Treating Social Phobias and Social Anxiety

Shyness And Social Anxiety System

The Shyness and Social Anxiety System is just as its name says. It is an e-book wherein in-depth discussions about the symptoms, causes and treatment for shyness and social anxiety are made. It is then written for individuals whose extreme shyness or social anxiety prevent them from enjoying a full life filled with social interactions among their family, friends and acquaintances in gatherings during holidays, outings and parties. The author Sean Cooper also suffered from shyness and social anxiety disorder so much so that he tried every trick in the book yet to no avail. And then he set out to conquer his own fears by researching into the psychology, principles and practices behind these two debilitating mental health issues. Read more...

Shyness And Social Anxiety System Summary

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Author: Sean Cooper
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My Shyness And Social Anxiety System Review

Highly Recommended

Recently several visitors of blog have asked me about this book, which is being advertised quite widely across the Internet. So I purchased a copy myself to find out what all the publicity was about.

This ebook served its purpose to the maximum level. I am glad that I purchased it. If you are interested in this field, this is a must have.

Social phobia social anxiety disorder

Social phobia (American Psychiatric Association, 1994) is characterised by a marked or persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to the possible scrutiny of others (American Psychiatric Association, 1994). The individual fears that he or she will act in a way or show anxiety symptoms that will be humiliating or embarrassing. For example, some patients with hyperhydrosis and rosacea often perspire or blush more prominently in embarrassing situations and may develop a social phobia as a result. Exposure to the feared social situation almost always provokes anxiety, which may take the form of a situationally bound panic attack, which in turn also results in an exaggerated autonomic reactivity of the skin. In social phobia the individual recognises that the fear is excessive or unreasonable however, intense anxiety results if the feared situation is not avoided. The anxious anticipation or distress of the feared...

Treatment of Social Phobia

SSRIs, such as paroxetine (Paxil) 20-40 mg day or sertraline (Zoloft) 50100 mg day, are the first-line medication for social phobia. Benzodiazepines, such as clonazepam (Klonopin) 0.5 - 2 mg per day, may be used if SSRIs are ineffective. B. Social phobia with performance anxiety responds well to beta blockers, such as propranolol. The effective dosage can be very low, such as 10-20 mg qid. It may also be used on a prn basis 20-40 mg given 30-60 minutes prior to the anxiety provoking event.

Treatment of Avoidant Personality Disorder

Individual psychotherapy, group psychotherapy and behavioral techniques may all be useful. Group therapy may assist in dealing with social anxiety. Behavioral techniques, such as assertiveness training and systematic desensitization, may help the patient to overcome anxiety and shyness. C. Since many of these patients will meet criteria for Social Phobia (generalized) a trial of SSRI medication may prove beneficial.

Differential Diagnosis of Social Phobia

Substance-Induced Anxiety Disorder. Substances such as caffeine, amphetamines, cocaine, alcohol or benzodiazepines may cause a withdrawal syndrome that can mimic symptoms of social phobia B. Obsessive-Compulsive Disorder, Specific Phobia, Hypochondriasis, or Anorexia Nervosa. Anxiety symptoms are common to many psychiatric disorders such as depression and the anxiety disorders. The diagnosis of social phobia should be made only if the anxiety is unrelated to another disorder. For example, social phobia should not be diagnosed in panic disorder if the patient has social restriction and excessive anxiety about having an attack. D. Mood and Psychotic Disorders. Excessive social worry and anxiety can occur in many mood and psychotic disorders. If anxiety occurs only during the course of the mood or psychotic disorder, then social phobia should not be diagnosed.

Differential Diagnosis of Avoidant Personality Disorder

Social Phobia, Generalized Type shares many features of avoidant personality disorder. Patients may meet criteria for both disorders. The two disorders may only be differentiated by a life-long pattern of avoidance seen in patients with avoidant personality disorder. C. Schizoid Personality Disorder. These patients also avoid interactions with others and are anxious in social settings however, schizoid patients do not fear criticism and rejection. Avoidant patients will recognize that social isolation is abnormal.

Nottingham Health Profile NHP

The version 2 contains 38 items in six sections, covering sleep, pain, emotional reactions, social isolation, physical mobility and energy level. Each question takes a yes no answer. As with the SIP, each item reflects departures from normal and items are weighted to reflect their importance. Earlier versions included seven statements about areas of life that may be affected by health, with the respondent indicating whether there has been any impact in those areas. These statements were less applicable to the elderly, unemployed, disabled or those on low income than were the other items, and are usually omitted. The NHP forms a profile of six scores corresponding to the different sections of the questionnaire, and there is no single summary index.

The psychological impact of skin disease

Research into the manifestations of psychocutaneous disorders has led to an increasing awareness of the psychosocial effects associated with skin disease. These include depression, a decreased sense of body image and self-esteem, sexual and relationship difficulties, and a general reduction in quality of life (Dungey & Busselmeir, 1982 Obermeyer, 1985 Porter et al., 1987 Papadopoulos et al., 1999). Indeed, research has shown that people with skin disease experience higher levels of psychological and social distress (Root et al., 1994), poorer body image and lower self-esteem than the general population (Papadopoulos et al., 1999) and higher avoidance of situations where their skin may be exposed (Rubinow et al., 1987). Leary and colleagues (1998) suggest that the degree of social anxiety depends on a person's confidence regarding their ability to successfully manage the impression they make and it has been shown that social anxiety is a mediating factor between the severity of a...

Newer cognitive approaches

As its name implies, social-cognitive theory is at its best when it comes to describing social and cognitive factors. It does a particularly good job of explaining the social situations in which complex behaviors are learned and the cognitive processes by which people decide whether or not to imitate those behaviors. Bandura and his followers argue that cognitive processes are especially important to study and

Mental Illness and Substance Abuse

For many people with this dual diagnosis, the substance abuse predates the onset of mental illness and the reasons for using seem to be the same reasons given by people without disabilities who abuse substances. Some researchers hypothesize that the drug use precipitates or induces the mental illness. For other individuals the reasons for using drugs and alcohol may include self-medication to alleviate psychiatric symptoms, to medicate side effects, to be liked by their peers without disabilities, or to increase their level of comfort in social interactions (Drake et al., 1991).

