Objetivo: Construir um programa de Exposição à Realidade Virtual para tratar Fobia Social, avaliá-lo e aperfeiçoá-lo por meio de uma análise quantitativa e qualitativa. Método: Finalizaram o tratamento 21 sujeitos (11 homens e 10 mulheres) entre 18 e 63 anos diagnosticados pelo Manual Diagnóstico Estatístico de Transtornos Mentais 4a edição- texto revisado (DSM -IV- TR) para fobia social. Foram excluídos os sujeitos com depressão grave, com risco de suicídio, transtornos psicóticos e abuso de substância. Principais medidas de avaliação quantitativa: Escala de Ansiedade Social de Liebowitz - LSAS; Escala de Impressão Clínica Global - CGI; Escala para Incapacitação de Sheehan; Escala de Adequação Social - EAS; e Questionário de Pensamentos Automáticos - ATQ 30. Avaliação qualitativa: Questionário Metodológico Qualitativo de Avaliação de Ansiedade Social. Procedimento: as Escalas e os Instrumentos foram aplicados no pré-tratamento, no pós-tratamento e no seguimento após seis meses de tratamento. O Questionário Metodológico Qualitativo de Avaliação de Ansiedade Social foi aplicado no pós-tratamento. O tratamento consistiu em até 12 sessões de 50 minutos cada de exposição à Realidade Virtual. Resultados: Observou-se redução significativa no escore pós-tratamento que se manteve no seguimento, nas escalas que avaliaram ansiedade, fobia e disfunções cognitivas (LSAS, ATQ e EAS). Na CGI, houve redução na gravidade da doença após o tratamento e isto se manteve no seguimento. Os pacientes apresentaram melhora do transtorno que também se manteve no período do seguimento. A Escala de Incapacitação de Sheehan mostrou melhora significativa da vida profissional, social e familiar. O número médio de sessões para a diminuição da ansiedade social foi de 7. Conclusão: O tratamento utilizado neste estudo teve boa aceitação, boa adesão, auxilia na diminuição da ansiedade social como também no enfrentamento das situações temidas. Estudos controlados ulteriores deverão ser realizados para verificar se ratificam estes resultados preliminares / Objectives: To build a Virtual Reality Exposure software for the treatment of Social Phobia, to evaluate and improve it based on quantitative and qualitative analysis. Method: The treatment was completed by 21 subjects (11 men and 10 women) aged between 18 and 63, diagnosed with social phobia by the Diagnostic Statistical Manual of Mental Disorders 4th edition - revised text (DSM - IV-TR). Subjects were excluded on account of deep depression, suicide risk, psychotic disorders or substance abuse. The main measurement instruments for quantitative evaluation were: Liebowitz Social Anxiety Scale - LSAS, Clinical Global Impression Scale - CGI, Sheehan Disability Scale, Social Adjustment Scale - SAS, Automatic Thoughts Questionnaire - ATQ 30. Qualitative evaluation: Methodological Qualitative Questionnaire for the Evaluation of Social Anxiety. Procedure: The Scales and Instruments were applied in the pre-treatment and post-treatment phases and in the follow-up assessment six months after treatment. The Methodological Qualitative Questionnaire for the Evaluation of Social Anxiety was applied in the post-treatment phase. The treatment consisted of twelve 50-minute sessions of exposure to Virtual Reality. Results: A significant decrease in the score in scales that measure anxiety, phobia and cognitive dysfunctions (LSAS, ATQ and SAS) was observed after treatment and it was maintained on follow-up. Patients have shown improvement of the disorder that was also preserved on follow-up. The Sheehan Disability Scale has shown significant improvement in professional, social and family life. The average number of sessions to achieve a reduction of social anxiety was seven. Conclusion: The treatment used in this study has been well received; patients have shown adherence to it and it has helped them to reduce their social anxiety and deal with situations they feared. Further controlled trials should be undertaken to endorse these preliminary results

