This dissertation examines the introduction of social phobia into France. My analysis is concerned with how this diagnosis, which is inconsistent with the psychoanalytic model that dominates French psychiatry, is increasingly being accepted by French physicians and patients. I argue that the diagnosis social phobia offers physicians and patients a justification for life difficulties that was not provided by existing diagnoses such as phobic neurosis, obsessional neurosis or 'normal' shyness. / In 2003-4 I carried out one year of fieldwork in North America and France. During this time I conducted participant observation and interviews with clinicians and members of a social phobia support group. Throughout this thesis, it is my objective to understand the disorder from three perspectives: historical, ethnographic, and sociocultural. / First, I examine French psychiatrists' claims that social phobia has existed in French psychiatric literature since the nineteenth century. I investigate the efforts of these French psychiatrists to prove that the diagnostic category has a legitimate place in French medicine. Second, I look at how a small group of Parisian psychiatrists who practice cognitive and behavioural therapy are fighting for greater awareness and acceptance of social phobia. Promoting social phobia is a means of spreading awareness of their therapeutic model. Their aim is to unseat psychoanalysis from its dominant position in French psychiatry. Many individuals prefer cognitive and behavioural therapists' explanations of social phobia symptoms to those of psychoanalysts because they are less stigmatizing and their predicted outcomes more optimistic. But many French clinicians reject the diagnosis social phobia and prefer psychoanalytic explanations for patients' symptoms. Some see it as a 'fashionable' disorder overly promoted by the pharmaceutical industry. Third, I investigate how social phobia is related to cultural behavioural ideals and societal expectations. I look at how these factors lead more people to become concerned about the symptoms of social phobia than in the past. / In the end, I explain that French physicians and patients are choosing social phobia from among other possible labels for this set of symptoms. The way that they describe this diagnosis, however, blends multiple therapeutic models and they create an explanation of the disorder which most thoroughly and positively describes patients' experiences.

As a corollary to The Declaration of Commitment, adopted by the United Nations General Assembly Special Session on HIV/AIDS in June 2001, the international community recently adopted a World AIDS Campaign that seeks to eradicate HIV/AIDS related stigma and discrimination. To this end, the campaign incorporates several educational strategies, such as a poster campaign, that advocate the just and equal treatment of people living with HIV/AIDS. In an effort to develop an understanding of these educational efforts, this study deconstructs the 2002-2003 World AIDS Campaign posters. While the overall results suggest that the campaign has been successful in redefining the image of HIV/AIDS, it was also found that the posters may actually serve to reinforce stigma and discrimination. Using a textual analysis, this study uncovers the underlying ideological and cultural assumptions that exist within campaign posters and indicates how they operate in relation to the overall objective of the campaign.

Social phobia is maintained in part by judgmental biases concerning the probability and cost of negative social events. One hypothesized mechanism of action of cognitive behavioral therapy (CBT) for anxiety disorders is its reduction in the exaggerated probabilities and costs associated with feared outcomes, termed the “cognitive mediation hypothesis” (Foa & Kozak, 1986). A number of studies have examined the cognitive mediation hypothesis; some investigations find cost bias to be more important to treatment outcome, whereas others find probability bias to be more important. However, methodological limitations of several of these studies leave open the possibility that changes in judgmental biases are simply correlates or consequences of social anxiety reduction. Attentional processes, which mark the first discrimination of incoming information, may serve as precursors to cognitive processes like probability and cost estimates. Though intuitively linked, whether social phobics’ pattern of attending to external threat cues is correlated with their appraisals of the cost and probability of negative events has yet to be examined empirically. The current project examines cost and probability biases and their relation to attention bias and treatment outcome in a randomized controlled trial of CBT for social phobia. It was found that, contrary to hypotheses, greater attentional bias for threat in either direction (vigilance or avoidance) did not predict higher cost and probability estimates. However, a significant relation was observed between attentional vigilance and outcome probability estimates, such that greater vigilance for threat predicted greater estimates of the likelihood that negative social events will occur. As hypothesized, early changes in cost and probability biases predicted later changes in social anxiety symptoms (and not vice versa). Changes in probability estimates were a stronger predictor of treatment outcome than changes in cost estimates. Broadly, findings provide support for the cognitive mediation hypothesis of social phobia and point to both outcome cost and outcome probability as potential treatment mechanisms. Findings are discussed in the context of extant theories of social phobia, and directions for future research are proposed.

