Shy Children, Phobic Adults: Nature And Treatment of Social Anxiety Disorder

396 Pages·2007·16.81 MB·English

by  Deborah C. Beidel

Shy Children,
Phobic Adults
Nature and Treatment
of Social Anxiety Disorder
SECOND EDITION
Deborah C. Beidel
Samuel M. Turner
American Psychological Association
Washington, DC
Copyright © 2007 by the American Psychological Association. All rights reserved. Except
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Library of Congress Cataloging-in-Publication Data
Beidel, Deborah C.
Shy children, phobic adults : nature and treatment of social anxiety
disorder / Deborah C. Beidel and Samuel M. Turner.— 2nd ed.
p. cm.
Includes bibliographical references and index.
ISBN-13: 978-1-59147-452-4
ISBN-10: 1-59147-452-3
1. Social phobia. I. Turner, Samuel M., 1944- . II. American
Psychological Association. III. Title.
[DNLM: 1. Phobic Disorders. WM 178 B422s 2007]
RC552.S62B45 2007
616.85'223—dc22 2006009554
British Library Cataloguing-in-Publication Data
A CIP record is available from the British Library.
Printed in the United States of America
Second Edition
To Sam
When describing our work, the words I, my, or mine were never part of your
vocabulary. For you, it was always we, us, and ours. And so it will always be.
Your courageous heart and generous spirit inspire me still.
Debbie
Contents
Preface ix
Acknowledgments xiii
Introduction 3
1 Clinical Presentation of Social Anxiety Disorder
in Adults 11
2 Clinical Presentation of Social Anxiety Disorder in
Children and Adolescents 47
3 Prevalence of Social Anxiety Disorder 81
4 Etiology of Social Anxiety Disorder 91
5 Assessment of Social Anxiety Disorder 121
6 Managing Patients With Social Anxiety Disorder
(and Their Parents) 151
7 Pharmacological Treatment of Social Anxiety Disorder 173
8 Behavioral and Cognitive-Behavioral Treatment
of Social Anxiety Disorder in Adults 201
9 Behavioral and Cognitive-Behavioral Treatment of Social
Anxiety Disorder in Children and Adolescents 261
Epilogue 315
References 321
Author Index 363
Subject Index 375
About the Authors 397
vn
Preface
C
linical and research interest in the field of social anxiety disorder
has increased dramatically since the publication of the first edition
of this volume in 1998. This interest has translated into increased knowl-
edge regarding the psychopathology, epidemiology and long-term im-
pact, assessment strategies, and treatment outcome (both psychological
and pharmacological) of the disorder. For example, in several areas of
the first edition, we were able to state that data were "beginning to
emerge." Now the data are firmly established, allowing us (and others)
to draw more substantive conclusions. In fact, it is difficult to identify
any aspect of social anxiety disorder for which there has not been a
substantial increase in knowledge. Thus, we felt that the time was right
for an update of this volume. In the following paragraphs, we highlight
some of the revisions that are found in this second edition.
One of the first changes that a reader will notice is the change in
the name of the disorder. As a result of the clear documentation of its
extensive and pervasive distress, social anxiety disorder (rather than social
phobia) has become the preferred term because phobia is still associated
with a circumscribed pattern of distress, and this clearly is not descriptive
of social anxiety disorder. In fact, over the past 8 years, clinicians and
researchers have seen many changes in several aspects of its clinical
presentation in both adults and children. For adults, we now know
that social anxiety disorder is a chronic condition, much more so than
depression or panic disorder, and that it results in significant impairment
across all areas of functioning. An exciting new development is the
emergence of neuroscience and sophisticated neuroassessment strategies.
The use of magnetic resonance imaging, for example, is yielding new
IX
PREFACE
data regarding the role of neuroanatomical structure and function in
social anxiety disorder. There is no doubt that this area will continue
to produce substantive findings over the next decade. Among children
and adolescents, there are now sufficient data to characterize clearly
the presentation of social anxiety disorder in these age groups and,
particularly, how the disorder manifests itself differently depending on
developmental age. Similarly, there are now more substantive data avail-
able regarding the prevalence of social anxiety disorder across various
cultural groups, although regrettably most samples are still limited to
Caucasian populations in Europe and North America. It is hoped that
data from other continents will follow soon.
Another significant change from the first edition is that there are
now a variety of assessment instruments specifically developed to assess
social anxiety disorder in adult, adolescent, and child populations. These
new strategies include well-validated self-report instruments and clini-
cian rating scales. In fact, the assessment chapter has been substantially
revised to reflect the burgeoning research in this area. The same word,
burgeoning, aptly describes the literature addressing pharmacological
treatment. Although the first edition was published less than a decade
ago, at that time there were no controlled trials examining SSRIs. Now
SSRIs are the pharmacological treatment of choice for patients of all ages.
Chapter 7 is the one that has undergone the most substantial revision
in this second edition, and the difference is striking. Although there are
still few studies comparing pharmacological and psychosocial interven-
tions, clear evidence is now available concerning the efficacy of many
medication classes. The chapters on psychosocial treatment in adults
and children have also benefited from the results of expanded controlled
treatment trials that are now available. Previously, debate existed regard-
ing the merits of a strictly behavioral versus a cognitive-behavioral
approach to the treatment of social anxiety disorder in adults. That
debate is now largely resolved, and the cumulative data clearly indicate
that the crucial therapeutic ingredient is exposure to the feared situation.
Chapter 9, on psychosocial treatment in children and adolescents, has
PREFACE
also undergone substantial revision, and unlike the state of the literature
at the time of the first edition, a number of controlled trials now indicate
the efficacy of behavioral treatments for this disorder.
Consistent with the changes in the empirical literature, this volume
benefits from the inclusion of new case descriptions and clinical materials
to assist clinicians in providing treatment to those suffering from this
disorder, which in our opinion still remains the primary reason for
conducting research. In summary, the wealth of new research data exam-
ining all aspects of social anxiety disorder make this second edition long
overdue. We are pleased that it is finally here.
XI
Acknowledgments
M
any individuals kindly contributed their time and effort to the
development of this book. First and foremost, we thank our
patients and their families who contributed their time and taught us so
much about this disorder and how to treat it. Second, we thank Brennan
Young and Adam Collins for their technical assistance in the completion
of the manuscript and the anonymous reviewers who so carefully and
thoughtfully made suggestions that improved the volume. Finally, we
thank Susan Reynolds, Susan Herman, and Tiffany Klaff in the Books
Department at the American Psychological Association for their consis-
tent support, encouragement, and suggestions.
xm
Shy Children,
Phobic Adults