<p>The present thesis investigated family history and neurobiology of social phobia. Social phobia is a disabling disorder characterized by a marked fear of scrutiny in a variety of social situations. By using a validated questionnaire, study I related family history of excessive social anxiety to social phobia and avoidant personality disorder in epidemiologically identified probands in the Swedish general population. A two- to threefold increased relative risk of social anxiety was observed for both diagnostic groups. Thus, having an affected family member is associated with approximately a doubled risk for both social phobia and avoidant personality disorder.</p><p>The neurobiological studies explored situational and anticipatory elicited anxiety by means of positron emission tomography and 15O-water. Study II examined the functional neuroanatomy of social anxiety provocation in social phobics and a healthy comparison group during a public speaking task. Social phobia symptomatology was associated with higher neural activity in the amygdaloid complex, i.e. "the alarm system" of the brain, and lower activity in the prefrontal cortex. Study III examined the neural correlates of anxiety elicited by the anticipation of public speaking in individuals with social phobia. Anticipatory anxiety was accompanied by enhanced regional cerebral blood flow in the dorsolateral prefrontal and inferior temporal cortices as well as in the amygdaloid-hippocampal region. Brain blood flow was lower in the temporal pole and in the cerebellum. These results suggest that social phobia has a neuroanatomical basis in a highly sensitive fear network centered in the amygdaloid-hippocampal region and encompassing the prefrontal cortex.</p>

The present thesis investigated family history and neurobiology of social phobia. Social phobia is a disabling disorder characterized by a marked fear of scrutiny in a variety of social situations. By using a validated questionnaire, study I related family history of excessive social anxiety to social phobia and avoidant personality disorder in epidemiologically identified probands in the Swedish general population. A two- to threefold increased relative risk of social anxiety was observed for both diagnostic groups. Thus, having an affected family member is associated with approximately a doubled risk for both social phobia and avoidant personality disorder. The neurobiological studies explored situational and anticipatory elicited anxiety by means of positron emission tomography and 15O-water. Study II examined the functional neuroanatomy of social anxiety provocation in social phobics and a healthy comparison group during a public speaking task. Social phobia symptomatology was associated with higher neural activity in the amygdaloid complex, i.e. "the alarm system" of the brain, and lower activity in the prefrontal cortex. Study III examined the neural correlates of anxiety elicited by the anticipation of public speaking in individuals with social phobia. Anticipatory anxiety was accompanied by enhanced regional cerebral blood flow in the dorsolateral prefrontal and inferior temporal cortices as well as in the amygdaloid-hippocampal region. Brain blood flow was lower in the temporal pole and in the cerebellum. These results suggest that social phobia has a neuroanatomical basis in a highly sensitive fear network centered in the amygdaloid-hippocampal region and encompassing the prefrontal cortex.

Syftet med denna studie var att belysa en gymnasieskolas stöd i ämnet svenska för talrädda elever, och detta gjordes genom intervjuer med fyra stycken lärare på gymnasienivå. Intresset grundade sig först och främst i det faktum att social fobi är ett vanligt problem bland ungdomar i Sverige och att det är i ungdomen som fobi för sociala sammanhang utvecklas. En del av social fobi är talrädsla, och gentemot vad läroplanen i svenska för gymnasieskolan säger om det muntliga språkets betydelse för människan och dennes utveckling, problematiserades den talrädda elevens förutsättningar för lärande och utveckling. Perspektiven som studien har utgått ifrån handlar inte om problematiken kring social fobi, utan om det demokratiska perspektivet och det faktum att gymnasieskolan vilar på en demokratisk grund, där alla elever bör få möjlighet att utveckla sin talförmåga och förmågan att våga göra sin röst hörd. Det sociokulturella perspektivet ligger också till grund för studien, där det muntliga språket, kommunikation, spelar en betydande roll för människans lärande och kunskapsutveckling, och i förståelse för sig själv och sin omvärld. Utöver dessa perspektiv berörs även ett filosofiskt synsätt, härlett från Aristoteles och tanken om att varje människa strävar efter att leva upp till sin fulla potential, självförverkligande. Vad studien kommer fram till är att det i ämnet svenska i gymnasieskolan inte finns något speciellt stöd för den talrädda eleven, och det finns inga pedagogiska riktlinjer för lärarna att förhålla sig till. Lärarna arbetar utefter egen förmåga med talrädda elever och de tycker överlag att det fungerar, att talrädda elever inte utgör ett så stort problem. Detta resultat diskuteras i förhållande till de teoretiska utgångspunkterna samt det filosofiska synsättet, vilket genererar i antagandet om att talrädda elever faktiskt ändå utgör ett problem, ett problem för sin demokratiska rätt, för sin kunskapsutveckling och för sitt självförverkligande. / The purpose of this study was to examine what kind of support a student in fear of speaking gets in the Swedish subject in an upper secondary school, and this was done through interviews with four teachers at secondary level. The interest was based primarily on the fact that social phobia is a common problem among young adults in Sweden and the fact that it is in youth that phobia for social situations develops. A part of social phobia is fear of speaking in public, and toward to what the curriculum for the Swedish subject in the upper secondary school says about oral language and its meaning to every human being and its development, a student in fear of speaking becomes problematized in regards to learning and development. The perspective of this study is not based on the problem concerning social phobia, but about the democratic perspective and the fact that the upper secondary school is based on democratic grounds, where every student should get opportunities to develop their speaking skills and their ability to have the courage to speak out loud. The social-cultural perspective is another base for this study, where the oral language, communication, has a significant role in learning and knowledge, as well as in self-understanding and in understanding the world. Besides these perspectives, the study also takes a philosophic approach derived from Aristotle and the idea that every human being strives to reach their full potential, self-fulfillment. This study concludes that the Swedish subject in upper secondary school doesn’t offer any support for students with fear of speaking and there is no educational guidelines for the teachers to follow. The teachers work along their own ability with students with fear of speaking and they think in general it works, they think that students with fear of speaking is not such a big problem. These results are discussed in relation to the theoretical starting points and the philosophical approach, which generates in the assumption that students with fear of speaking actually is a problem, a problem for their democratic rights, to their knowledge and their self-fulfillment.