Selection Interviewing

And effective way of doing this is to meet all the candidates in a relaxed social context prior to the interviews. For instance, with professional candidates, this could involve having a meal together the evening before the interviewing day. Including in the party a member of the potential peer group from the laboratory or similar working environment helps to relieve the tension amongst the candidates. These social gatherings are a good way of picking up any behavioural aspects, e.g. verbosity, shyness which may not be apparent or, conversely, greatly emphasised in the more formal atmosphere of the interviewing room. Managers can use these observations to adapt or modify their interviewing styles to suit each candidate and get the best out of them during the interviews. It is only the style of the interview that is modified, not the process of interviewing, which should be consistent for each candidate in order to make the post interview comparisons valid. Time is also saved by using...

Vulnerable Populations

Effective risk communication messages can also mitigate the effects of disasters among those populations most vulnerable to their effects. During the 1995 Chicago heat wave, approximately 700 people, primarily elderly and poor residents, died in just three days. According to Eric Klinenberg of New York University, American society has assigned these populations less social importance, and this contributed to their isolation. As a result, their access to warnings, life-saving social interactions, and medical treatments was limited.

Personality disorders

The personality disorders (American Psychiatric Association, 1994) are defined as an enduring pattern of inner experience and behaviour that is pervasive across a wide range of personal and social situations and deviate markedly from the expectations of the individual's culture. The personality disorders that are most frequently encountered in dermatology include Borderline, Narcissistic and Histrionic personality disorders which all fall in the 'Cluster B' (American Psychiatric Association, 1994) category in the DSM-IV and Obsessive-compulsive personality disorder (which is categorised in 'Cluster C'). Borderline personality disorder is associated with a pattern of instability in interpersonal relationships, affects and self-image, and impulsive behaviours. Such patients are often 'difficult' as their instability in interpersonal relationships and self-image are also manifested in their relationship with their dermatologists and other health care providers. Such patients often try to...

Relationships Between Policy And Legislation Legislation and Mental Health

Perhaps to a significantly larger degree than any other health care field, mental health care is especially dependent on and affected by law. Social interactions of persons with mental disorders have traditionally raised two levels of concern which appear to be foundations for early legal interventions in the field of mental health.

Both 1 and 2 are Required

The anxiety is not better accounted for by another disorder such as social phobia, where phobic avoidance is only limited to social situations. D. The panic attacks are not caused by another mental disorder such as panic on exposure to social situations in social phobia, or panic in response to stimuli of a severe stressor, such as with post-traumatic stress disorder.

Prevention of Eating Disorders

Preventive measures should include education about normal body weight for height and techniques used in advertising and the media to promote an unrealistic body image. Parents, teachers, coaches, and health care providers all play a role in prevention. Parents, coaches, and teachers need to be educated about the messages they give to growing children about bodies, body development, and weight. In addition, they need to be aware of early signs of risk. Health care providers need to include screening for eating disorders as a routine part of care. Specific indicators include dieting for weight loss associated with unrealistic weight goals, criticism of the body, social isolation, cessation of menses, and evidence of vomiting or laxative or diuretic use.

How might stigmatisation be reduced

One approach is to reduce the visibility of a stigmatising mark. There is good evidence that cosmetic surgery (Sarwer et al., 1998) and cosmetic prostheses can help people feel better about themselves and their appearance. With respect to skin conditions, skin camouflage creams can be used to disguise skin blemishes such as scars and vitiligo. Kent (2002) found that clients who consulted the British Red Cross Skin Camouflage Service felt more confident in and exhibited less avoidance of social situations after their appointment than before. Although there was no measure of enacted or felt stigma in that study, qualitative comments indicated that clients were less preoccupied by how others would react to them. Laser treatment can also be helpful for those with port wine stains (Troilius et al., 1998), as is medical treatment for a variety of skin conditions including acne and eczema (Kurwa & Finlay, 1995 Kellett & Gawkrodger, 1999). Other approaches are more psychologically based. Some...

Predictions Learning Emotion and Behavior

Lance and alertness to danger, increased startle reaction even to benign events, and a greater tendency to interpret the actions and facial expressions of others as dangerous. These predictive mechanisms may result in excessive avoidance of intimacy, leading the person to feel as emotionally deprived as they did in childhood. The heightened vigilant and suspicious nature of these already traumatized individuals can be abrasive and difficult for others to deal with. This may lead to more conflict, negative affect, and rejection in social situations, again further reinforcing the person's lack of trust in personal relationships. Even without overt trauma, high degrees of infant distress can occur with failures of emotional responsiveness 25 . A child with, for example, a hostile or withdrawn parent may learn through conditioning to use compliance or cheerfulness to avoid the misattuned parental response.

Rehabilitation Within The Community

Used at all in the UK, mainly because of concerns about generalisability. The aim of social skills training is to increase social performance and reduce social distress and difficulties of the sort experienced by people with schizophrenia. Many people with schizophrenia experience debilitating problems affecting their ability to interact socially, and these exacerbate their social isolation and stigmatization. This in turn leads to a poor prognosis and quality of life 88 . Social skills training programmes rely on a range of structured psychosocial interventions, which may be carried out either individually or in groups. By enhancing social performance and reducing difficulties in social situations, social skills training may reduce overall symptomatology and, perhaps, relapse rates. The interventions are essentially behavioural and emphasise careful assessment of social and interpersonal skills. Importance is placed on both verbal and non-verbal communication. This includes the...

