What Are The Best-Validated Treatments For Social Anxiety Disorder In Adolescence?

Abstract

The objective of this report is to evaluate the different types of treatments to control social anxiety in adolescents. It will explore several articles and journals a total around 8.  This investigation is carried out by the sources of different websites, clinical journals, books and alternative sources and articles on treatments used.  It will analysis the treatments and discuss which one is the best treatment for social anxiety in adolescents. This report is based on a descriptive and exploratory field and documentary investigation, The report aims to improve the best treatment for social anxiety in adolescents, in addition to improving the quality of life of people suffering from these diseases.

Keywords: Anxiety, quality of life, control

What Are The Best-Validated Treatment For Social Anxiety In Adolescence?

Investigation of Social Anxiety Disorder

In this report, I will evaluate the different types of treatments to control social anxiety in adolescents. This investigation is carried out by the sources of different websites, clinical journals, books and alternative sources and articles on treatments used. I broke down my paper into different sections in which at first I introduced Social Anxiety. Afterward, how is a Adolescent classified with the following disorder? Then I explained the development of Social Anxiety. It will analysis the treatments and discuss which one is the best treatment for social anxiety in adolescents. Furtherone then I explained many of the resources I used to explain the different type of treatments. The purpose of this report is to improve the best treatment for social anxiety in adolescents and improve the quality of life of people suffering from these diseases.

What is Social Anxiety?

According to Mash and Wolfe (2019) text Social Anxiety is also known as Social Phobia and it affects Adolescents in that they have a fear of socializing and performing in front of crowds that will put them in a situation in which they are exposed to critical observations or situations in which they can be embarrassed Knappe, Beesdo-Baum,& Wittchen,(2010). Also, Leigh and Clark (2018) stated it is the third most common mental health disorder and then after that comes depression and substances Abuse.  During this time they become more independent from the parents and more reliable on their peers. They talk about social orientation and how its development is a neurocognitive ability. One of those Abilities is self- consciousness which is attention inwards both private and public. They say that Self-consciousness is involved in  Social Anxiety and Worries because these things tend to arise in the Adolescent years.

What do Adolescents with Social Anxiety do? Well, they try to avoid situations where something can occur. They face the challenge that they fear even though they are terrified. It is normal that a child avoids contact with strangers and to have fear but it different when a child becomes a certain age and continue not to socialize with others as almost like running away or avoiding them. Tend to be shy around people the same age as them and they might cling to the parents at a young age and they stay silent and they don’t speak. They are emotional, socially fearful, sadness, and lonely and experience social distress. These children are also unable to cope effectively. They want to be liked by their peers around them but they mostly only talk to family members nobody outside they avoid it. It is difficult for them to attend school and to be apart of extracurricular activities.

How would we go to classifying these children with Social Anxiety? 

According to Mash and Wolfe (2019), their anxiety needs to appear in peer settings it can not only be near adults. Professionals follow the DSM-5 criteria to classify a child with Social Anxiety. Adolescents who suffer from SOC avoid, telephone calls, parties, as well as dating. Another fact is that SOC tends to have more than one anxiety Disorder. Adolescence who have SOC and another anxiety disorder may experience episodes of outbursts, intense anger, and aggression. GAD and SAD are common Comorbid anxiety disorders that they may also have. Their biggest fear is to act in a way in where they will show their anxiety in a negative way. Social situations always occur with a person feeling fear or Anxious. The way they show this is by crying, tantrums or they tend to fail in social situations.  The following occur for 6 months or more and it can have clinical distress.  People that suffer from SOC can have severe anxiety that can produce sweating, stammering, upset stomach, rapid heartbeat which will lead to a panic attack. Specifically, to Adolescence, they believe that their physical reactions make them get exposed to what they are feeling an increase in their anxiety.

The following is an example of an explanation on a survey that was done with University Students in Alberta to see if the following factors were linked to Social Anxiety. According to Maertz(2001) on a survey that was done on university students of Alberta Campus for Social Anxiety/ Shyness to demonstrate what leads a person to have Social Anxiety. What came out of this investigation was that 45% of the students reported that shyness is a problem while 50% said that public speaking. Stating that these were characteristics that could lead someone to Social Anxiety. Shyness could be viewed in two ways, the first one the person is simply shy but does not disturb their daily life while a person who is shy and their daily life which will lead them to substance abuse to better their social skills in that form can be a strong sign as well like turning down a project and opportunities because it involves public speaking. About 20% of the general population are being diagnosed with Social Anxiety.

How is Social Anxiety Developed?

