<p>The purpose of this essay is to perform a comparative study of first a pedagogical/rhetorical and then a therapeutic method, to help students overcome their speech anxiety. My choice stayed at focusing on the academic world and the benefits offered to mainly students. I have chosen two institutions with long experience of work with speech anxiety: Instutionen of Swedish, rhetoric and journalism at Södertörns Högskola and Student Health at Uppsala University. I want to find the advantages and disadvantages of the two universities and in no way define what is more favorable.</p>

<p><strong>Bakgrund: </strong>Social fobi är en sjukdom där personen har en irrationell rädsla för situationer där personen kan bli iakttagen och bedömd av andra. Rädslan kan vara så stark att det kan vara outhärdligt att vistas i samma rum som andra. <strong>Syfte: </strong>Syftet med studien var att belysa hur det är att leva med social fobi. <strong>Metod: </strong>Studien är en allmän litteraturstudie som baserades på femton kvantitativa artiklar och en självbiografisk bok. Artiklarna var publicerade efter år 1995. Enheter som svarade på syftet identifierades och sammanställdes till resultatet. <strong>Resultat: </strong>Personer med social fobi har en lägre livskvalitet. Personer med social fobi räds sociala interaktioner och anses utstråla mindre värme än andra personer. Under samtal upplever personer med social fobi ångest, de nedvärderar sitt eget uppförande då de är fokuserade på sitt eget uppträdande, vilket leder till en negativ självbild. Kognitivbeteendeterapi har visat sig vara en effektiv behandlingsmetod för att behandla social fobi. <strong>Slutsats: </strong>Livskvaliteten hos personer med social fobi är reducerad och självkänslan är ofta låg. Ångest uppstår vid social interaktion. KBT ger goda behandlingsresultat för personer med social fobi. Det är viktigt att sjukvårdspersonalen bemöter personen med social fobi på ett positivt sätt för att främja relationen.</p> / <p><strong>Background: </strong>When suffering from social phobia people experience an irrational fear of being observed and judged by others. The fear can be so powerful that being in the same room with other people is unbearable. <strong>Aim: </strong>The aim of the study was to illustrate what it is like to live with social phobia. <strong>Methods: </strong>The study is a general literature study based on fifteen quantitative articles and one autobiography. Articles were published after the year of 1995. Unites responding to the aim were identified and assembled into a result. <strong>Results: </strong>Person with social phobia has a reduced quality of life. They fear social interaction and are perceived by others to emit less warmth than other people. During conversation persons with social phobia experiences anxiety, they underestimate their own performance when being excessively focused on their own behaviour. This leads to a negative self image. Cognitive behavioural therapy has shown to be an effective treatment of social phobia. <strong>Conclusion: </strong>The quality of life is reduced in social phobia and the self-esteem is often low. Social interactions result in anxiety. Cognitive behavioural therapy yields effective results for social phobia. Positive treatment from health care staff is of high relevance to promote the relationship.</p>

<p>Social phobia is a disabling, lifelong disorder characterised by fear in social settings.</p><p>The aim of the present study was to gain more knowledge about diagnostic, neurobiologic and epidemiologic aspects of social phobia.</p><p>Thirty-two individuals were assessed by the Structured Clinical Interview for DSM-IV Axis I and II psychiatric disorders, the Karolinska Scales of Personality and the Temperament and Character Inventory. Social phobia was accompanied by concurrent axis I disorders in about 28% of individuals, lifetime axis I disorders in 54%, personality disorders in 60%, and avoidant personality disorder (APD) in 47%. This suggests that there is a high comorbidity between social phobia and APD according to the DSM-IV criteria. The personality profiles associated with social phobia were dominated by anxiety-related traits that were primarily related to social phobia itself and not to the presence of concurrent personality disorders.</p><p>Eighteen subjects with social phobia and eighteen controls were investigated with positron emission tomography and the radiolabeled serotonin precursor, [3 -11C]–5-HTP (5-HTP). Individuals with social phobia demonstrated proportionally lower regional relative whole brain accumulation of 5-HTP in areas of the frontal and temporal cortices as well as the striatum, but higher accumulation in the cerebellum. This suggests that there are imbalances in presynaptic serotonin function in individuals with social phobia, although this could only be confirmed in men, and not in women.</p><p>By means of a postal survey, distributed to 2000 randomly selected individuals, social phobia in Sweden was found to be common, with a point prevalence of 15.6%.</p>