We examined parental psychopathology and family environment in subthreshold and DSM-IV threshold conditions of social anxiety disorder (SAD) in a representative cohort sample of 1,395 adolescents. Offspring and parental psychopathology was assessed using the DIAX/ M-CIDI; recalled parental rearing and family functioning via questionnaire. Diagnostic interviews in parents were supplemented by family history reports from offspring. The cumulative lifetime incidence was 23.07% for symptomatic SAD, and 18.38 and 7.41% for subthreshold and threshold SAD, respectively. The specific parent-tooffspring association for SAD occurred for threshold SAD only. For subthreshold and threshold SAD similar associations were found with other parental anxiety disorders, depression and substance use disorders. Parental rearing behaviour, but not family functioning, was associated with offspring threshold SAD, and although less strong and less consistent, also with subthreshold SAD. Results suggest a continued graded relationship between familial risk factors and offspring SAD. Parental psychopathology and negative parental styles may be used defining high-risk groups to assign individuals with already subthreshold conditions of SAD to early intervention programs.

Background. To examine the role of parental psychopathology and family environment for the risk of social anxiety disorder (SAD) in offspring from childhood to early adulthood, covering an observational period of 10 years. Method. A community sample of 1,395 adolescents (aged 14 to 17 years at baseline) was prospectively followed-up over the core high risk period for SAD onset. DSM-IV offspring and parental psychopathology was assessed using the Munich-Composite International Diagnostic Interview; direct diagnostic interviews in parents were supplemented by family history reports from offspring. Parental rearing was assessed by the Questionnaire of Recalled Rearing Behavior in offspring, family functioning by the McMaster Family Assessment Device in parents. Results. Parental SAD was associated with the offspring’s risk to develop SAD (OR = 3.3, 95%CI: 1.4-8.0). Additionally, other parental anxiety disorders (OR = 2.9, 95%CI: 1.4-6.1), depression (OR = 2.6, 95%CI: 1.2-5.4) and alcohol use disorders (OR = 2.8, 95%CI: 1.3-6.1) were associated with offspring SAD. Offspring’s reports of parental overprotection, rejection and lack of emotional warmth, but not parental reports of family functioning were associated with offspring SAD. Analyses of interaction of parental psychopathology and parental rearing indicated combined effects on the risk for offspring SAD. Conclusions. These findings extend previous results in showing that both parental psychopathology and parental rearing are consistently associated with the risk for offspring SAD. As independent and interactive effects of parental psychopathology and parental rearing may have already manifested in early adolescence, these factors appear crucial and promising for targeted prevention programs.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal

