Social Anxiety Social Anxiety Clinical, Developmental, and Social Perspectives Second Edition Edited by Stefan G. Hofmann and Patricia M. DiBartolo AMSTERDAM • BOSTON • HEIDELBERG • LONDON NEW YORK • OXFORD • PARIS • SAN DIEGO SAN FRANCISCO • SINGAPORE • SYDNEY • TOKYO Academic Press is an Imprint of Elsevier Academic Press is an imprint of Elsevier 32 Jamestown Road, London NW1 7BY, UK 30 Corporate Drive, Suite 400, Burlington, MA 01803, USA 525 B Street, Suite 1800, San Diego, CA 92101-4495, USA Second edition Copyright © 2010 Elsevier Inc. All rights reserved No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means electronic, mechanical, photocopying, recording, or otherwise without the prior written permission of the publisher Permissions may be sought directly from Elsevier’s Science & Technology Rights Department in Oxford, UK: phone (44) (0) 1865 843830; fax (44) (0) 1865 853333; email: [email protected]. 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Because of rapid advances in the medical sciences, in particular, independent verification of diagnoses and drug dosages should be made British Library Cataloguing-in-Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging-in-Publication Data A catalog record for this book is available from the Library of Congress ISBN : 978-0-12-375096-9 For information on all Academic Press publications visit our website at www.elsevierdirect.com Typeset by MPS Limited, a Macmillan Company, Chennai, India www.macmillansolutions.com Printed and bound in the United States of America 10 11 12 13 10 9 8 7 6 5 4 3 2 1 Contents Contributors xv Introduction : Toward an Understanding of Social Anxiety Disorder Stefan G. Hofmann and Patricia M. DiBartolo Delineation of Social Anxiety xx Theoretical Perspectives xxii Treatment Approaches xxiv Conclusion xxv References xxvi Part I Delineation of Social Anxiety 1 . Evolution of Terminology and Constructs in Social Anxiety and Its Disorders Daniel W. McNeil Introduction 3 Overlapping and Contrasting Emotional States 5 Defi nitions 7 Diagnostic Nosology Classifi cations 8 Relation of Performance Defi cits and Social Anxiety 10 Subtypes of SAD 11 Cultural and Developmental Considerations 14 Coverage Across Disciplines and Subdisciplines 15 Summary and Conclusions 16 Acknowledgments 17 References 17 2 . Assessment of Social Anxiety and Social Phobia James D. Herbert, Alyssa A. Rheingold, and Lynn L. Brandsma The Clinical Interview 24 Structured Interviews 2 6 Interviewer -Rated Scales 28 Self -Report Measures 29 v vi Contents General Measures of Social Anxiety and Social Phobia 30 T he Liebowitz Social Phobia Scale – Self-Report 30 T he Social Phobia and Anxiety Inventory 3 0 Social Interaction Anxiety Scale 3 2 Social Phobia Scale 3 3 Fear Questionnaire 3 3 Social Phobia Inventory 3 4 Mini-SPIN 3 5 Measures of Theoretically Derived Components of Social Anxiety 3 5 Fear of Negative Evaluation Scale 3 6 Social Avoidance and Distress Scale 3 7 Cognitive-Somatic Anxiety Questionnaire 3 8 Self -Report Measures for Children and Adolescents 39 Liebowitz Social Anxiety Scale for Children and Adolescents 3 9 Social Phobia and Anxiety Inventory for Children 39 Social Anxiety Scale for Children 4 0 Social Skills Questionnaires 4 0 Spence Children’s Anxiety Scale 4 1 Kutcher Generalized Social Anxiety Scale for Adolescents 4 1 Role -Playing Procedures 42 Role-Play Test 4 2 Simulated Social Interaction Test 4 4 Self-Monitoring 4 5 Thought -Listing and Thought-Endorsement Procedures 45 Social Interaction Self-Statement Test 4 6 T hought-Listing and Thought-Recall 4 7 Psychophysiological Assessment 48 Cardiovascular Assessment 4 9 Electrodermal Recordings 5 0 Other Physiological Assessments 5 0 Summary 51 References 52 3 . Shyness, Social Anxiety, and Social Anxiety Disorder Lynne Henderson and Philip Zimbardo Introduction 65 Defi nitions 67 Prevalence 70 Cultural Infl uences 70 Comorbidity in a Shyness Treatment Sample 71 Development of Chronic Shyness 72 A reas of Overlap 7 4 A ge of Onset 7 4 A dolescent Onset 7 5 Individual Differences in Shy and Socially Phobic Individuals 76 Subgroups 7 7 Characteristics of Shy and Socially Phobic Individuals 77 Contents vii Somatic Symptoms 7 7 Cognitive Features and Perception 7 8 A ffective Features 7 9 Behavior 7 9 Family Characteristics 8 0 Treatment 81 A ddressing Attribution Style in Treatment and