Changes in social networks

For some couples, skin disease brings new responsibilities into a relationship and this may be taxing if traditional gender roles become unbalanced (Danoff-Burg & Revenson, 2000). For example, in one affected couple, a wife had to seek employment when her husband was unable to continue his job at a dry cleaner because the steam and chemicals aggravated his eczema. Functional limitations may also lead to changes in a couple's leisure activities for instance, patients with psoriasis receiving psoralen plus ultraviolet light (PUVA) treatment often sacrifice holidays in the sun. If, for the sake of the relationship, partners also forgo valued activities, they too are in danger of becoming isolated through their own loss of freedom. Firstly, by missing out on social interactions that were previously shared and

Relationshipfocused coping

Various aspects of coping can also be shared with other significant relationships in a couple's network. Communal coping refers to the process whereby close friends or family members make skin disease 'our problem' and thus cope with the emotional and instrumental aspects of the disease with the patient. Consequently, in times of stress, friends and family are expected to help. From the patient's perspective, adopting a communal orientation involves developing greater concern for the welfare of others this may include considering how disfigurement, for example, influences the coping of family or friends in social situations. This change in focus, often leads to less self-involvement (Lyons et al., 1995a), promotes communication, and can enhance mutual problem-solving. It is also a form of legitimacy as it involves having others accept the reality and nature of constraints that are placed on the couple (Locker, 1983). What constitutes legitimacy in a relationship however is a complex...

Evolution Of Sociality

The diverse relationships of individuals in a social network interact to create complex emergent patterns. These patterns, like the vortex that appears in an emptying sink, is not contained in the structure of a single component. Because a society represents a whole with properties different from those of its component parts, the ultimate consequences of social interactions may be remote from an observed action. This is a fact that evolution by natural selection can take in its stride but that we, as primarily linear cause-and-effect thinkers, may find hard to accommodate. It may be clear that a lion killing a zebra is behaving adaptively, but less clear whether it is adaptive when the same lion prevents a conspecific from feeding at the kill. The immediate effect is that the first lion may have more food to eat, but the ultimate effects reverberate through a stochastically unpredictable system of long-term consequences among the whole pride. Denied food or coalitionary aid by an ally...

Conservation Applications

An understanding of the dynamics of a social system is a prerequisite to predicting the effect of human activities on, for example, spatial organization, population dynamics, and dispersal. For example, attempts to control the transmission of bovine tuberculosis by killing badgers, a reservoir of the disease, clearly disrupts the society of survivors. The effects of such perturbation on social dynamics may alter the transmission of the disease, plausibly for the worse (Swinton et al. 1997). A similar case may be argued regarding rabies control (Macdonald 1995). Translocation of elephants without regard for the social structure that provides adolescent discipline has led to problem animals in some African parks (McKnight 1995). Tuyttens and Macdonald (in press) review some consequences of behavioral disruption for wildlife management. Population control has been shown to affect the rate and pattern of dispersal (Clout and Efford 1984), home range size (Berger and Cunningham 1995),...

Sources for Further Study

Overcoming Social Anxiety and Shyness A Self-Help GGuide Using Cognitive-Behavioral Techniques. New York New York University Press, 2001. A practical guide to changing negative thought patterns in order to increase self-esteem. Jones, Warren H., Jonathan M. Cheek, and Stephen R. Briggs. Shyness Perspectives on Research and Treatment. New York Plenum Press, 1986. Presents a thorough view of the development of shyness and the impact it has on social relationships. Many individuals with low self-esteem suffer from shyness, and it is difficult to understand one without the other. The writing is technical appropriate for a college audience. Kernis, Michael. Efficacy, Angency, and Self-Esteem. New York Plenum Press, 1995. A collection of papers that challenge existing notions of self-esteem in modern therapy or offer suggestions for new areas of research. Rosenberg, Morris. Society and the Adolescent Self-Image. Reprint. Collingdale, Pa. DIANE, 1999. Although written in the...

Building the Case for Oral Health Care

The Surgeon's General report Oral Health in America went beyond health to document the pervasive effects of oral diseases and conditions on the well-being of disadvantaged members of U.S. society (U.S. Department of Health and Human Services, 2000). That is, oral diseases and their treatments may undermine self-image and self-esteem, discourage family and other social interactions, and lead to chronic stress and depression all at great emotional and financial costs. They also interfere with vital functions of daily living such as breathing, eating, swallowing, and speaking in assorted areas of activity, including work, school, play, and home (U.S. Department of Health and Human Services, 2000).

Open to Mutual Communication

More mature human beings that they will encounter in the extrauterine environment. Fetuses are simply not equipped for complex social interactions with other fetuses. Human communication is foreign and nonfunctional to the usually solitary 9 months of gestation, and especially so to the first half of gestation. Intrapair stimulation, which is a feature of twin pregnancies, seems to be considered relevant solely to support the belief that twins are highly communicative partners. As a consequence, all fetuses are regarded as potentially open to communication.

The body as aesthetic object

Individual CBT can allow a therapist to study Jake's view of himself and the premium he placed on the aesthetic value of his body. Many schemas are laid down in the early years of living and those that act maladaptively can integrate later experience within this maladaptive context. They may work to create such ramifications as feelings of social anxiety, shame and poor self-esteem.

Planning Care Well Exemplary Clinical Microsystems

5ps Nursing Assessment

As described in detail in Chapter Six, exploring the 5 P's deepens a clinical microsystem's knowledge of the patients who are the beneficiaries of care, the professionals providing care, the processes used to provide services, and the patterns of social interactions, health outcomes, and process measures. This knowledge positions the microsystem to engage in meaningful improvements. The microsystem becomes informed, aware of its identity as a system, and curious to try out improvements based on this new information.

The Drosophila Protein Interaction Network May Be neither Power Law nor Scale Free

Scale-free networks have become a topic of intense interest because of the potential to develop theories universally applicable to networks representing social interactions, internet connectivity, and biological processes. Scale-free topology is associated with power-law distributions of connectivity, in which most network components have only few connections while a very few components are extremely highly-connected. Here we investigate the power-law and scale-free properties of the network corresponding to protein-protein interactions in Drosophila melanogaster. We examine power-law behavior with a standard statistical technique designed to distinguish whether a power-law fit is adequate to describe the vertex degree distribution. We find that the degree distribution for the entire network, consisting of baits and preys, decays faster than power law. This fit may be confounded by artifacts of the screening procedure. The prey-only degree distribution is less likely to be confounded...

