Behavioral Treatment Programs for Social Anxiety Disorder - Research Paper Example

Behavioral Treatment Programs for Social Anxiety Disorder Abstract This paper attempts to look at behavioral treatments that are effective to help people with social anxiety disorder. There are several different types of treatments administered through behavioral therapies or medications. As these treatments sometimes do not always work, psychiatrists and researchers are continuously looking for additional ways to help people cope with this disorder. Studies are constantly being conducted to test new drugs that will help make people's lives more functional and productive but with lesser side effects. Additionally, new therapeutic tactics are emerging in order to help others cope at a faster and have long term effects. Behavioral Treatment Programs for Social Anxiety Disorder Reason for Analysis There are numerous treatments available for social anxiety disorders. The goal is to analyze behavioral treatment programs that are available for people suffering from this mental illness. People are continuously emerging with disorders related to social phobias, many of which are not completely understood as to where they were triggered from. It is important to recognize, for the sake of these people, that mental health professionals and psychiatrists continue to develop new research and experiments to treat these many social phobia and anxiety disorders. Unfortunately, many anxiety disorders are also triggers for depression and perhaps even suicide. It is important to evaluate which treatments are the most successful and work the quickest as to help to save the person from themselves before they embark on hopelessness. It is also a goal to evaluate current treatments for this disorder as well as identify future and emerging behavioral treatments that may be more effective for patients that have social anxiety disorders. Many different treatments and therapies are available, including medicinal treatments. The problem with some of these therapies may be that they are not as effective only with certain patients or perhaps patients even try to resist these treatments. Just as all individuals are different, they will respond to different behavioral modification therapies differently as well. Many of these treatments will depend on the severity in which the social anxiety exists in each person. Social Anxiety Defined Anxiety is defined as “an unpleasant emotion triggered by anticipation of future events, memories of past events, or ruminations about the self,” by the Gale Encyclopedia of Mental Disorders (2003). According to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, also known as DSM-IV, social phobias can exist and be displayed in numerous social situations producing anxious moments such as scenarios like public speaking or eating in a restaurant. However, social anxiety can be more distinctly defined where a person does not like to be in stores, restaurants, at picnics, around people they do not know in small group or other social situations because of the nervousness that they feel when they are in these situations. An average of about 7 percent of American adults suffer from social interaction disorders and phobias. This can lead to avoidance behaviors where they stop participating in any activities such as going to the movies, the mall, concerts, holiday gatherings or any other similar situation and start to become withdrawn (American Psychiatric Association, 2000). Social anxiety disorder is the feeling that a person is in constant scrutiny from other people and are also afraid of being humiliated in a social situation. It often results in a lowered quality of life and increases personal emotional trauma significantly. Additionally, it is debilitating to a person in any personal, social or work environment in their daily lives (Bouchard, S., Dumoulin, S., Robillard, G. Guitard, T. Klinger, E. Forget, H., Roucaut, F.X., 2011). Adolescents typically have the first symptoms of social anxiety disorder due to the emotional chaos that they go through when going through puberty. They are changing in ways that they do not understand, are facing peer pressure and are still trying to discover their identity (Alfano, C.A., Beidel, D.C., 2011). However, there are treatments available and their methods are varying. Treatments and Experiments Numerous behavioral treatments and techniques have been evaluated by researchers that are in hopes of discovering the best treatment for people suffering from social anxiety disorders. There are many factors that could potentially come into play that have created a social phobia in the first place. Sometimes, even uncovering the root of the anxiety may help them to deal with the social phobia. Many forms of treatment such as cognitive behavioral therapy, social skills training, medications, prevention and intervention, talk therapy and exposure therapy may prove to be successful depending on each and every individual person suffering from the social anxiety disorder. There have been and will be numerous future experiments to test theories and hypotheses to find more effective behavioral modification treatments for this disorder. One method of behavioral modification for social anxiety is social skills training. This type of training is used by numerous teachers and therapists to help people who have difficulties interacting with others. The goal is to teach others how to develop interpersonal skills so they know how to react in various social settings. Many of these patients have not ever been exposed to some situations and therefore may come across as shy or are even unable to read and interpret social cues. Sometimes a person may have been shy all their lives or they are becoming withdrawn due to a tragedy in the family or a change in their lives such as a death, divorce, or any other issue. Some of