Social Anxiety develops after puberty but it’s rare to see a child under 10 to develop the disorder during that age. Social Anxiety shows up more in age group related in mid Adolescence. According to Leigh and Clark (2018), the peak of Social Anxiety is at the onset age of 13 which is the Adolescence development process. They have a severe fear of social situations and the prevalence of SOC increases through age. Social Anxiety can go on to Adulthood up to the age of 25 years old.  According to Mash and Wolfe (2019) text that the prevalence of  SOC is 6% to 12% and that it affects girls as much as boys. Social Anxiety can be different in gender in that girls might tend to develop it more in that they care for about Social Competence and they have greater importance for interpersonal relationships as well how their peers view them (Inderbitzen-Nolan & Walters,2000). They state that there was a brain imaging study performed on 9-10 years old females and males that evaluated the Neural Activity correlates to the peers (Guyer, McClure-Tone, Shiffrin, Pine, & Nelson, 2009). What this did demonstrated was that females showed that when they wanted a peer interaction age- related that their brain region activation increased mainly in the hippocampus. The hippocampus is related to the emotional information of a person. What they evaluated was that in males there was no increase which justifies that females care more on social competence and interpersonal relationships with peers. They suggest that female adolescents have an increase in biological sensitivity and that as time passes it creates an increase in vulnerability for them to develop SOC. In conclusion neural activity increases in females and for males it remains neutral.

Cognitive Distortions related to Social Anxiety In the article “Cognitive distortions in patients with Social Anxiety Comparison of a clinical group and healthy” According to Kuru, Safak, Ozdemir, Tulasi, Ozdel, Ozkula, & Orsel (2017) they talk about a comparison of the patient with Social Anxiety in terms of their cognitive distortions. They noticed that the distortions for the patient group, the results were higher in that it states that they were used more in a patient with Social Anxiety than the control group. Which meant that the following are cognitive distortions that are used in Social Anxiety and had no effect in the control group.  According to Maertz(2001) on a survey that was done on university students of Alberta Campus for Social Anxiety/ Shyness she did the following she broke her analyzes and information she had gathered in different categories. Starting with the common characteristics which are performance and interaction two skills in which a person with Social Anxiety is weak. As well it can be understood by their physical, cognitive and Behavioral attitudes they demonstrate. People with Social Anxiety have a different mindset than others who are confident in themselves. When a person starts to have negative thoughts and star to believe in unhelpful thoughts. Which then states that a coping strategy was identifying Cognitive Distortions that a person with Social Anxiety demonstrates. They demonstrate perfectionism, All-or-none thinking, Mind reading, discounting the positive, overgeneralization, Emotional Reasoning, Turning Predictions into facts, Assuming you are the center of the universe and False theory of Relativity are all common Cognitive.  When you are able to identify one of theses distortions you will be able to assimilate and understand what is the source of your social Anxiety.

Treatments for Social Anxiety

Some of the following are Treatments used for Social Anxiety Cognitive Behavioral Therapy a form of  Psychotherapy, Social Effectiveness Therapy, Medications, SSRIs(Paroxetine, Fluoxetine, Sertraline, and Fluvoxamine), SNRIs (Serotonin and Norepinephrine), Benzodiazepines, and Beta Blockers. All of the following are treatments that have been used in treating Social Anxiety. Each one has their way of helping the Adolescent achieve better results but some treatments are better others. Some other things that can help in treating Social Anxiety are Environmental Modification, medicine, and many different types of therapies which will be mentioned further on. It will then clarify which one is the better treatment out of all of them.

Types of Psychotherapy

Cognitive Behavioral Therapy is a type of psychotherapy, what this does is challenge negative thoughts of the self and the world to be able to get rid of unwanted behavior and this is typically used to treat Social Anxiety and other disorders like mood disorders and depressions. According to Mayo Clinic, 2017 Psychotherapy helps the patient change negative thoughts about themselves and develop skills to gain confidence in oneself to confront social situations in the world. CBT is considered to be a very effective treatment by doctors whether being individually or in a group.  In the following Article “Understanding Social Anxiety Disorder in Adolescents and Improving Treatment Outcomes: Applying the Cognitive Model of Clark and Wells (1995)”. According to Leigh and Clark (2018) overall before coming up with a treatment for Social Anxiety, you must be able to understand the adolescence and its developmental influences and the long term effects that are crucial during the Adolescents period. The Treatments that were mentioned in the Article was Cognitive Behavioral Therapies (CBT). In numerous studies, it has shown that the generic CBT is less effective on young people that have SAD. Throughout the years they went improving the therapies and building it up to group therapies that would help them build up their Social Skills and help the management of their Anxiety and exposure this was one of the treatments that were designed for Social Anxiety. In the other hand according to Rodebaugh, Holaway, Heimberg(2004) stated that CBT is more beneficial to Adults then Adolescents.

