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.

Parental psychopathology and unfavorable family environment are established risk factors for onset of offspring social phobia (SP), but their associations with the further course, e.g., persistence of the disorder, remain understudied. A community cohort of 1395 adolescents and their parents was followed-up over almost 10 years using the DIA-X/M-CIDI. Parental diagnostic interviews were supplemented by family history data. Parental rearing was retrospectively assessed by the Questionnaire of Recalled Parental Rearing Behavior in offspring, and family functioning by the Family Assessment Device in parents. Persistence measures (proportion of years affected since onset) were derived from diagnostic interviews, using age of onset, age of recency, and course information. Lack of emotional warmth and dysfunctional family functioning characteristics were associated with higher SP persistence, particularly in interaction with parental psychopathology. Predictors for SP persistence differ from those predicting SP onset. Unfavorable family environment alone and in interaction with parental disorders predict higher SP persistence.

Objectives: For characterizing the association between parenting and offspring social phobia (SP), contrasting maternal vs. paternal contributions, putative predictors of unfavorable parenting behaviors and its specificity for SP are warranted to delineate targeted prevention and intervention strategies. Methods: A population-based sample of 1053 adolescents was followed-up using the M-CIDI. Parenting was assessed via questionnaire in offspring passing the high risk period for SP-onset. Natal complications and childhood serious health problems as assessed by maternal reports were hypothesized to relate to unfavorable parenting. Results: The pattern of maternal overprotection, paternal rejection and lower emotional warmth was associated with SP, but not with other offspring anxiety disorders. Natal complications were related to overprotection and lower emotional warmth; trend-level associations emerged for serious health problems and unfavorable parenting. Conclusions: Paternal behavior appears particularly relevant for SP. The pattern of maternal overprotection, paternal rejection and lower emotional warmth was observed in SP only, suggesting that its detailed assessment provides a promising opportunity for targeted prevention and intervention in SP.

Bakgrund: 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. Syfte: Syftet med studien var att belysa hur det är att leva med social fobi. Metod: 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. Resultat: 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. Slutsats: 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. / Background: 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. Aim: The aim of the study was to illustrate what it is like to live with social phobia. Methods: 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. Results: 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. Conclusion: 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.

published_or_final_version / Clinical Psychology / Master / Master of Social Sciences

[pt] O medo de voar é um problema comum nos dias de hoje. Também conhecido como aerofobia ou aviofobia, o medo pode ser definido como uma fobia específica marcada por um medo excessivo persistente pela experiência ou possibilidade de se viajar através do ar. Diversas pessoas sofrem com esse tipo de fobia, o que faz com que a procura por tratamentos seja alta. O tratamento mais efetivo é o tratamento via exposição in vivo. Porém, este tratamento geralmente é muito caro, já que exige o deslocamento até o aeroporto e a entrada no avião, sendo que o paciente pode acabar nem voando pelo medo. O presente trabalho propõe a criação de um simulador de voo 3D em realidade virtual, com ênfase no ângulo de visão do passageiro. Além deste simulador, uma aplicação de controle em dispositivo móvel foi desenvolvida para que o psiquiatra responsável possa controlar o estado da aplicação e a quantidade de estímulos passada ao paciente sem quebrar a imersão do mesmo no ambiente virtual. A eficiência da realidade virtual em transmitir a sensação de medo para o usuário da aplicação e a eficácia da aplicação móvel foram avaliadas junto a psiquiatras e através de um teste-piloto com um paciente do IPUB/UFRJ, além de uma apresentação a psiquiatras da PUC-Rio. / [en] The problem known as fear of flying is common nowadays. Also known by other names such as aviophobia or aerophobia, this kind of fear can be defined as a specific phobia noted by a persistent excessive fear of travelling or possibility of travel through the air. Many people suffer from this kind of phobia, creating a high demand for treatments in this area. The most effective way to treat someone is by in vivo exposition. However, this kind of treatment is usually expensive, since there is a need to go to an airport and to get aboard a plane. At the end, the patient may not even try to go through with the flight because of his/her excessive fear. The present work focuses on creating a 3D virtual reality flight simulator, from the passenger point of view. In addition to this simulator, there is also a mobile application that controls the current state of the main application and the stimulus that can be passed to the patient without interrupting the immersion on the main application. The effectiveness of the virtual reality application in transmitting the sense of fear and the effectiveness of the mobile application were evaluated with the help of psychiatrists from IPUB/UFRJ and a pilot test, plus a presentation to PUC-Rio psychiatrists.