<p>Social phobia is a disabling anxiety disorder characterized by an excessive fear of negative evaluation in social situations. The present thesis explored the epidemiology and neurobiology of the disorder. By means of a mailed questionnaire, the point prevalence of social phobia in the Swedish general population was estimated at 15.6%. However, prevalence rates varied between 1.9 and 20.4% across the different levels of distress and impairment used to define cases. Thus, although social anxiety is widespread within the community, the precise diagnostic boundaries for social phobia are difficult to determine. Social phobia was associated with female gender, low educational attainment, psychoactive medication use, and lack of social support. A cluster analysis revealed that subtypes of social phobia mainly differed dimensionally on a mild-moderate-severe continuum, with number of cases declining with increasing severity. Public speaking was the most common social fear in all groups of social phobics and in the population at large.</p><p>In the neurobiological studies, positron emission tomography was used to examine brain serotonin metabolism and changes in the regional cerebral blood flow (rCBF) response to public speaking stress following treatment with a selective serotonin reuptake inhibitor (SSRI) or cognitive-behavioral group therapy. Social phobics exhibited lowered serotonin turnover, relative to non-phobics, mainly in the medial temporal cortex including the bilateral rhinal and periamygdaloid regions. Symptom improvement with cognitive-behavioral- as well as SSRI-treatment was accompanied by a reduced rCBF-response to public speaking in the amygdala, hippocampus and adjacent temporal cortex, i.e. regions that serve important functions in anxiety. Thorough suppression of rCBF in limbic brain regions was associated with favorable long-term treatment outcome. These results provide neuroimaging evidence for a presynaptic serotonergic dysfunction in social phobia and for a common neural mechanism whereby psychological and pharmacological anti-anxiety treatments act.</p>

<p>The present thesis investigated the relationship between rapid facial muscle reactions and emotionally relevant stimuli. In Study I, it was demonstrated that angry faces elicit increased <i>Corrugator supercilii</i> activity, whereas happy faces elicit increased <i>Zygomaticus major</i> activity, as early as within the first second after stimulus onset. In Study II, during the first second of exposure, pictures of snakes elicited more corrugator activity than pictures of flowers. However, this effect was apparent only for female participants. Study III showed that participants high as opposed to low in fear of snakes respond with increased corrugator activity, as well as increased autonomic activity, when exposed to pictures of snakes. In Study IV, participants high as opposed to low in speech anxiety responded with a larger difference in corrugator responding between angry and happy faces, and also with a larger difference in zygomatic responding between happy and angry faces, indicating that people high in speech anxiety have an exaggerated facial responsiveness to social stimuli. In summary, the present results show that the facial EMG technique is sensitive to detecting rapid emotional reactions to different emotionally relevant stimuli (human faces and snakes). Additionally, they demonstrate the existence of differences in rapid facial reactions among groups for which the emotional relevance of the stimuli can be considered to differ.</p>

Social phobia is a disabling anxiety disorder characterized by an excessive fear of negative evaluation in social situations. The present thesis explored the epidemiology and neurobiology of the disorder. By means of a mailed questionnaire, the point prevalence of social phobia in the Swedish general population was estimated at 15.6%. However, prevalence rates varied between 1.9 and 20.4% across the different levels of distress and impairment used to define cases. Thus, although social anxiety is widespread within the community, the precise diagnostic boundaries for social phobia are difficult to determine. Social phobia was associated with female gender, low educational attainment, psychoactive medication use, and lack of social support. A cluster analysis revealed that subtypes of social phobia mainly differed dimensionally on a mild-moderate-severe continuum, with number of cases declining with increasing severity. Public speaking was the most common social fear in all groups of social phobics and in the population at large. In the neurobiological studies, positron emission tomography was used to examine brain serotonin metabolism and changes in the regional cerebral blood flow (rCBF) response to public speaking stress following treatment with a selective serotonin reuptake inhibitor (SSRI) or cognitive-behavioral group therapy. Social phobics exhibited lowered serotonin turnover, relative to non-phobics, mainly in the medial temporal cortex including the bilateral rhinal and periamygdaloid regions. Symptom improvement with cognitive-behavioral- as well as SSRI-treatment was accompanied by a reduced rCBF-response to public speaking in the amygdala, hippocampus and adjacent temporal cortex, i.e. regions that serve important functions in anxiety. Thorough suppression of rCBF in limbic brain regions was associated with favorable long-term treatment outcome. These results provide neuroimaging evidence for a presynaptic serotonergic dysfunction in social phobia and for a common neural mechanism whereby psychological and pharmacological anti-anxiety treatments act.