these skills are as simply as learning telephone manners that they can incorporate into their everyday skills (Koenigsberg, J. 2003). Though this does help people to cope with their day to day activities, oftentimes it is not as intensive as a form of behavioral therapy as some of the other social anxiety therapies options are. Other therapies are more intensive such as one that a young college student underwent at Stanford University in 2009. As a withdrawn person, he was unable to make small talk with his peers and would only go shopping in case of an emergency, unable to even look at the cashier. However, Stanford University came up with a clinical trial that used cognitive behavioral therapies that completely eliminated his social anxiety using brain scan images to identify whether or not the therapy would make dramatic changes in the brain's operations (Bohan, S., 2011). Recently, Stanford also began a new five-year clinical trial to extend the research on their previous treatment. Stanford researchers are using non-drug treatments and are instead using cognitive behavioral therapy and mindful meditation to help eliminate the stressors of social anxiety. Mindful meditation basically helps a person to escape reality by being able to clear their mind free of everything. Additionally, guided imagery can also be helpful as audio recordings are used to take a patient to a peaceful place such as a waterfall through a forest or perhaps sitting on the beach listening to the waves, putting the person into another mental state, rather than physical. These brain scans, including MRIs, have shown that mindful meditation has been effective to reduce the social anxiety and helps patients reconsider their distorted thinking and negative self views (Bohan, S., 2011). Cognitive behavioral therapy is designed to help train a person to become more relaxed. Sometimes exposure techniques are used in order to eliminate fear and anxiety in patients. Relaxation training on its own has shown no improvement for social anxiety disorder on its own (Rodebaugh, T.L., Holaway, R.M., & Heimberg, R.G., 2004). Oftentimes, combination of medication and cognitive behavioral therapy are treatments for social anxiety disorders. Though if used separately, there is often pros and cons for their usage as a treatment. They may be useful mostly in short-term time frames. They are more effective if used together and many clients have better results for longer periods of time. Additionally, according to research, more treatment is no substitute for well-informed treatment (Heimberg, R.G., Rodebaugh, T.L., 2005). Medications may work more quickly, however they also appear to have more significant rates or relapse if taken alone as a client will build up a tolerance to the medications. Up to 30 to 60 percent of people using psychoactive medication alone may have recurrences of social anxiety disorders, many of these include paroxetine, sertraline, venlafaxine and several others (Stein, Veriani, Hair & Kumar, 2002). However, there is argumentation of whether or not the combined treatments are in fact as effective as researchers and psychiatrists originally thought. To determine the effectiveness of combined treatments, it is necessary to do research that have two different treatments types. According to research, an experiment was performed that combined cognitive behavioral therapy with medication or instead a placebo. The performance of the combination of therapies was unclear between the two treatment groups (Clark & Agras, 1991). The combinations could include using medication before using cognitive behavioral therapy, cognitive behavioral therapy before adding medication, or using medication and cognitive behavioral therapy simultaneously. It is difficult to generalize in which order the treatments are best effective. Various experiments have thoroughly examined the relationship that these three methods have on a patient with social anxiety disorder. Thus far, results have been inconclusive or unclear though experiments on social anxiety disorders have been conducted for over two decades (Heimberg, R., Rodebaugh, T, 2005) Theories and research suggest that combined treatment for social anxiety disorder is sensitive to the specific combination methods. Medications do increase the efficiency of cognitive behavioral therapy in the short term but it is unclear if it is in fact a long term solution to social anxiety disorders. Clients will learn that social situations are safe places to be, however, they may end up being dependent on the psychoactive medicines and without their usage, may result in a relapse or an increased fear in a social situation. The best way to rid a patient of medicine is to eliminate it over a gradual period of time while still undergoing cognitive behavioral therapy so to prevent relapse. Some of the best results show that starting medication before cognitive behavioral therapy is the best option and to continue the medication simultaneously along with therapy sessions (Heimberg, R.G., Rodebaugh, T.L., 2005). Another experiment to help identify effective treatments for social anxiety disorders was also conducted by a group of researchers to evaluate combined treatments. In this experiment, they used a group of 45 adults who had all been diagnosed with social anxiety and divided them into three test groups. Seventy-one percent of these adults were females. In these three groups, each person was randomly assigned to one of three groups: a traditional individual cognitive behavioral therapy treatment where exposure was conducted in vivo; one where exposure was in virtuo and one that were on a waiting list that were later treated with cognitive behavioral therapy combined in vivo and in virtuo. Exposure scenarios involved various social settings and even public speaking situations. The in virtuo exposure included the use of computer