Introdução: A fobia de dirigir é caracterizada como uma fobia específica do tipo situacional e causa sofrimento aqueles que a sentem, não só pelo impacto na rotina, dificultando a mobilidade, mas pelo sofrimento físico e cognitivo causados. Objetivos: Levantar o perfil sociodemográfico e clínico geral de quem procura ajuda para tratar a fobia de dirigir, analisar e comparar os perfis relacionados aos desfechos, com a finalidade de identificar as variáveis que poderiam predizer o abandono do tratamento. Métodos: O estudo foi realizado em duas fases: estudo transversal, descritivo com 1.640 pacientes que buscaram tratamento para Fobia Específica de Dirigir e estudo transversal, de uma coorte retrospectiva, com 1.541 pacientes, do sexo feminino, submetidos a tratamento psicoterápico para esta fobia e que alcançaram os desfechos Sucesso ou Insucesso. Todos os dados foram coletados dos formulários de pacientes atendidos em uma clínica especializada, entre 2008 e 2016, cadastrados no Research Eletronic Data Capture (REDCap), transportados para o Statisctical Package for Social Science for Windows (SPSS) e suas variáveis submetidas a análise descritiva e testes estatísticos do Qui-quadrado de Pearson, Exato de Fisher, Teste T ou Teste não Paramétrico. Resultados e Conclusão: Considerando a primeira fase, variáveis como sexo, estado civil, escolaridade, ocupação, aquisição da Carteira Nacional de Habilitação, dificuldades técnicas, intenções com o veículo, reações fisiológicas, posse de um veículo, treinamento após a aquisição da habilitação, histórico de acidentes, diagnósticos psiquiátricos e presença de outras fobias, assemelham-se aos achados da área. Outras variáveis levantadas diziam respeito, particularmente, à amostra estudada e não puderam ser comparadas. Na segunda fase, as variáveis que se mostraram estatisticamente significativas e que poderiam ser consideradas preditoras para interrupção do tratamento relacionavam-se ao estado civil separado, baixo nível de escolaridade, ocupações braçais, aquisição mais tardia da CNH, maior queixa de medo, idealização da direção como uma ação que traria liberdade e autonomia, mais do que facilidades na rotina, experiência de acidentes leves como motoristas e com vítimas como passageiros, mais diagnósticos psiquiátricos, mais fobias relacionadas à avaliação social, mais medo de nadar e maiores chances de abandono de tratamentos de longa duração / Introduction: The driving phobia is characterized as a specific phobia of the situational type and causes suffering for those who feel it, not only in the impact on their routine, hindering their mobility, but in the physical and cognitive suffering that it causes. Objectives: To find the socio-demographic and general clinical profile of those seeking help to address their phobia, analyzing and comparing outcome-related profiles in order to identify the variables that could predict treatment withdrawal. Methods: The study was carried out in two phases: a descriptive cross-sectional study of 1640 patients who sought treatment for Specific Driving Phobia and a cross-sectional study of a cohort retrospective of 1541 female patients undergoing psychotherapeutic treatment for this phobia that have reached Success or Failure. All data were collected from patients forms seeing at a specialized clinic, between 2008 and 2016, and enrolled in the Research Electronic Data Capture (REDCap), then transferred to the Statistical Package for Social Science for Windows (SPSS) and its variables submitted to descriptive analysis and statistical tests of Pearson\'s chi-square, Fisher\'s Exact, T-Test or Non-Parametric Test. Results and Conclusion: Considering the first phase, variables such as gender, marital status, education, occupation, validation of the national driver\'s license (CNH), technical difficulties, intentions with the vehicle, physiological reactions, vehicle´s ownership, accidents history, psychiatric diagnoses and presence of other phobias, resembles the findings in the area. Other variables raised are, in particular, the sample studied that could not be compared. In the second phase, variables that were statistically significant and could be considered as predictors of treatment withdrawal were related to a separated marital status, low level of education, manual labor, later CNH validation, fear complaint, idealization that the driving action would bring freedom and autonomy, more than the conveniences of routine, experience in small accidents while drivers and victims were passengers, more psychiatric diagnoses, more phobias related to social assessment, more fear of swimming and greater chances of abandoning long treatments

