User:Ongmianli/Portfolios/Social phobia

=Social Anxiety Disorder=

Diagnostic Changes
The essential features of social anxiety disorder (social phobia) (formerly called social phobia) remain the same. The changes in DSM-5 to social anxiety disorder are as follows:
 * Deletion of the requirement that individuals over age 18 years must recognize that their fear or anxiety is excessive or unreasonable
 * Duration criterion of “typically lasting for 6 months or more” is now required for all ages
 * The “generalized” specifier has been deleted and replaced with a “performance only” specifier. The DSM-IV generalized specifier was problematic in that “fears include most social situations” was difficult to operationalize. Individuals who fear only performance situations (i.e., speaking or performing in front of an audience) appear to represent a distinct subset of social anxiety disorder in terms of etiology, age at onset, physiological response, and treatment response.

Recommended Diagnostic Interviews
The Anxiety Disorders Interview Schedule for Children (ADIS-C/P) has been used most frequently and accrued a strong evidence base (κ for SOP = 0.92; Silverman et. al, 2001). Hardcopy in assessment file cabinet at Finley. More information at http://www.excellenceforchildandyouth.ca/resource-hub.

Screening Instruments
Area under Curve (AUCs) and Likelihood Ratios for [Social Anxiety Disorder] Potential Screening Measures

Empirically Supported Treatment

 * The website www.effectivechildtherapy.com is a website sponsored by Division 53 of the American Psychological Association (APA), or The Society for Child and Adolescent Psychology.
 * Using information from a recent meta-analysis by Silverman, Pina, and Viswesvaran (2008), the website outlines Evidence Based Practice (EBP) options for Social Phobia.
 * No “Well-Established” treatments have been empirically validated for Social Phobia.
 * However, group Cognitive Behavioral Therapy, or Group CBT, for Anxiety has been identified as “Probably Efficacious” in treating Social Phobia.
 * According to Effective Child Therapy, the “Probably Efficacious” distinction marks a treatment as having “strong research support” but lacking the criteria that at least two large-scale randomized controlled trials have been conducted by “independent investigatory teams working at different research settings.”
 * This prevents the treatment from moving into the “Well-Established” group.
 * Currently, however, CBT is identified as the most promising treatment for childhood and adolescent social phobia.

Effective Child Therapy identifies the following core components of CBT for anxious youth, including those with Social Phobia: challenges. (challenging anxious thoughts with more positive, realistic thoughts), concrete problem-solving, or rehearsal of desirable skills. a child to cope with anxiety. Sources: Silverman, W. K., Pina, A. A., & Viswesvaran, Chock
 * Emotions Education and Relaxation. Parents and child are taught about the interrelated physiological, cognitive, and behavioral components of anxiety.
 * Activities help demonstrate different emotions, body postures, and cognitive and physiological correlates. Progressive relaxation training helps anxious children develop awareness and control over their own physiological and muscular responses to anxiety.
 * Cognitive restructuring. Cognitive restructuring helps children identify and replace distorted cognitions with more adaptive beliefs.
 * Basic cognitive strategies include identifying and reducing negative self-talk, generating positive self-statements, thought stopping, thought challenging (weighing evidence for and against), testing both dysfunctional and adaptive beliefs, and creating a coping plan for feared situations.
 * Imaginal and in-vivo exposure. The goals of exposures are to encourage approach behavior by positioning the child in a previously feared or challenging situation.
 * The child attempts to complete tasks in a graded "fear hierarchy" such that the child experiences early success before attempting greater
 * During individual exposures, a child is encouraged to use any number of coping skills, including relaxation exercises, coping thoughts
 * Parent Interventions. Parents may have their own preconceptions about the threatening nature of anxiety and they may not know how best to encourage
 * CBT provides parents education about the risks of continued avoidance and guidance in managing their own anxiety.
 * CBT may also impart basic parenting strategies (e.g., positive/negative reinforcement, planned ignoring, modeling, reward planning) to facilitate the practice of therapy skills in the home.

Table 3. Clinically Significant Change Benchmarks with Common Instruments and Rating Scales