Assessing Results 82 Shyness Clinic Treatment 8 3 Social Fitness Model 85 References 87 4 . Are Embarrassment and Social Anxiety Disorder Merely Distant Cousins, or Are They Closer Kin? Rowland S. Miller The Nature of Embarrassment 94 Feelings 9 4 Physiology 9 5 Nonverbal Behavior 9 6 A ntecedent Events 9 6 T he Development of Embarrassment 9 8 Individual Differences 1 00 T he Fundamental Cause of Embarrassment 1 01 Behavioral Sequelae 1 03 Others ’ Reactions 1 03 Embarrassment Across Cultures 104 Reprise: The Nature of Embarrassment 105 Embarrassment and Social Anxiety Disorder 106 Phenomenology 1 06 T iming 1 07 Behavioral Sequelae 1 08 Development 1 08 Normality and Abnormality 1 09 Similarities of the States 1 12 Conclusions 112 References 113 5 . Social Anxiety Disorder and Its Relationship to Perfectionism Randy O. Frost, Katharine Glossner, and Sarah Maxner Perfectionism and Measures of Social Anxiety in Nonclinical Samples 121 Perfectionism in Patients with Social Anxiety Disorder 125 Perfectionism in Social/Evaluative Contexts 129 Perfectionism and Social/Evaluative Avoidance 134 T he Effect of Treatment for Social Phobia on Perfectionism 138 Summary and Conclusions 139 References 140 viii Contents 6 . Social Phobia as a Deficit in Social Skills Ariel Stravynski, Angela Kyparissis, and Danielle Amado Introduction 147 W hat Could Account for This Peculiar Pattern of Conduct? 147 A im and Method 1 48 The Notion of Social Skills 148 W hat Are Social Skills? 1 49 T wo Views of Social Skills 1 50 Assessment of the Social Skills of Social Phobic Individuals 152 Self-reports 1 53 Role-Play Tests 1 57 Skills Defi cits and Social Phobia – Direct and Indirect Evidence 160 A re Highly Shy/Socially Anxious Individuals Less Skilled than Those Who Are Not? 1 60 A re the Social Phobics’ Skills Different from Those of Normal Individuals? 1 64 A re Any Social Phobic Individuals Defi cient in Their Social Skills? 167 A re Better Skills Acquired through Social Skills Training? 1 68 Is Improvement in Performance of Social Tasks Related to Skill-Acquisition? 1 71 Discussion 1 72 Social Phobia as a Problem in Social Functioning 172 The Treatment of Social Phobia as an Antidote to Its Etiology, or, Social Skills Training for Social Skills Defi cits 174 Conclusion 176 References 1 76 7 . Relation to Clinical Syndromes in Adulthood Amy Wenzel Comorbidity in Studies Using DSM-III and DSM-III-R Criteria 183 Comorbidity in Studies Using DSM-IV Criteria 188 Lifetime Comorbidity Rates 1 89 Current Comorbidity Rates 193 Comorbidity Between Social Anxiety Disorder and Other Conditions 197 Eating Disorders 1 97 Body Dysmorphic Disorder 1 97 Bipolar Disorder 1 98 Psychosis 1 98 Suicidality 1 99 Cross - Cultural Expressions of Comorbidity 200 Comment and Future Directions 201 References 202 8 . Avoidant Personality Disorder and Its Relationship to Social Phobia James Reich Introduction 207 Diagnostic Issues Using The DSM 207 Contents ix Review of Early Findings 209 Studies Comparing SP to APD 209 T he Association of SP to Other Personality Disorders 2 10 T reatment and Outcome Studies for SP and APD 210 Course of SP 216 A PD and State Effects 216 Findings from More Recent Literature 216 Other Relevant Reviews 216 Recent Empirical Evidence on the Construct of APD 216 Recent Empirical Evidence on the Relationship of APD and SP 217 State Personality Effects 217 Genetic Findings 218 Discussion 2 18 Conclusions 2 19 References 2 19 9 . S ocial Anxiety in Children and Adolescents: Biological, Developmental and Social Considerations Michael F. Detweiler, Jonathan S. Comer, and Anne Marie Albano History and Morphology of Social Anxiety Disorder (Social Phobia) 224 Biological Factors 225 Genetic Infl uence 226 Brain/Cognitive Development 227 A mygdala 228 Puberty 232 Developmental Factors 236 A ttachment 236 T emperament 237 Social Factors 239 Parenting Style 239 Peer Infl uence 240 The Maintenance of Childhood Social Anxiety: A Cognitive Behavioral Model 242 Evidence -Based Treatment of Social Anxiety 243 Conclusion /Future Directions 248 References 249 Part II Theoretical Perspectives 10 . N euroendocrinology and Neuroimaging Studies of Social Anxiety Disorder K . Luan Phan and Heide Klumpp Introduction 273 Neuroendocrinology of Social Anxiety Disorder 274 Neuroanatomy of Social Anxiety Disorder 278 Brain Imaging and Neurophysiological Approaches 278