Bakgrund: Uppskattningsvis lider 10 % av världens befolkning utav någon form av stickrädsla. Vaccinationer och blodprovstagning är vanligt förekommande i dagens moderna sjukvård och stickrädda patienter kan undvika sjukvården och på så vis försämra sin hälsa. Sjuksköterskan kan lindra lidandet som rädslan medför hos den enskilda individen genom beprövad kunskap om stickrädsla. Syfte: Belysa omvårdnadsmetoder sjuksköterskan kan använda sig av för att lindra patientens lidande vid stickrädsla. Metod: Litteraturstudie baserad på kvalitativa artiklar med kvalitativ ansats. Resultat: Resultatet redovisas i enligt med de fyra teman som framkom i analysen. Miljö som visat sig spela stor roll för den stickrädda patienten och om sjuksköterskan kan skapa en mindre klinisk miljö samt dölja nålar och dylikt så hjälper det patienten att klara sin rädsla bättre. Tid som ges till patienter som känner rädsla och obehag inför vaccinationer, blodprovstagning eller dylikt, har visat sig lugna stickrädslan. Likaså sjuksköterskans förmåga att göra proceduren kort om så önskas, uppskattas utav patienten. Distraktion har visat sig som en mycket bra metod att omhänderta stickrädda patienter och kan ske i form utav samtal, andningstekniker, ordspel eller pussel. Bli tagen på allvar är ofta avgörande om patienten upplever vården som god och en förutsättning för att en stickrädd patient vid ett senare tillfälle skall förlita sig på sjukvården och söka sig dit om behov finns. Slutsats: Det finns vetenskapligt bevisade omvårdnadsmetoder sjuksköterskan kan använda sig utav för att lindra lidandet hos patienter med stickrädsla. Klinisk betydelse: Ett stort problem hos vårdpersonal är kunskapsbrist om att stickrädsla förekommer hos vuxna. Därför hoppas författarna att genom att belysa ämnet inom sjukvården, skall även vuxna få likvärdigt omhändertagande för sin stickrädsla som barn har tillgång till. / Background: Approximately 10% of the world population suffers from some kind of needle fear. Vaccinations and blood sampling is common in today's modern health care and patients with needle fear may therefore avoid medical care which in turn could have a negative impact on their health. The nurse can alleviate suffering caused on the individual through proven knowledge of needle fear. Aim: To illustrate different nursing practices that can be used to relieve patients suffering from needle fear. Method: Literature review. Result: The results are reported under four themes. The Environment is shown to play a major role for the needle fear patient. The nurse can create a less clinical setting and hide needles, which have shown to help the patient cope with their fears better. The Time given to patients who feel fear and discomfort with vaccinations, blood tests or similar, have been shown to calm the needle fear. Likewise, the nurse's ability to make the process short, if desired, is appreciated by the patient. Distraction has been proven as a very good method to take care of needle fear patients and good examples are conversations, breathing techniques, word games or puzzles. Being taken seriously is often important to give a needle fear patient a good care experience and has also shown to be crucial as to whether the needle patient at a later date would rely on medical services and seek help or not. Conclusion: There are nursing care methods, which have been scientifically proven, that nurse can use to alleviate the suffering from patients with needle fear. Clinical significance: A major problem within the health profession is a lack of knowledge that needle fear occurs among adults. Therefore, the authors hope that by highlighting the topic in health care, adults should receive the same considerate needle fear care as children have access to today.

"It is thought that phobias are caused by a fear of the unknown and can be overcome by self-help learning resulting in better understanding. Observation and scientific investigation have been used to create a body of artwork for the purpose of helping to desensitize people who suffer from arachnophobia. Field trip collections, photography, printmaking and installations have been used to capture, explore and create visual artworks that have been designed to highlight fact-based features of spiders and their webs." / Master of Arts (Visual Arts)

"It is thought that phobias are caused by a fear of the unknown and can be overcome by self-help learning resulting in better understanding. Observation and scientific investigation have been used to create a body of artwork for the purpose of helping to desensitize people who suffer from arachnophobia. Field trip collections, photography, printmaking and installations have been used to capture, explore and create visual artworks that have been designed to highlight fact-based features of spiders and their webs." / Master of Arts (Visual Arts)

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