According to Harvard Health Publishing (2010), one way of achieving CBT is by setting goals when interacting with someone. In order for the treatment to work, they say the patient has to go to at least 12-16 weeks of sessions constantly. The sessions of CBT consist of 60-90 minutes each to build up the patients skills in interacting. A different Psychotherapy according to Mayo clinic 2017 is Exposure- Based Cognitive Behavioral Therapy. What the following therapy does is it builds the person up to face what they fear. It helps you increase your coping skills and develop confidence in Anxiety situations. Participating in role play can help the person skill training. Another therapy similar to the Exposure-Based Cognitive Behavioral Therapy is Interpersonal therapy which uses role-playing to improve the ability to interact and socialize more with people. Another therapy that is under investigation is psychodynamic therapy is based on feelings of Shame and Guilt dealing with social interactions. Psychodynamic therapy is still being investigated if it’s effective on Social Anxiety and gives off good results. Internet-Based Cognitive-Behavior Therapy has become something that has gotten attention in the Clinical Psychiatry. According to Alaoui, Hedman, Kaldo, Hesser,Kraepelien, Andersson,Andersson, & Ruck (2015) what this is for is to improve evidence-based psychological treatments.

Psychopharmacology

Another form of treatment according to (Rapee,2012,p.12-13) in Psychopharmacology there main focus was SSRI’s. In many of the studies that were made, there was a very high efficacy of SSRIs (fluoxetine, sertraline, and paroxetine) to manage Social Anxiety. Harvard Health Publishing, 2010 states that SSRI’s is going to regulate your mood, sleep, appetite, and also no pain sensation. When you have low serotonin it will contribute to the anxiety the person as well as depression. SSRI’s what they do is increase serotonin which will cause a change in the functioning of critical brain circuits that would lower symptoms. While SNRI like venlafaxine will aim towards serotonin and adrenaline. Serotonin and Adrenaline are involved in controlling fear and stress this might also include physiological responses. There have been great results after taking venlafaxine for the continuous 12 weeks but it does not matter what kind of type of drug is used for several weeks at least. The majority of the medications to treat Social Anxiety will have a similar effect. Regularly when a doctor prescribes venlafaxine the dosage in the start is half and they go increasing it as the time passes by.  In a research that was conducted by Ginsburg, Riddle & Davies(2006) on how you can treat children and Adolescents with Social Anxiety that demonstrated Somatic Symptoms. They used the SSRI’s Fluvoxamine vs Placebo and noticed that the treatment had an effect on the Adolescents that received the treatment. In conclusion the Fluvoxamine decrease in lowering Somatic Symptoms. According to Davidson (1998) conducted an experiment on different Pharmacotherapy for Social Anxiety and the end results proved that SSRIs are effective in reducing relapse based on moderate-quality evidence. The medications that came out to being good treatments were SSRI’s, SNRI’s venlafaxine, benzodiazepines. The researchers stated that they should do more future studies to see if the the results change throughout time. According to Stein, Liebowitz & Lydiard (1998), Paroxetine is an effective treatment for patients with Social phobia or Social Anxiety.  They stated that this could be a great way to reduce SAD.

What Medical Doctors Usually prescribe?

Medical related according to Mayo Clinic (2017) doctors prefer to prescribing SSRI’s which are treated for continuous symptoms of SAD. As well doctors usually prescribe SNRI’s (venlafaxine, Effexor) but these can be optional. When the doctor starts to prescribe the patient on this medication they start them usually with a low dose and they go increasing it as the time passes. Medications don’t start to work automatically they need some weeks or months for the treatment to start working. Anti-Anxiety medications Benzodiazepines what it does is reduce the level of anxiety, work quickly on tasks, can be habit forming, sedating the most important thing knowing while taking this medication is that it’s only for a short time. Beta Blockers are another form of treatment which doctors prescribe which block the stimulating effect of epinephrine. What this does is reduce heart rate, blood pressure, and the pounding of the heart and the shaking of your voice. This treatment works best when it’s not used often but not to be recommended to be a general treatment of SAD.

Other Type of Treatment

According to Etkin & Wager (2015), Functional Imaging has been a great influence on Anxiety Disorders. This treatment helped them figure out that in social Anxiety as well PTSD, and specific phobias they showed activity in the amygdala and insula. What this did was refine the way we understand how we view Social Anxiety.  With this they were able to find out the Social Anxiety has trigger cues in fear and avoidance. Anxiety Disorders have abnormally elevated fear responses.

Psycological Treatments Vs. Medical Treatment

Psychological treatment involves all sorts of different type of therapies that will help the adolescent be able to cope better in social situations. CBT is one of those therapies which deal with how the person feels can influence someone behavior. It helps you change the negative thoughts you have about yourself and the world. It makes you face what you fear the most that are part of the therapy. While Medical Treatment involves various different types of medications which some are effective while others are not. We have the SSRI’s, SNRI’s, beta blockers, Anti-Anxiety meds. They are both different in that some are helpful than other while the similarity is that they all treat the same disorder.

