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David Baxter

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Social Phobia Common But Under-Recognized
by Leslie Sabbagh

WEDNESDAY, Sept. 6 (HealthDay News) -- Social anxiety disorder is a common psychiatric condition with a lifetime prevalence of 12 percent, but many people don't get the treatment because clinicians simply don't recognize it, a New York physician reports in the Sept. 7 issue of the New England Journal of Medicine.

Franklin R. Schneier, M.D., of the Anxiety Disorders Clinic, New York State Psychiatric Institute in New York City, reviewed social anxiety disorder treatment strategies including cognitive-behavioral therapy and pharmacotherapy. The disorder is diagnosed on clinical presentation including marked persistent fear of one or more social or performance situations with exposure to unfamiliar people or possible scrutiny; the recognition that the fear is excessive or unreasonable; the fear interferes with normal routines; and the social fear is unrelated to an existing general medical condition or another mental disorder.

Cognitive-behavioral therapy addresses the cycle of anticipatory negative thoughts and maladaptive behavior and negative self-appraisals that increase avoidance behavior, Schneier writes. Cognitive restructuring techniques identify and question maladaptive thoughts, then provide alternatives. Therapeutic exposure eases the patient into feared situations while the patient simultaneously uses cognitive strategies to manage anxiety.

For most patients, cognitive-behavioral therapy is appropriate initially, given the data supporting its potential long-term benefit. "Selective serotonin-reuptake inhibitors or venlafaxine are alternative first-line treatments for patients who prefer medication, have prominent coexisting depression, or lack access to a trained therapist," Schneier writes. "Patients should be encouraged to try to increase their social activities gradually, and they may benefit from adjunctive use of self-help literature oriented toward a cognitive-behavioral approach," he concludes.
 

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