Evidence-based psychotherapeutic methods compete with each other, while meta-analysis have shown that variability due to different methods related to outcome is remarkably low. In this qualitative study six former patients were interviewed about experiences of method and technique in Affect-focused therapy, with a slight overweight towards unsatisfactory experiences. Responses were analysed and categorised in emergent themes. Methodological focus on affect showed to be a much appreciated, as well as insufficient, element. Alongside positive experiences or summaries of therapy, methodological frames were felt to be at times restrictive, even invalidating, as far as not allowing focus on what was felt to be the more predominant need. These needs were varied and individual; e.g. more/less of undetermined space free of preconceptions, more/less focus on affect, more direction forward, or more space for existentially oriented aspects. Results found good support in previous research except for a strong validation of therapists, even when aspects of therapy had been severely problematic. Experiences of applied method differed extremely among participants. The study highlighted lack of relation between method and outcome, and that positive regard of therapy and alliance were not synonymous with good outcome. Prominent themes were quality of methodological focus on affect and of therapeutic relationship, basic humanistic values, and individual factors of variance. Future research was suggested to focus on integration of methods, on therapists’ common factors, as well as on issues of power in the therapeutic relationship.

This study was an investigation into the clinical judgments made by counseling psychologists when faced with a patient who had major depression and AIDS. Two hundred and eighty one counseling psychologists evaluated one of four vignettes depicting an individual with major depression. In three of the vignettes the individual also had AIDS but the vignette varied on how the virus was contracted (unprotected gay sex, IV drug abuse, hemophilia). In the fourth vignette (the control group) the individual did not have AIDS. Results of the study suggested, that the presence of AIDS overshadows the evaluation and treatment decisions made by counseling psychologists when their patient has major depression and AIDS. Three factors-counseling psychologists' general experience with people who have AIDS, their clinical experience with AIDS patients and how the AIDS virus was contracted-were investigated for possible moderating effects of the overshadowing bias. How the AIDS virus was contracted was used as an indirect measure of clinician attitude toward people with AIDS. Neither general or clinical experience with AIDS patients appeared to have an effect on the diagnostic or treatment decisions made by counseling psychologists when evaluating depressed patients with AIDS. As with experience, method of contracting the AIDS virus did not have a moderating effect on the overshadowing bias. Implications of these results for the evaluation and treatment of depression in AIDS patients, as well as future research are discussed. / Department of Counseling Psychology and Guidance Services

Erythrophobie wird als klinische Bezeichnung für die Angst zu erröten verwendet, wenn das Einzelsymptom Erröten im Vordergrund einer Angstproblematik steht. Die vorliegende Übersicht beruht auf einer umfangreichen Literaturrecherche und wird ergänzt durch eigene klinische Beobachtungen aus einer Pilotstudie zur kognitiv-behavioralen Gruppentherapie der Errötungsangst. Wir referieren den aktuellen Kenntnisstand zu Erythrophobie in Bezug auf die differentialdiagnostische Einordnung, auf ätiologische und pathogenetische Konzepte sowie auf die Verhaltenstherapie der Störung. Insgesamt zeigt die Übersicht, dass Erythrophobie am sinnvollsten als Subsyndrom der Sozialen Phobie beschrieben werden kann. Patienten mit Errötungsangst als Hauptbeschwerde unterscheiden sich jedoch von anderen Patienten mit Sozialer Phobie im Hinblick auf Behandlungsanliegen, Inanspruchnahmeverhalten, Behandlungserwartung und Therapieziele sowie durch spezifische aufrechterhaltende Mechanismen der Störung, insbesondere durch eine übertriebene und inflexible Aufmerksamkeitsfokussierung auf körperliche Symptome. Der Einsatz eines Aufmerksamkeitstrainings als spezifisches Behandlungsmodul bei Errötungsangst ist vielversprechend und sollte in bekannte Ansätze zur Therapie der Sozialen Phobie integriert werden. Abschließend werden Impulse für weiterführende Forschungsaktivitäten skizziert. / Erythrophobia is the pathological form of fear of blushing. This review is based upon an extensive literature research and supplemented by clinical observations from a pilot study of a cognitive-behavioural group therapy for fear of blushing. Current knowledge about fear of blushing is reported regarding diagnostic considerations, aetiologic and pathogenetic mechanisms, and cognitive-behavioural therapy. In conclusion, this review indicates that fear of blushing should be classified as a sub-syndrome of social phobia. Patients suffering from fear of blushing as predominant complaint differ from other patients with social phobia in health-care utilisation, treatment expectation and treatment goals. However, the most prominent difference lies in the exaggerated and inflexible self-focused attention these patients direct to their arousal and bodily symptoms. Therefore, attention training as a specific treatment unit is promising and should be integrated in standard treatment approaches for social phobia. Finally, options for further research are outlined. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.