software. Additional psychological data was also compiled as well as cortisol samples from salivary excretions throughout these 16 sessions with group members during their exposure. The outcome showed that exposure in virtuo is effective for treatment of social anxieties and is just as effective as in vivo. It is also a more cost-effective method. This group of researchers acknowledged that this experiment was somewhat limited as people who were suffering social anxiety disorders could be exposed to more extreme social situations that are completed in vivo (Bouchard, S., et. al, 2011). When it comes to social anxiety disorder in adolescents, many other treatment programs are available. Many of these focus on prevention and intervention so that it is combated at an earlier age so they will have less of a struggle in adulthood or for a lifespan. Many of these, as previously discussed, result as a reaction to peer pressure and finding their identity at this crucial life stage. Adolescents are at a higher risk for additional emotional and mental disruptions such as depression and suicide at this point in their life, at a time when they are going through hormonal changes and are therefore are more vulnerable and influential in determining their self worth (Albano, A.M., 2000). At this point of time in life, it is also a stage at which people are becoming more mature not just physically, but also mentally, cognitively and behaviorally. It is most important at this point that they have a strong family or guardian support group but also are allowed to explore some independence from their family. It is also important to develop long-term friendships and find a niche that they fit in with their peer group (Albano, A.M., 1995). For young people who have been suffering social phobias and social anxiety disorders, it is important to evaluate their progress in given social situations. At times, if the condition is not treated immediately, it could then be too disabling to hide. It is at this time that intervention is necessary and most effective. Early identification will be key in preventing the social phobia to develop into a full blown debilitating disorder that could plague them for the rest of their lives (Albano, A.M., 2000). Conclusion Through various different treatment theories and experiments, it is inconclusive as to which is actually the best option. It is very beneficial to ensure that proper exposure to social situations is implemented in youth and particularly in adolescence so that a child or teenager will become more comfortable with themselves, can practice independence away from their family and formulate a self identity. Though a person is exposed at an early age does not mean that the development of social anxiety disorder will not emerge at a place later in life. Though research has been conducted for over 20 years plus and incorporate everything from exposure to medication, every person is an individual and therefore it is difficult to generalize the best treatment that is the most effective per person. Additionally, patients have social anxiety disorders that vary over a wide array of severity. Constant exposure may be enough to get them through a social situation that makes a person anxious. However, if not treated or addressed, a fear or phobia may become a part of their lives. Continuous fearfulness will then more than likely result in avoidance behaviors and will therefore increase the risk of additional mental illnesses such as depression, generalized anxiety disorders, other anxiety disorders or even suicide at some point. It is imperative for a person suffering from social anxiety disorder to not lose hope of treatments that are available. While one treatment may not be as effective, another behavioral modification may be more effective. Research will continue within these areas of psychology to attempt to discover even more effective medications or cognitive behavioral therapy methods. As researchers and other people have learned a lot about this disorder in the past 20 years, there is an unlimited amount of knowledge that the next 20 years may also have in store in regards to this mental disorder. Further analysis of these treatments will likely be available in the future. References Albano, A.M. (2000, January 1) Treatment of social phobia in adolescents: cognitive behavioral programs focused on intervention and prevention. Journal of Cognitive Psychotherapy. Springer Publishing Company. Albano, A.M. (1995). Treatment of social anxiety in adolescents. Cognitive and Behavioral Practice, 2, 271-298. Alfano, C.A., Biedel, D.C., (2011). Social anxiety in adolescents and young adults: translating developmental science into practice, introduction. Retrieved from http://www.apa.org/pubs/books/4317259.aspx. American Psychiatric Association, (2000). Diagnostic and Statistical Manual of Mental Disorders. Fourth edition, text revised. Washington, D.C.: American Psychiatric Association. Anxiety and anxiety disorders (2003). In Gale Encyclopedia of Mental Disorders. Farmington Hills, Michigan: The Gale Group, Inc. Bohan, S., (2011, July 14). Stanford study vanquishes social anxieties without drugs. The Oakland Tribune. Retrieved from http://www.highbeam.com/doc/1P2-29387497.html. Bouchard, S., Dumooulin, S., Robillard, G., Guitard, T., Klinger, E., Forget, H., Roucaut, F.X., (2011, June 22) A randomized control trial for the use of in virtuo exposure in the treatment of social phobia: final results. Journal of CyberTherapy and Rehabilitation. Virtual Reality Medical Institute. Clark, D.B., & Agras, W.S. (1991). The assessment and treatment of performance anxiety in musicians. American Journal of Psychiatry, 148, 598-605. Heimberg, R.G., Rodebaugh, T.L. (2005, January 1). Combined treatment for social anxiety disorder. Journal of Cognitive Psychotherapy. 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