The Self as a Regulator of Individual Processes

Bandura's concept of self-observation has been further refined in research on self-awareness, self-consciousness, and self-monitoring. American social psychologists such as Robert Wicklund, Arnold Buss, Mark Davis, and Stephen Franzoi have defined self-awareness as a state of focusing attention on oneself, while self-consciousness is defined as a traitlike tendency to spend time in the state of such self-awareness. Most such research distinguishes between private self-awareness or self-consciousness, in which a person attends to internal aspects of self, such as thoughts and emotions, and public self-awareness or self-consciousness, in which a person attends to external aspects of self that can be observed by others, such as appearance, physical movements, and spoken words. Private self-awareness and self-consciousness have been associated with intense emotional responses, clear self-knowledge, and actions that are consistent with one's own attitudes and values. Self-monitoring is...

Acquisition of New Behaviors and Memory Formation

In the activities of daily life, gestalt perception is closely tied to the differential initiation of action. As an example, most social situations require differential responding to faces and objects. This is also true for most experimental paradigms of gestalt closure, which require differential key press or similar operationalizations. Previous work has shown that oscillatory brain activity was enhanced in specific frequency ranges and time windows following the presentation of coherent, but not incoherent visual stimuli (Tallon et al., 1995 Tallon-Baudry et al., 1997). Likewise, periods of EEG synchronization in the gamma range across electrodes were reported in response to identifiable vs. inverted face figures (Rodriguez et al., 1999). In an attempt to study acquisition of meaningful gestalt representations, Gruber and co-workers (Gruber et al., 2002) used a rapid perceptual learning design. They presented fragmented pictures, which were selected in such a way that subjects were...

People with Mental Illness as Parents

Parents with a serious mental illness face the challenges that every other parent faces, often have the additional burden of being a single parent, and, in addition, they have specific, unique challenges associated with having a severe and persistent mental illness. Some of the universal challenges of parenthood include the economic burdens of caring for children, the need to develop and apply new skills to provide effective childrearing, and the need for social support from the extended family, their own parents, or friends who can provide advice, encouragement, and emotional support for their efforts. Parents with mental illness face these same challenges, often exacerbated by their mental illness, poverty, and social isolation. For example, people with mental illness face particularly serious economic challenges, particularly if they are dependent on public benefits, which are barely adequate for their own support, let alone those of dependent children. Many individuals, because of...

The Future of ACT and Case Management Approaches

What is the future of ACT and related approaches Gary Bond and his colleagues (2005) have made a number of predictions (see box for a profile of Gary Bond). They believe the basic ACT model will continue to improve in two ways. First, ACT will systematically incorporate EBPs such as illness management (Chapter 3), motivational interviewing for dual disorders (Chapter 8), supported employment (Chapter 9), and family psychoeduca-tion (Chapter 13) into its service package. Second, ACT will be enhanced by the development of new strategies. For example, another service that may be integrated within ACT teams is supported socialization. Supported socialization employs volunteers or staff members who go on social and recreational outings with clients. The social isolation and loneliness of many persons with severe and persistent mental illness is well known. Bond et al. (2005) pointed out that ACT has had very little impact on social functioning. Yet

Psychopharmacological Therapy for PTSD

Selective serotonin reuptake inhibitors (SSRIs) are currently considered first-line therapies for PTSD and are considered a treatment of choice (Friedman, 2004). Treatment guidelines from the International Society for the Treatment of Traumatic Stress (ISTSS) state that SSRIs are the most effective medication for PTSD. Improvement and symptom reduction has been shown as early as 1 to 2 weeks after the drugs are first administered. Remission has been associated with treatment lasting at least 15 months. Fluoxetine has been found to significantly reduce overall PTSD symptoms, including intrusive symptoms and arousal. Sertraline has been found efficacious in both short-term and long-term therapy and has shown specific effects on anger and irritability. Further, the United States Food and Drug Administration recently designated sertraline as a specific treatment for PTSD. This finding is of note according to Friedman (2001) because the effectiveness of sertraline for PTSD appears to be...

Critiques of Kohlbergs stage theory

Related to Rest's modification of Kohlberg's stages is domain theory, usually identified with the work of Elliott Turiel. Turiel came to distinguish between children's moral development and other domains of social knowledge in order to account for anomalies in the data from Kohlberg's long-term follow-up studies of the subjects from his dissertation research. Turiel's domain theory holds that children's conceptions of morality and social conventions develop as a result of different social experiences associated with these two domains. Actions in the moral domain have certain effects on other people that occur without regard to social rules that may or may not be associated with the action. An example would be striking another person for no apparent reason. The moral domain is structured around the concepts of fairness, harm caused to others, and the welfare of others. Conventions, by contrast, are agreed-upon rules that smooth social interactions within a group they are structured to...

Philosophy The constructivists vision

Piaget wrote. I think that knowledge is a matter of constant, new construction, by its interaction with reality and that it is not preformed. There is a continuous creativity. As a constructivist, part of the philosophical school of structuralism, Piaget understood learning as an active process in which new ideas or concepts are constructed based on current or past knowledge. The individual selects and transforms information, constructs hypotheses, and makes decisions, relying on a cognitive structure that provides meaning and organization to the experiences. For Piaget, constructivism means that an individual always and only learns through constructing. He maintained that biological maturation provides the range of potential for cognitive growth, but developing the ability to perform operations requires an active, supportive environment and social interactions that encourage children to construct their own knowledge. Piaget also understood that there is no...

Quality of Life in Epilepsy QOLIE89

In contrast with the previous examples, the QOLIE-89 is a 13-page, 89-item questionnaire aimed at patients with epilepsy (Devinsky et al., 1995) Appendix E10 shows extracts. It is based upon a number of other instruments, in particular the SF-36, with additional items from other sources. It contains five questions concerning worry about seizures, and questions about specific bothersome epilepsy-related limitations such as driving restrictions. Shorter versions with 31 and 10 items are available. The QOLIE-89 contains 17 multi-item scales that tap into a number of health concepts, including overall QoL, emotional well-being, role limitations owing to emotional support, social support, social isolation, energy fatigue, seizure worry, health discouragement, attention concentration, language, memory, physical function, health perceptions. An overall score is derived by weighting and summing the scale scores. There are also four composite scores representing issues related to epilepsy,...