The Best Treatment for Social Anxiety

After analyzing the articles and references in the following report the majority of them all stated the same treatment. The best treatment to treat Social Anxiety Disorder is through CBT which has had the greatest effect throughout the years. CBT establishes a way in was the adolescent can get help to get off their fear and sometimes the sessions can be the only resource but others as well as combine CBT with medications. It is common to take CBT with medication because it betters the treatment because the medication is given depending on the status of the Adolescent. Talk therapy helps them create a strong boundary but it can only help if the person wants to get treated. Adolescents with SAD are sometimes repugnant to search for help or seek it.

Conclusion of Social Anxiety Disorder

In the following report, I investigated to find the best treatment for Social Anxiety Disorder. Throughout the research and information that I looked into many of them stated that the greatest treatment was CBT. We should also keep in mind as well that there are several other studies are being made as well for treating SAD. There have been lots of new discoveries but they still are in progress and need to be tested more to see if there are effect just as CBT. I mentioned some in my report but they believe that they need more years of research to make this accurate and it can be treated as actual treatments but for know the better treatment that we have for SAD is CBT.

References

• Davidson, J. R. (1998). Pharmacotherapy of social anxiety disorder. The Journal of clinical psychiatry, 59, 47-53.
• El Alaoui, S., Hedman, E., Kaldo, V., Hesser, H., Kraepelin, M., Andersson, E., … & Lindefors, N. (2015). Effectiveness of Internet-based cognitive–behavior therapy for social anxiety disorder in clinical psychiatry. Journal of consulting and clinical psychology, 83(5), 902.
• Etkin, A., & Wager, T. D. (2007). Functional neuroimaging of anxiety: a meta-analysis of emotional processing in PTSD, social anxiety disorder, and specific phobia. American Journal of Psychiatry, 164(10), 1476-1488.
• Ginsburg, G. S., Riddle, M. A., & Davies, M. (2006). Somatic symptoms in children and adolescents with anxiety disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 45(10), 1179-1187.
• Guyer, A. E., McClure-Tone, E., Shiffrin, N. D., Pine, D. S., & Nelson, E. E. (2009). Probing the neural correlates of anticipated peer evaluation in adolescence. Child Development, 80, 1000–1015
• Harvard Health Publishing. (2010, March). Treating social anxiety disorder. Retrieved from https://www.health.harvard.edu/newsletter_article/treating-social-anxiety-disorder
• Inderbitzen-Nolan, H. M., & Walters, K. S. (2000). Social anxiety scale for adolescents: Normative data and further evidence of construct validity. Journal of Clinical Child Psychology, 29, 360–371.
• Knappe, S., Beesdo-Baum, K., Wittchen, H.-U. (2010). Familial factors in social anxiety disorder: Calling for a family-oriented approach for targeted prevention and early intervention. European Child & Adolescent Psychiatry, 19, 857–871.
• Kuru, E., Safak, Y., Özdemir, İ., Tulacı, R. G., Özdel, K., Özkula, N. G., & Örsel, S. (2018). Cognitive distortions in patients with social anxiety disorder: Comparison of a clinical group and healthy controls. The European Journal of Psychiatry, 32(2), 97-104.
• Leigh, E., & Clark, D. M. (2018, April 13). Understanding Social Anxiety Disorder in Adolescents and Improving Treatment Outcomes: Applying the Cognitive Model of Clark and Wells (1995). Retrieved from
• Mash, E. J., & Wolfe, D. A. (2019). Abnormal child psychology. Australia: Cengage.
• Mayo Clinic Staff. “Social Anxiety Disorder (Social Phobia).” Mayo Clinic. August 29, 2017. Accessed April 29, 2019. https://www.mayoclinic.org/diseases-conditions/social-anxiety-disorder/diagnosis-treatment/drc-20353567.
• Maertz, K. (2001). Social Anxiety/Shyness. Retrieved from https://www.mcgill.ca/counselling/files/counselling/social_anxiety_coping_strategies_1.pdf
• Rapee, R. (2012). Anxiety disorders in children and adolescents: nature, development, treatment, and prevention.
• Rodebaugh, T. L., Holaway, R. M., & Heimberg, R. G. (2004). The treatment of social anxiety disorder. Clinical Psychology Review, 24(7), 883-908.
• Stein, M. B., Liebowitz, M. R., Lydiard, R. B., Pitts, C. D., Bushnell, W., & Gergel, I. (1998). Paroxetine treatment of generalized social phobia (social anxiety disorder): a randomized controlled trial. Jama, 280(8), 708-713.