Social phobia is a disabling, lifelong disorder characterised by fear in social settings. The aim of the present study was to gain more knowledge about diagnostic, neurobiologic and epidemiologic aspects of social phobia. Thirty-two individuals were assessed by the Structured Clinical Interview for DSM-IV Axis I and II psychiatric disorders, the Karolinska Scales of Personality and the Temperament and Character Inventory. Social phobia was accompanied by concurrent axis I disorders in about 28% of individuals, lifetime axis I disorders in 54%, personality disorders in 60%, and avoidant personality disorder (APD) in 47%. This suggests that there is a high comorbidity between social phobia and APD according to the DSM-IV criteria. The personality profiles associated with social phobia were dominated by anxiety-related traits that were primarily related to social phobia itself and not to the presence of concurrent personality disorders. Eighteen subjects with social phobia and eighteen controls were investigated with positron emission tomography and the radiolabeled serotonin precursor, [3 -11C]–5-HTP (5-HTP). Individuals with social phobia demonstrated proportionally lower regional relative whole brain accumulation of 5-HTP in areas of the frontal and temporal cortices as well as the striatum, but higher accumulation in the cerebellum. This suggests that there are imbalances in presynaptic serotonin function in individuals with social phobia, although this could only be confirmed in men, and not in women. By means of a postal survey, distributed to 2000 randomly selected individuals, social phobia in Sweden was found to be common, with a point prevalence of 15.6%.

The present thesis investigated the relationship between rapid facial muscle reactions and emotionally relevant stimuli. In Study I, it was demonstrated that angry faces elicit increased Corrugator supercilii activity, whereas happy faces elicit increased Zygomaticus major activity, as early as within the first second after stimulus onset. In Study II, during the first second of exposure, pictures of snakes elicited more corrugator activity than pictures of flowers. However, this effect was apparent only for female participants. Study III showed that participants high as opposed to low in fear of snakes respond with increased corrugator activity, as well as increased autonomic activity, when exposed to pictures of snakes. In Study IV, participants high as opposed to low in speech anxiety responded with a larger difference in corrugator responding between angry and happy faces, and also with a larger difference in zygomatic responding between happy and angry faces, indicating that people high in speech anxiety have an exaggerated facial responsiveness to social stimuli. In summary, the present results show that the facial EMG technique is sensitive to detecting rapid emotional reactions to different emotionally relevant stimuli (human faces and snakes). Additionally, they demonstrate the existence of differences in rapid facial reactions among groups for which the emotional relevance of the stimuli can be considered to differ.

The present dissertation consists of three empirical studies on children and adolescents presenting with various specific phobias in Stockholm, Sweden and in Virginia, USA. The overall aim was to contribute to our understanding of childhood fears, anxiety and phobias and to evaluate the efficacy and portability of a one-session treatment of specific phobias in youth. Study I tested the dimensionality of the Parental Bonding Instrument, across three generations and for two countries, and examined if parenting behaviors of indifference and overprotection were associated with more anxiety problems in children. The results showed that the four-factor representation of parental behavior provided an adequate fit for the instrument across informants. Perceived overprotection was associated with significantly more anxiety symptoms and comorbid diagnosis in children. Study II explored parent-child agreement on a diagnostic screening instrument for youths. The results indicated that children scoring high on motivation at treatment entry had generally stronger parent-child agreement on co-occurring diagnoses and severity ratings. Parents reported overall more diagnoses for their children, and parents who themselves qualified for a diagnosis seemed more tuned in to their children’s problematic behavior. Study III compared a one-session treatment with an education-supportive treatment condition, and a wait-list control condition for children presenting with various types of specific phobias. The results showed that both treatment conditions were superior to the wait-list control condition and that one-session exposure treatment was superior to education-supportive treatment on several measures. Treatment effects were maintained at a 6-month follow-up. Overall, the above findings suggest that the one-session treatment is portable and effective in treating a variety of specific phobias in children and adolescents.

Social phobia is a common disorder associated with significant psychosocial impairment, representing a substantial public health problem largely determined by the high prevalence, and the lifelong chronicity. Social phobia starts in early childhood or adolescence and is often comorbid with depression, other anxiety disorders, alcohol and substance abuse or eating disorders. This cascade of comorbidity, usually secondary to social phobia, increases the disability associated with the condition. The possibility that social phobia may be a trigger for later developing comorbid disorders directs attention to the need for early effective treatment as a preventive measure. The most recent drug class to be investigated for the psychopharmacological treatment of social phobia is the SSRI group for which there is growing support. The other drug classes that have been evaluated are monoamine oxidase inhibitors (MAOIs), benzodiazepines, and beta-blockers. The SSRIs represent a new and attractive therapeutic choice for patients with generalized social phobia. Recently the first, large scale, placebo-controlled study to assess the efficacy of drug treatment in generalized social phobia has been completed with paroxetine. Paroxetine was more effective in reducing the symptoms than placebo and was well tolerated. Many now regard SSRIs as the drugs of choice in social phobia because of their effectiveness and because they avoid the problems of treatment with benzodiazepines or classical MAOIs.