Applications of the Principles of Behaviorism

The behaviorism of Watson has resulted in applications in psychology and many other disciplines. The most notable form of application of Watson's behaviorism is the psychological treatment known as systematic desensitiza-tion. This treatment was created by South African psychiatrist Joseph Wolpe (1915-1997). Systematic desensitization was designed to reverse the outcome of the classical conditioning process in which extremely intense negative emotional responses, such as fear or anxiety, are elicited by everyday aspects of the environment. This outcome is referred to as a phobia. The treatment first requires training in relaxation. The second component of treatment takes a person through a hierarchy of steps beginning with a setting very distant from the feared stimulus and ending with the problem setting. At each step, the individual is asked to note and in some manner signal the experiencing of fear or anxiety and then is instructed to relax. Movement through the hierarchy is...

A theoretical framework for skin disease what do patients know about their own skin disorder

The psychology of the dermatology patient is a relatively under-researched area and so suffers from a relative lack of clarity. We have substantially covered the psychosocial effect that skin disease can have upon an individual and their social system but, just as important, is the way that the patient represents their illness. Understanding these dermatological illness representations might play a fundamental role in understanding treatment compliance, behavioural adaptation, impact upon relationships, the way a person copes with the often episodic nature of the disease and a number of other crucial aspects of the skin disease experience discussed throughout the book. Yet, so little is still known about how people actually conceptualise their disease along a number of cognitive dimensions. The literature indicates that there are generally higher levels of psychological distress amongst people with skin conditions but crucially, there is also evidence to suggest that there is...

Skin disease and body image

It has been reported that there are moderate associations between body dissatisfaction and poor psychological adjustment for men and women across the lifespan (Cash, 1985) and research has revealed that evaluative body image accounts for around a quarter to a third of variance in global self-esteem (Cash & Pruzinsky, 1990). As such, body satisfaction can have a considerable influence on psychosocial health. The literature has also shown a relationship between body satisfaction and depression (Noles et al., 1985), social confidence and social evaluation anxiety (Cash, 1993).

Differential Diagnosis of Specific Phobia

Panic Disorder, Obsessive-Compulsive Disorder, Social Phobia, Hypochondriasis or Anorexia Nervosa. Many psychiatric disorders present with marked anxiety, and the diagnosis of specific phobia should be made only if the anxiety is unrelated to another disorder. For example, specific phobia should not be diagnosed in panic disorder if the patient has excessive anxiety about having a panic attack.

Psychosocial impact of skin diseases

Used by these patients were concealment and avoidance, which were mostly utilised in order to avoid negative reactions from others. Moreover, acne patients have been shown to limit exposure through social avoidance and to conceal skin lesions (Kellett & Gilbert, 2001). Psoriasis patients have also been found to engage in anticipatory and avoidance coping behaviours, which are unrelated to the severity of their condition and this is hypothesised to relate to stigmatisation and rejection (Griffiths & Richards, 2001). Like previous work on disfigurement and social anxiety, skin disease patients use these dysfunctional behavioural strategies to manage the impression they make on others and their frequent use illustrates the overriding concerns about social exclusion (Thompson et al., 2002).

Psychological Aspects of Thyroid Cancer

Stajduhar et al. 15 elicited feedback from a small number of patients (n 27) who had undergone treatment with radioactive iodine. Profound physical and social isolation was the greatest concern for these patients. They reported not having had adequate information or preparation prior to treatment, in order to enable them to cope effectively. They were aware

Mirror Neurons and the Understanding of Intentions

Monkeys may exploit the mirror neuron system to optimize their social interactions. At least, the evidence we have collected so far seems to suggest that the mirror neuron system for actions is sophisticated enough to enable its exploitation for social purposes. Recent results by Cisek and Kalaska 41 show that neurons in the dorsal premotor cortex of the macaque monkey can covertly simulate observed behaviors of others, like a cursor moved to a target on a computer screen, even when the relation between the observed sensory event and the unseen motor behavior producing it is learned through stimulus-response associations. My hypothesis is that monkeys might entertain a rudimentary form of teleological stance, a likely precursor of a full-blown intentional stance. This hypothesis extends to the phylogenetic domain, the ontogenetic scenario proposed by Gergely and Csibra 42 for human infants. New experiments are being designed in my lab to test this hypothesis.

The impact of skin conditions on selfesteem

Unlike adults, young children will often stare openly at a child who looks different, and will sometimes make hurtful comments or ask questions in quite a disin-hibited way. In addition, they will often react with disgust or horror without any attempt to disguise their reaction because it may upset the person concerned. Young children have been shown to have clear preferences for children who look attractive and so a child who is visibly different can easily feel rejected or excluded by his or her peers (Sigelman et al., 1986). Managing these types of reactions can be very difficult for a young child with a skin condition and may result in them becoming increasingly self-conscious. This will obviously have an impact on the child's self-esteem but can also set up a 'negative mind set' which results in the child becoming increasingly sensitive to other's comments and at worst withdrawing from or avoiding social situations because of this. Nonetheless, the child will face some incidents...

Miller Dollard and social learning

Bandura picked up where Miller and Dollard left off. He, too, emphasized that children learn from social situations. However, he suggested that rewards were not necessary for this to occur. Bandura also moved internal thought processes to center stage. For Miller, Dollard, and the behaviorists before them, the essence of personality was in people's behavior. For Bandura, it was in their thoughts and beliefs.

Cognitive factors personality characteristics and core beliefs

Shame-proneness is another personality factor linked to early relationships (Tangey & Fischer, 1995 Gilbert & Miles, 2002). Feelings of shame have frequently been described by some people living with chronic skin conditions (e.g. Jowett & Ryan, 1985). Indeed, it has been argued that shame, self-esteem, appearance consciousness, fear of negative evaluation, and social anxiety are all similar concepts, in terms of their developmental origins, their relation to one's sense of being accepted by others, and their underlying cognitive processes (Thompson, 1998). This may explain why some earlier studies have found self-esteem to be closely related to adjustment (Porter et al., 1990 Van der Donk et al., 1994).

