Barriers to the treatment of social anxiety. Olfson, Mark; Guardino, Mary; Struening, Elmer; Schneier, Franklin R; et al. The American Journal of Psychiatry; Washington157.4 (Apr 2000): 521-7.
Social anxiety was strongly associated with functional impairment, feelings of social isolation, and suicidal ideation. Compared to participants without social anxiety, those with social anxiety were significantly more likely to report that financial barriers, uncertainty over where to go for help, and fear of what others might think or say prevented them from seeking treatment.
1996 National Anxiety Disorders Screening Day. These data provide a unique opportunity to examine self-reported barriers to treatment in a large adult population with symptoms of social anxiety, defined as a fear of doing things in front of others, such as public speaking or eating and avoiding or feeling very uncomfortable in social situations
Participants with both social anxiety symptoms also had a lower level of formal education and were proportionately more likely to be unemployed or disabled than their counterparts who did not have social anxiety
Almost one in four of the individuals with social anxiety in the study reported that they had thoughts of committing suicide in the past month.
The Contribution of Experiential Avoidance and Social Cognitions in the Prediction of Social Anxiety. Mahaffey, Brittain L; Wheaton, Michael G; Fabricant, Laura E; Berman, Noah C; Abramowitz, Jonathan S. Behavioural and Cognitive Psychotherapy; Cambridge41.1 (Jan 2013): 52-65.
Cognitive models propose that social anxiety arises from specific dysfunctional cognitions about the likelihood and severity of embarrassment. Relational frame theory (RFT – which informs ACT), on the other hand, posits that social anxiety arises from the unwillingness to endure unpleasant internal experiences (i.e. experiential avoidance [EA]). Although cognitive models have garnered empirical support, it may be that newer models such as RFT can improve our ability to predict and treat social anxiety.
Study found: EA and social anxiety specific cognitive distortions overlap to a moderate extent.
RFT posits that cognitions exert their effects based not only on their form or frequency, but also based on the context in which they occur (Hayes et al., 2006). Unlike CBT models, however, RFT views contexts that encourage the control of private experiences such as thoughts and emotions as problematic. EA is defined as efforts to control or avoid unpleasant private events such as negative thoughts and emotions
social anxiety is thought to arise from efforts to control or eliminate the emotional and physiological experiences associated with anxiety, as well as thoughts and fears of embarrassment and negative evaluation. Thus, the RFT model of anxiety disorders departs from the cognitive model in that EA is focused not on one’s specific dysfunctional beliefs and interpretations (i.e. dysfunctional cognitions) about events or surroundings, but rather how emotional flexible individuals are and they tolerate anxious affect in the presence of fear cues. ACT seeks to ameliorate EA by helping socially anxious patients to accept and endure the negative experiences described above (i.e. develop greater “psychological flexibility”), rather than resort to avoidance and escape strategies (Eifert and Forsyth, 2005).
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