.
Avoidance, fear, or anxiety of social interactions last for 6+ months, significantly impacting social & occupational activities.
Anxiety is not explained by other mental/medical disorders or substance abuse.
Safety behaviors (e.g., avoiding eye contact) aim to reduce anxiety.

Prevalence

Lifetime prevalence in Western societies is 4-13%.
Women experience more severe symptoms, especially in performance situations, while men seek treatment more often for fears, often related to dating.
SAD usually begins in early-middle teens, before age 18.
New onset beyond late adolescence is uncommon and usually secondary to another mental disorder.
SAD has the lowest remission rate among anxiety disorders.

Etiology

SAD is classified separately from specific phobias, due to unique cognitive biases.
Genetic factors play a moderate role (twin studies).
Heritable traits include submissiveness, anxiousness, social avoidance, and behavioral inhibition.
Heritability of social fear is estimated to be 13%, while general anxiety characteristics are 30-50%.
Offspring with SAD are more likely to have parents, especially mothers, with SAD.
Children with behavioral inhibition temperament have a higher risk for SAD.
Behavioral inhibition heritability is 50-70%.
Early parent-child interaction styles (controlling, less warmth, less sociable, use of shame) may contribute but are not necessarily causal.
Humiliating experiences (extreme teasing) early in life are reported by over 90% of SAD sufferers.

Cognitive Factors

SAD sufferers exhibit negative predictions about social events, rating their probability higher than individuals with other anxiety disorders or controls.
They overly criticize their performance and underestimate their social skills.
They miss positive feedback cues given by observers.
Excessive post-event rumination about negative experiences or outcomes contributes to anxious feelings.
Individuals tend to notice threatening social cues and interpret them negatively.

Treatment

Both pharmacological treatments (SSRIs, SNRIs, benzodiazepines, beta-blockers) and CBT are effective.
CBT includes exposure therapy (in vivo or role-playing), social skills training, cognitive restructuring, and mindfulness-based interventions.
Drug therapy is faster-acting but requires CBT for maintenance.
CBT group therapies are also effective due to natural social interactions.

Agoraphobia and Panic Disorder

Agoraphobia involves fear of places where escape or help might be difficult (public transport, open spaces, shops, etc.).
50% of agoraphobia cases involve prior panic attacks.
Agoraphobia onset is most frequent in the early 20s.
Women are diagnosed with agoraphobia more often.
Individuals with agoraphobia may avoid leaving their homes.
Panic disorder diagnoses exist when panic attacks are frequent (unexpected, unprovoked), leading to significant worry & behavioral changes.
People with panic disorder often fear serious illnesses, have worries of dying/going crazy, and experience disability due to worrying about panic attacks.

Cognitive Mediation of Panic Attacks

Biological challenge tests (e.g., sodium lactate, CO2 breathing, hyperventilation) induce panic in individuals with panic disorder.
Misinterpretations of benign bodily sensations are more indicative of inducing panic in SAD patients.
Cognitive mediation models emphasize how misinterpretations create panic.
Anxiety may be triggered by catastrophic interpretations of bodily sensations.
Interventions target catastrophic thinking and misinterpretations.

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Description

Test your knowledge on the distinctions between pre-event rumination and worry in social anxiety disorder (SAD). This quiz covers predictors of rumination, therapeutic strategies for its reduction, and essential components of classical cognitive-behavioral therapy for SAD.