A Proximity to the nearest neighbour

Figure 10.8 The same observations of social interactions can be expressed in three ways as the total flux of a given behavior pattern, as a rate, or as a proportion. In this case, the total frequency is greater between A and B than between A and C (b c), but qualitatively the components of their relationship are the same. Figure 10.8 The same observations of social interactions can be expressed in three ways as the total flux of a given behavior pattern, as a rate, or as a proportion. In this case, the total frequency is greater between A and B than between A and C (b c), but qualitatively the components of their relationship are the same.

Differential Diagnosis of Obsessive Compulsive Disorder

Specific or Social Phobia, Body Dysmorphic Disorder or Trichotillomania. Recurrent thoughts, behaviors or impulses may occur in these disorders. OCD should not be diagnosed if symptoms are caused by another psychiatric condition (eg, hair pulling in trichotillomania).

The Implications Of Dual Diagnosis For Community Mental Health Services

Addiction techniques, such as motivational interviewing education about the effects of substance abuse and relapse prevention, are used. Attention is directed towards the social skills required to maintain abstinence. For example, if clients are not assertive enough to refuse drugs offered by their peers, staff may focus on developing the skills required for them to do so. Staff aim to identify and address the reasons for substance misuse. These may include self-medication of distressing symptoms, escape from boredom and social isolation, or difficulties in coping with stressful social situations or relationships. Addiction treatments are modified so that the problem is confronted in a gentle manner, and clients who have difficulty in attaining abstinence or who relapse very frequently are not ejected from the services. Staff help clients to find activities and social networks that do not involve substance misuse, and ensure that basic needs for housing, food and money are met.

Major depressive disorder

Depressive disease is a clinically important feature of psoriasis (Russo et al., 2004). Onset of psoriasis prior to age 40 years has been associated with greater difficulties with the expression of anger (Gupta et al., 1996), a personality trait which may predispose the patient to develop depression and be more vulnerable to psychosocial stressors. Psoriasis-related stress has been associated with greater psychiatric morbidity (Fortune et al., 1997) as patients who feel stigmatised in social situations have higher depression scores. Adult psoriasis patients who experienced greater deprivation of social touch as a result of their psoriasis had higher depression scores than patients who did not feel stigmatised (Gupta et al., 1998). Pruritus, which is reported to be one of the most bothersome features of psoriasis, has been associated with suicide. In psoriasis, severity of pruritus correlates directly with the severity of depressive symptoms (Gupta et al., 1988 Gupta et al., 1994)....

Regeneration of Hippocampal Neurons

Regardless of their location, the presence of NSCs in the hippocampus suggests that maintenance regeneration might be crucial for the retention or formation of memory and for learning new information and tasks. Several experimental results support this idea. Studies in vivo strongly suggest that the number of new neurons born in the hippocampus of mice is influenced by both physical and cognitive activity. Running on a treadmill, or placement in an enriched environment (more mice per cage to increase social interactions, mouse toys and treats, and re-arrangable sets of tunnels) increased stem cell proliferation and neurogenesis in the dentate gyrus of mice above the level of controls (Kempermann et al., 1998 van Praag et al., 1999a, b). Enriched-environment mice also learned a maze faster than controls. Control mice exhibited a decline in the number of BrdU-labeled new neurons in the hippocampus with age that was correlated with a reduction in the speed at which the maze was learned....

Case Studies and Therapy Techniques

Steve was diagnosed as having a severe social phobia. His therapy included a contract with his teachers in which it was agreed that he would not be called upon in class until therapy had made it possible for him to answer with only moderate anxiety. In return, he was expected to attend all his classes. To help make this transition, a psychiatrist prescribed an antianxiety drug to help reduce the panic symptoms. A psychologist began relaxation training for use in exposure therapy, which would include Steve volunteering answers in class and seeking social interactions with his peers. Steve finished high school, though he left the state university at the end of his first semester because of a worsening of his phobias. His therapy was resumed, and he graduated from a local community college, though his phobias continued to recur during stressful periods in his life.

Speech and Communication

Speaking, hearing, and understanding are essential to human communication. A disorder in one or more of these abilities can interfere with a person's capacity to communicate. Impaired communication can influence all aspects of life, creating many problems for an individual. Behavioral effects resulting from the speech disorder can be found in both children and adults. Children with speech disorders can experience difficulties in learning and find it hard to establish relationships with others. Speech disorders in adults can adversely affect social interactions and often create emotional problems, which may interfere with a person's ability to earn a living. Disorders such as those described above can interfere with a person's relationships, independence, well-being, and ability to learn. People who have trouble communicating thoughts and ideas may have trouble relating to others,

Emotions in cognitive therapy

An example of eliciting a state-dependent memory during a therapy session concerns a patient diagnosed with avoidant personality disorder. Guided discovery is often used with these patients, because they frequently report that their minds go blank when painful feelings are aroused. In this instance, the therapist had been doing an imagery exercise with the patient, asking her to imagine herself going out to eat with a friend. Suddenly, the patient stated that she didn't want to go on with the exercise. When the therapist asked her what she was feeling, she replied, Depressed and real scared. The therapist continued, What do you think will happen if you keep feeling this way The patient said that she would freak out, go crazy, and that the therapist would see her as a basket case. The therapist reassured her that the feelings she was trying to avoid would lead to some useful information if she could stay with them just a little longer. Returning to the image of sharing a restaurant...

Alteration of Prefrontal Response to Dopamine in a Developmental Animal Model of Schizophrenia

A neonatal VH lesion in rodents and primates has been proposed as a developmental animal model of schizophrenia. These animals exhibit abnormal behaviors such as exaggerated locomotion in response to DA agonists (Lipska et al., 1993), NMDA antagonists (Al-Amin et al., 2001), or stress (Lipska et al., 1995), but only after puberty. This time course is similar to what is observed in the onset of symptoms in schizophrenia (Weinberger, 1995). In addition, cognitive deficits in working memory (Lipska et al., 2002), latent inhibition (Grecksch et al., 1999), or sensory gating (Lipska et al., 1996), and reduction of social interactions (Sams Dodd et al., 1997) are commonly observed in animals with neonatal VH lesion as well as in schizophrenia patients. Thus, this animal model stresses the link between early-life limbic compromise (Lipska and Weinberger, 2000) and delayed symptom onset in schizophrenia. Because the VH has a massive projection to the PFC (Jay et al., 1989 Jay and Witter,...