This thesis is focused on the development of games as a treatment for people who suffer from acrophobia, the fear of being in high-heighted situations. The purpose is to look over the immediate reactions of the players and study what effect first person gaming has on them in a short term. To achieve this, a series of three mini games is employed. Each game corresponds to a level. The first level is a tutorial which makes the player familiar with the game. In the second level, players are required to do a simple task. Finally, in the third level, the task is more pressuring and players need to be quicker to achieve the necessary goals. What is expected from this study is that the full control of the playable character makes the players feel immersed. Additionally, as the game progresses, the players will be more comfortable with heights. Last but not least, it is assumed that fast pace enhances immersion, a major factor of this study. As a result of our experiment, it is demonstrated that the control of the character from the player is a great tactic for immersion. Furthermore, it shows that the players start feeling better with heights even after one session. Finally, the study indicates that the fast pace enhances immersion, but over the time the increase of the pace has lower impact. These statements come as a result from the answers of the experiment‟s participants and will be shown in detail in this paper.

Studien har syftat till att undersöka samband mellan samsjuklig psykologisk problematik och katastroftänkande hos ungdomar utifrån ett transdiagnostiskt perspektiv. Katastroftänkandets roll för förändring av social ångest och depressiva symtom undersöktes utifrån en studie av internetbaserad KBT-behandling mot social fobi (N=18).  Resultatet indikerar att ungdomar med hög initial nivå av katastroftänkande har större reduktion av depressiva symtom än ungdomar med låg nivå av katastroftänkande. Detta talar för att hänsyn bör tas till grad av katastroftänkande vid utformning av behandling för personer med social fobi, särskilt vid samsjuklighet med depression. Kopplingen mellan katastroftänkande och samsjuklighet undersöktes utifrån en tvärsnittsstudie av gymnasieungdomar (N=713).  Resultatet visar på en koppling mellan katastroftänkande och social rädsla, sömnproblematik och nedstämdhet. / This study was aimed at examining the relationship between co-existing psychological problems and catastrophizing in adolescents from a transdiagnostic perspective. The role of catastrophizing for the change of social anxiety and depression was analyzed in an internet based CBT-treatment for social phobia (N=18). The results indicate that adolescents with high initial level of catastrophizing have a larger reduction of depression than adolescents with low initial level of catastrophizing. This suggests that catastrophizing should be considered when specifying treatment for social phobia, especially if it co-occurs with depression. The relationship between catastrophizing and comorbidity was analyzed in a cross-sectional study of adolescents (N=713). The result suggests that catastrophizing is associated with the level of social fear, sleep problems and depression.

Despite the acknowledged reality that HIV-related stigma is a major barrier to effective HIV prevention and treatment, and perhaps because it is complex in nature, few local empirical scales have been developed to measure stigma and to be able evaluate the impact of anti-stigma interventions. Whilst the development of two recent South African HIV-related stigma scales can be celebrated as a major breakthrough, the reliability and validity of these scales across contexts remains largely unknown. This research project employs these two local, and competing, HIV-related personal stigma scales - the first developed by Kalichman et al. (2005) and the second developed by Visser, Kershaw, Makin and Forsyth (2008)-to compare the psychometric properties of the scales and to obtain a measure of HIV-related stigma with a sample of 246 service staff employed at either Rhodes University Catering Division or the Hi-Tec Security company, both organisations located in Grahamstown, a small town in the Eastern Cape, South Africa. Both organisations are major employers of semi-skilled workers in this local context. The results suggest that the Visser et al. scale (2008) reports slightly better psychometric properties than the Kalichman et al. (2005) scale for this sample. Furthermore, the security guards appear to be more stigmatising than the caterers, and it is suggested that this might be a consequence of the combined influences of normative occupational roles and workplace context. Results also show that participants who practices safe sex, know someone with HIV and/or who have been tested for HIV show lower levels of HIV-related stigma. Finally, personal stigma scores are generally lower than attributed stigma scores, which might offer a useful point of intervention.