Behavioral and Social Emotional Problems

Conduct disorders are more common in children born preterm, but so are traits such as shyness, unassertiveness, withdrawn behavior, and social skill deficits (Bhutta et al., 2002 Grunau et al., 2004 Sommerfelt et al., 1996). In a meta-analysis of 16 case-control studies of children 5 years old or older who had been born preterm, 13 (81 percent) of the studies found that children born preterm had more behavioral problems than controls born full term (Bhutta et al., 2002). Two-thirds of the studies found a higher prevalence of ADHD, 69 percent found a higher prevalence of externalizing symptoms (e.g., delinquency), and 75 percent found a significantly higher prevalence of internalizing symptoms (e.g., anxiety, depression, and phobias). Many of these children withdraw from challenging tasks. Many preterm children with nonverbal learning disabilities have social skill deficits that seriously influence their social interactions and peer relationships (Aylward, 2002 Fletcher et al., 1992)....

Behavior Therapies

One example of a cognitive-behavioral treatment, which was developed by Philip Kendall and Lauren Braswell, is intended to teach the child to learn five steps that can be applied to academic tasks as well as social interactions. The five problem-solving steps that children are to repeat to themselves each time they encounter a new situation are the following Ask What am I supposed to do ask What are my choices concentrate and focus in make a choice and ask How did I do (If I did well, I can congratulate myself if I did poorly, I should try to go more slowly next time.) In each therapy session, the child is given twenty plastic chips at the beginning of the session. The child loses a chip each time he or she does not use one of the steps, goes too fast, or gives an incorrect answer. At the end of the session, the child can use the chips to purchase a small prize chips can also be stored in a bank in order to purchase an even larger prize in the following sessions. This treatment...

Assessment

In common with many other methods and theories in psychology, the approach is imbued with assumptions that people do make sense of their social world, do carry around with them (albeit probably at an unconscious level) a set of implicit social rules, do behave purposively, etc. But people may be inconsistent or behave in an unthinking manner in social situations, sometimes even following inappropriate scripts. Langer (1978) suggests that for a lot of the time in social interactions we do not behave in a thoughtful fashion, but rather act 'mindlessly'. Thus the findings may be so completely idiosyncratic as to be not worth discussing. As has been mentioned above, it could be that observation may actually produce a structured and crystallized 'reality', rather than a reflection of the messy nature of things as they really are.

QoL and Stoma

Progress in neoadjuvant therapy and the use of mechanical staplers have led to a dramatic reduction in the number of abdominoperineal extirpations (APE) during the last 20 years. So far, whenever feasible, the golden standard in the treatment of rectal cancer is a sphincter-saving procedure such as AR. In many of the works in the literature, a definitive stoma is generally associated with a reduced QoL 37-40 , with an increase in social isolation 41 and deterioration of body image.

Coping

Avoidance, concealment, escape, and the use of subtle safety behaviours (such as turning one's body so as to hide one's perceived worse side in social situations) are all common shame and social anxiety-related coping strategies. Such coping mechanisms have frequently been linked to poor adjustment (Rapp et al., 2001 Hill & Kennedy, 2002 Kent, 2002). However, this picture is not clear cut, in so much as people may recognise the limitations of using such strategies and feel ambivalent in their use of them, but nevertheless feel recourse to do so as other strategies (such as being socially proactive) may be more demanding of personal resources (Thompson, 1998). Nevertheless, coping factors are clearly important in accounting for differences in adjustment and warrant further study. Importantly, there is growing evidence that interventions aimed at helping people to develop coping skills to manage the reactions of other can be useful (Robinson et al., 1996).

Sequential Services

A popular misconception on the part of mental health providers has contributed to this method of treatment. Many providers believe that people with mental illness engage in substance use solely as an attempt to self-medicate. In other words, drugs or alcohol are used to provide relief from their psychiatric symptoms. If this is the case, it follows that adequate treatment of the psychiatric disorder would eliminate the need for the use of substances. This theory has not proven to be helpful for many people with dual disorders. Studies of motivation for using substances indicate that people with psychiatric disorders use substances for a variety of reasons other than relief from symptoms such as to feel relaxed, to improve social interactions, to be accepted by their peer group, and to alleviate boredom (Bellack & DiClemente, 1999 Nishith, Mueser, Srsic, & Beck, 1997 Spencer, Castle, & Michie, 2002). Not surprisingly, it appears that people with mental illness use substances for some...

Diagnosis

The personality disorders have been the subject of criticism by researchers because of the difficulty in diagnosing them reliably. Individuals with a personality disorder often display symptoms of other personality disorders. For example, researchers have debated about the distinction between schizoid personality disorder and avoidant personality disorder, as both disorders are characterized by an extreme in social isolation. Individuals with personality disorders are more likely than the general population to suffer from other psychological disorders, such as depression, bulimia, or substance abuse. This overlap of symptoms may lead to difficulty with diagnostic reliability. The personality disorders occur so frequently with other types of psychological disorders that it is challenging to sort through symptoms to determine what is evidence of each disorder. It is difficult to estimate the prevalence of personality disorders in the United States, as individuals with these disorders do...

Anorexia Nervosa

Anorexia nervosa is characterized by obsessive-compulsive features (counting calories, hoarding food), diminished sexual activity, rigid personality, strong need to control ones environment, social phobia (fear of eating in public). Anorexia nervosa commonly coexists with major depressive disorder. C. Social Phobia. Social phobia may manifest as fear of eating in public, but it is distinguished from anorexia by the presence of additional fears (eg, speaking in public).

Inorganic Mercury

Chronic low-level exposure to inorganic mercury may lead to a glomerular disease which has an immunologic basis. This type of nephropathy is accompanied by proteinuria and may involve glomerular damage due to immune complexes. Also, chronic exposure can give rise to salivation and gingivitis and erethism which involves psychological effects such as nervousness and shyness. Mercurous salts are less toxic than mercuric salts, probably as a result of lower solubility. Exposure of human subjects to mercurous chloride (calomel) may result in hypersensitivity reactions.

Ethics

Studied, and unless we have obtained informed consent, we should really only observe in situations where observation by strangers is normally expected. Thus we should restrict ourselves to settings such as public social situations, but even then we need to be aware that variables such as local cultural values need to be taken into account.

Suicidal gesture

Research supports Durkheim's ideas that suicide is associated with social isolation and recent loss. Many other variables, both demographic and psychological, have also been found to be related to suicide. Numerous studies have shown that the following demographic variables are related to suicide sex, age, marital status, employment status, urban versus rural dwelling, and race. Paradoxically, more females than males attempt suicide, but more males than females commit suicide. The ratio in both cases is about three to one. The difference between the sex ratios for attempted and completed suicide is generally explained by the fact that males tend to employ more lethal and less reversible methods than do females (firearms and hanging, for example, are more lethal and less reversible than ingestion of drugs).

About the book

The psychiatric comorbidity in dermatological disorders is often one of the most important indices of the overall disability associated with these conditions and it is well established that significant psychiatric and psychosocial comorbidity is present in at least 30 of dermatology patients. Chapter 3 looks at the psychological morbidity associated with skin disease. Dr Madhulika Gupta, a Psychiatrist from the University of Ontario with expertise in the psychosocial aspects of skin disorder, highlights the relationship between dermatological disease and psychiatric comorbidity. This chapter focuses on the results of research on the relationship between skin disease and such psychosocial constructs as depression, suicidal ideation, social anxiety and body dysmorphic disorder.

Conclusion

The interface between psychiatry and dermatology is multidimensional and begins in early development. The skin is a vital organ of communication and the earliest social interactions between the infant and its caregivers occur via the body, especially through touch. A disruption in tactile nurturance, for example, as a result of a skin disorder during infancy or due to childhood abuse and or neglect can be associated with serious psychiatric morbidity in later life including major depressive disorder, body image pathologies, a tendency to self-injure and dissociative states when there is significant psychological trauma present in association with the neglect. The importance of the skin in social communication is further exemplified during adolescence when the development of a cosmetically disfiguring skin disorder such as acne can be associated with depression, suicidal ideation and body image disorders including eating disorders. The role of the skin as an organ of communication...

Defense mechanisms

Examples A male with aggressive impulses becomes an all-state linebacker on the school football team. Were these same aggressive impulses acted out in common social situations, it would be considered inappropriate and possibly abusive to those on the receiving end. But given that hitting is inherent in a contact sport, the student can legitimately channel his aggressive tendencies toward a socially acceptable performance. Not only does this give the student a release for the unconscious aggression, but it may also provide social approval for reinforcing the aggressive behavior in that context.

Hawthorne Studies

A second example involves a case study that was part of a larger group known as the Hawthorne studies, conducted at the Western Electric Company, near Chicago, in the 1920's. One particular study, called the Bank Wiring Observation Room Study, was initiated to examine the informal social interactions that occur within a small group of employees in an industrial plant. A group of fourteen men was moved to a self-contained work room that simulated the plant environment a psychologist was assigned to observe the behavior of the group. No manipulation of any variables occurred there was only passive observation of the employees' behavior. As might be expected, the presence of the observer discouraged many of the men from behaving as they normally would if someone were not present. The men were suspicious that the psychologist would inform their supervisor of any behaviors that were not allowed on the job. After a month passed, however, the men became accustomed to the observer and started...

Cluster C

Cluster C disorders include avoidant personality disorder, dependent personality disorder, and obsessive-compulsive personality disorder. The behavior of people with a cluster C personality disorder is described as anxious or fearful. People with avoidant personality disorder display a pervasive pattern of social discomfort and a fear of being disliked by others. Because of these feelings, a person with this disorder avoids social interactions with others. People with avoidant personality disorder are extremely shy and have great difficulty establishing interpersonal relationships. They want to be liked by others, but their social discomfort and insecurities prevent them from engaging in interpersonal relationships.

Harlows Experiments

Perhaps the most famous psychological experiments on animals were those by Harry Harlow in the 1950's. Harlow was studying rhesus monkeys and breeding them in his own laboratory. Initially, he would separate infant monkeys from their mothers. Later, he discovered that, in spite of receiving adequate medical care and nutrition, these infants exhibited severe behavioral symptoms They would sit in a corner and rock, mutilate themselves, and scream in fright at the approach of an experimenter, a mechanical toy, or another monkey. As adolescents, they were antisocial. As adults, they were psychologically ill-equipped to deal with social interactions Male monkeys were sexually aggressive, and females appeared to have no emotional attachment to their own babies. Harlow decided to study this phenomenon (labeled maternal deprivation syndrome ) because he thought it might help to explain the stunted growth, low life expectancy, and behavioral symptoms of institutionalized infants which had been...

Human Imprinting

Lationships over many years when many behaviors are involved. There is some evidence, however, which indicates that failure to imprint may be associated with such things as learning disabilities, child-parent conflicts, and abnormal adolescent behavior. Nevertheless, other cases of imprinting failure seem to have no effect, as can be seen in tens of thousands of adopted children. The success or failure of maternal imprinting in humans is a subject of considerable importance in terms of how maternal imprinting affects human behavior and social interactions in later life.

Maternal Imprinting

The maternal imprint is the means by which a newborn identifies its mother and the mother identifies its young. In birds, the newborn chick follows the first moving object that it sees, an object that should be its mother. The critical imprinting period is within a few hours after hatching. The chick visually will lock on its moving mother and follow it wherever it goes until the chick reaches adulthood. The act of imprinting not only allows for the identification of one's parents but also serves as a trigger for all subsequent social interactions with members of one's own species. As has been established in numerous experiments, a newborn gosling that first sees a female duck will imprint on the duck and follow it endlessly. Upon reaching adulthood, the grown goose, which has been raised in the social environment of ducks, will attempt to behave as a duck, even to the point of mating. Newborn goslings, ducklings, and chicks can easily imprint on humans.

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